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Eustachian tube dysfunction, ear virus, sick on planes, scopolamine, meclizine, motion sickness

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I am 53 yrs old and have not flown for 25 years due to eustacian tube dysfunction in my left ear caused by an ear virus in 2005. I've had problems flying maintaining equilibrium since birth and get very sick on planes because of this and now fear. For business, I was told I need to take a flight this coming weekend 1 May on a 2.5 hour flight and to CA , a 5.5 hour flight. Saw my ENT and GP and each gave me Xanax to calm me, and said to take either the Scop patch or Meclizine. Having this bad ear and some imbalance on land, will the Meclizine still work with my worsened ear? I hear the Scop patch is very potent & the side effects are marked (I'd like to try the SCOPACE, tablet form of this drug instead as I HEAR IT IS MOST EFFECTIVE). I'm seeking your advice please as to what to take for assurance of motion sickness prevention ! Patch, Scop pills (scopace) or the meclizine given my ear condition. It gets full from allergies so I'm already on Flonase, sudafed, and diuretic for HPB (low dose). Please advise! THank you.
Posted Thu, 3 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank You for your query.

1. Oral low dose scopolamine, an hour before travel, is the best option for you as your flights are of short duration.
2. The scopolamine patch has erratic absorption compared to an oral dose. Patches need to be used several hours before travel. They are useful for extended travel lasting a day or longer.
3. Meclizine and Promethazine are also time tested. These have stronger central effects as they cause more drowsiness, dry mouth, blurring of vision, urinary retention and other anticholinergic effects. At your age, there should be no problem.
4. In contrast, scopolamine has lesser central effects, so it's efficacy in a damaged vestibular system is debatable. However it will effectively suppress the vestibular system.
5. Motion sickness is vehicle specific, like airsickness in your case. Therefore there is a role for supportive measures such as travelling in the center of the plane nearer the central gravity where pitch, roll and yaw movements are the least. Request such a seating arrangement. Take a nap or close your eyes. This reduces the vision to ear input mismatch. Avoid looking out, and if you do, look towards the horizon.
6. If you have a couple of days, try out a tablet each of both oral scoplamine and meclizine on successive days in advance to check for adverse effects.
7. Penicillin allergy is not a problem. How long have you been taking your current medication?
8. Now, 25 years later, getting an Impedance Audiogram (I/A) will easily reveal whether it is Eustachian Tube Dysfunction or Motion Sickness. There are also many tests now available to evaluate the vestibular system.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.

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