BACKGROUND: Health incapacitation is a serious threat to flight safety. Therefore, a study conducted 10 yr ago examined the incidents of ear-nose-throat (ENT) barotrauma and upper respiratory infection (URI) among commercial pilots and found that a large number continued to carry out their duties despite the risk of incapacitation. Now, 10 yr later, this new study examines if the attention to URIs has improved. METHOD: This study was conducted at the Danish Aeromedical Centre over the course of 1 yr with 463 valid respondents to a questionnaire on URIs and ENT barotrauma. These respondents were compared to 940 respondents answering the same questionnaire 10 yr prior in the same setting. RESULTS: This study shows a significant increase in the number of pilots flying despite signs of an URI from 42.8 to 50.1% and in the number of pilots using decongestant medicine from 43.3 to 59.5%. The proportion of pilots experiencing one or more ENT barotraumas has also increased from 37.4 to 55.5% for barotitis media and from 19.5 to 27.9% for barosinusitis. CONCLUSION: Half of all pilots in this study fly despite signs of an URI. This is a significant increase and shows that after 10 yr an URI is still not considered a valid reason for reporting in sick despite international aeromedical recommendation. Based on these findings, the study recommends that awareness of the risk of flying with an URI be increased.