This study looks at whether working as a hot-air balloon pilot-being exposed to burner noise, changes in air pressure/temperature, and vertical acceleration-is linked to changes in hearing, Eustachian tube function, and vestibular (balance) function. Adult pilots from Cappadocia will be compared with adults who do not have these exposures.

Approximately 90 participants are expected to be enrolled For contextual exposure information, representative in-field noise measurements during balloon operations and basic flight parameters may be documented

Each participant will attend one visit (~60 minutes) in an ENT/audiology laboratory. After a short questionnaire and an ear exam (otoscopy), the following non-invasive tests will be performed: tympanometry; tympanometry with simple maneuvers (Valsalva/Toynbee) to evaluate Eustachian tube function (ΔTPP); pure-tone audiometry (including extended high frequencies); otoacoustic emission tests (TEOAE and DPOAE); acoustic (stapedius) reflex thresholds; and a brief cervical vestibular evoked myogenic potential (cVEMP) test. Symptom-triggered questionnaires will also be used: for participants reporting tinnitus, the Tinnitus Handicap Inventory (THI); for those reporting dizziness, the Berg Balance Scale (BBS).

No medications or blood tests are involved. Testing is safe and routinely used in clinical care. Risks are minimal (for example, temporary ear-canal pressure or brief dizziness). Testing will be stopped if any discomfort occurs. Personal information will be kept confidential, and results will be reported only in group form. Findings from this study may help improve occupational health guidance for hot-air balloon pilots.

This study looks at whether working as a hot-air balloon pilot-being exposed to burner noise, changes in air pressure/temperature, and vertical acceleration-is linked to changes in hearing, Eustachian tube function, and vestibular (balance) function. Adult pilots from Cappadocia will be compared with adults who do not have these exposures.

Approximately 90 participants are expected to be enrolled For contextual exposure information, representative in-field noise measurements during balloon operations and basic flight parameters may be documented

Each participant will attend one visit (~60 minutes) in an ENT/audiology laboratory. This is a cross-sectional study with a single assessment visit. The following non-invasive tests will be performed

Tympanometry.

Acoustic (stapedius) reflex thresholds.

Tympanometry with simple maneuvers (Valsalva/Toynbee) to evaluate Eustachian tube function (pressure change in the middle ear) (ΔTPP).

Pure-tone audiometry (standard clinical frequencies and extended high frequencies).

Otoacoustic emission tests (OAE), including transient-evoked (TEOAE) and distortion-product (DPOAE), with analysis including high frequencies.

Cervical vestibular evoked myogenic potential (cVEMP) (a test of inner-ear balance reflexes), administered for all participants using a standardized protocol and EMG monitoring for adequate sternocleidomastoid activation.

Symptom-triggered questionnaires:

For participants reporting tinnitus, the Tinnitus Handicap Inventory (THI) will be administered.

For participants reporting dizziness, the Berg Balance Scale (BBS) will be administered.

Testing is non-invasive and performed in a sound-treated environment per routine clinical practice. If any discomfort (e.g., significant dizziness, pain, or elevated blood pressure) occurs, the relevant test is stopped and the participant may be withdrawn from testing at the investigator's discretion. For contextual exposure information, representative in-field noise measurements, air-pressure and altitude during balloon operations and basic flight parameters may be documented where available; these are not required for participation.

Data are recorded under coded study IDs and stored on secure institutional servers with access restricted to authorized study staff. Results will be reported in aggregate to protect confidentiality.

Inclusion Criteria:

• Age ≥18 years (preferably 18-70).

Pilot group: Licensed, professional and actively flying hot-air balloon pilots with regular flight over the past 12 months (on average 5 days per week and at least 20 flights in month), not using any hearing-protection equipment, and typically each flying et least 60-90 minutes.

Control group: Adults without occupational or recreational exposure to significant pressure/altitude/noise (e.g., no mountaineering, scuba diving, or cabin crew duties).

Otoscopic suitability for testing (no tympanic membrane perforation; no active ear infection).

Exclusion Criteria:

• Acute upper respiratory tract infection (URTI) or otitis at the time of testing.,
• High noise exposure within the past 24-48 hours (e.g., concert, workshop).
• Tympanic membrane perforation; impacted cerumen that cannot be cleared; chronic suppurative otitis; presence of an active ventilation (tympanostomy) tube.
• History of otologic surgery.
• Menière's disease; significant otosclerosis; vestibular neuritis within the past 6 months; recent sudden hearing loss.
• Significant neurological disease or history affecting balance (e.g., multiple sclerosis, stroke).
• Use of ototoxic medications within the past 3 months (e.g., aminoglycosides, cisplatin).
• Contraindications to cVEMP testing (e.g., significant cervical pathology or prior cervical surgery, uncontrolled hypertension, suspected advanced carotid artery disease).

Adults (≥18 years) in two cohorts: (1)(Hot-Air Balloon Pilots) licensed hot-air balloon pilots operating in the Cappadocia/Nevşehir region with ≥10 flights in the prior 12 months; and (2)(Controls) age-matched adults with no occupational or recreational exposure to significant noise, altitude, or barometric pressure variation (e.g., non-pilots, non-divers, non-cabin crew). Participants are healthy volunteers with otoscopic suitability (no perforation or active infection). Recruitment is via local pilot companies/registries and the surrounding community; all assessments occur at the SBÜ Gaziosmanpaşa Training and Research Hospital ENT/audiology laboratory (single-center). Planned enrollment: 45 pilots and 45 controls.

No plan to share individual participant data (IPD). The informed consent and protocol do not authorize IPD sharing, and the cohort is small and identifiable (hot-air balloon pilots in a defined region), increasing re-identification risk. Per protocol, only aggregate, de-identified results will be reported; source data remain on secure institutional servers accessible only to the study team.