In the era of the competition for the first transatlantic flight at the beginning of the nineteenth century, numerous accidents occurred. Whereas engine failure, bad weather and navigational problems are usually held responsible, the human factor has hardly been addressed.

In view of current insights, an inventory was made of possible physiologic and otoneurologic factors that could have contributed to failures and accidents.

Extreme fatigue, hyperventilation with vestibular hyperreactivity and airsickness may have played roles. When flying in the dark and in clouds, pilots were subject to spatial disorientation because of vestibulo-visual conflicts and gravitational misinformation. The loudness of the engines was deafening, which may have caused noise-induced vertigo. In some cases, asymptomatic third-window lesions may have become manifest and may have contributed to dizziness.

Accidents and failures in the early days of aviation were not only the result of technical defects. Undoubtedly, human physiology played a role as well.