Facial and trigeminal nerves neuropathy induced by atmospheric pressure changes: A meta-analysis

Oded Ben-Ari, Yehuda Zadik, Idan Nakdimon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Barometric pressure changes during flight or diving may cause facial barotrauma. Neuropathy of the fifth (CN5) or the seventh (CN7) cranial nerves is a rare manifestation of this condition. The aim of this study was to analyze risk factors for baroneuropathies of CN5 and CN7. Methods: A search of PubMed and Cochrane Library databases was conducted to identify all published cases of CN5 and CN7 neuropathies. Only original case reports and series that documented events of neuropathies associated with the trigeminal nerve or facial nerve while flying, diving, or mountain climbing were included. Assessed variables included sex, medical history, age, setting (flight or diving), atmospheric pressure changes, number of episodes, symptoms, treatment, and recovery. Results: We identified a total of 48 articles described >125 episodes in 67 patients. Mean age was 33.5 ± 12.1 years with a male predominance (76.1 %). Cases were equally distributed between flight and diving (50.7 %, 46.3 %, respectively). CN5 involvement was observed in 77.6 % of patients, with ear pain and facial numbness as the most common symptoms. The latter was correlated with positive otolaryngology medical history. CN7 was involved in 88.1 % of patients. Flying, as opposed to diving was correlated with spontaneous resolution of symptoms (86.7 % vs. 42.3 % of cases resolved spontaneously, respectively, p = 0.001). Conclusions: Flight is an equal risk factor to diving with respect to CN5 and CN7 barotrauma. Involvement of CN7 was observed in most cases, but possibly due to report-bias. Positive medical history is a risk factor for facial numbness.

Original languageAmerican English
Article number104311
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number4
StatePublished - 1 Jul 2024

Bibliographical note

Publisher Copyright:
© 2024 Elsevier Inc.


  • Barotrauma
  • Diving
  • Facial nerve
  • Flight
  • Trigeminal nerve


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