Ease Ear Pain When Flying

Most of us experience some level of ear discomfort when traveling in an airplane due to the change in air pressure that occurs at higher altitudes. However, if you’re experiencing real pain, you might want to talk to your doctor to determine whether a health issue is to blame. Virtua ear, nose and throat doctor Stephen Gadomski, MD, FACS, explains a few common causes of eustachian tube dysfunction, which is the medical term for the blockage that can make air travel a painful proposition.

But first, a quick anatomy lesson

The ear can be thought of as divided into three parts, commonly known as the outer, middle, and inner ear. For the purposes of this discussion, we need focus only on the outer and middle ear. The outer ear is everything from what’s visible on the side of your head (the auricle) to the ear canal, which is about an inch long, and the tympanic membrane, or “eardrum.” The middle ear is what’s on the other side of the eardrum; when healthy, it’s an air-filled  chamber with a small tunnel (the eustachian tube) that connects the chamber to the back of the nose. “This tunnel is extremely important, as the free flow of air into and out of the middle ear is what keeps air pressure equal on both sides of the eardrum,” says Dr. Gadomski.

So, what causes eustachian tube dysfunction?

Anything that blocks the free flow of air through the eustachian tube can cause eustachian tube dysfunction. The nasal ends of the eustachian tubes connect to the back of each nasal passageway. Because of this, upper respiratory infections, sinus infections, allergies, or adenoid inflammation are all likely to causes blockages. “When air can’t flow in and out of the middle ear, this can cause a vacuum,” says Dr. Gadomski. “The middle ear is lined with a mucus membrane that will continue to absorb the remaining air inside the middle ear after a blockage occurs – this causes a vacuum effect and ‘sucking in’ the eardrum.”

As uncomfortable as this might be on land, the symptoms are all the more severe and/or painful if this blockage occurs during a significant change in air pressure outside the ear such as with flying or scuba diving.

That’s why air travel can really hurt if your middle ear can’t “breathe.” Symptoms can include cracking, popping, or “hollow” sounds, temporary hearing loss, dizziness, uncomfortable pressure, and, in more severe cases, bloody drainage or even eardrum perforation.

• Oral decongestants
  “Over-the-counter decongestants can be helpful, but proceed with caution if you have a history of high blood pressure or cardiac arrhythmia,” says Dr. Gadomski.

• Over-the-counter nasal sprays
  A nasal spray such as Afrin is a fast-acting, temporary solution to clogged nasal passages. “Try a few squirts in each nasal passageway an hour or two before descent, which is usually when symptoms are most severe,” says Dr. Gadomski.

• Steroidal nasal sprays
  These take longer to work than over-the-counter sprays, but can be a good solution for people whose eustachian tube dysfunction is caused by chronic nasal allergy symptoms.

• Performing the Valsalva maneuver
  The Valsalva maneuver (named after the 17th century scientist who first described it) is essentially breathing out against a closed airway, and if the blockage is not severe, it may temporarily open the eustachian tube enough to equalize the pressure between the outer and middle ear. Other actions that mimic the effect of the Valsalva maneuver work the muscles that surround the eustachian tube, and include swallowing, chewing, and yawning.

• Staying awake during air pressure changes
  It’s generally assumed that the eustachian tubes are more prone to blockage when we sleep, which means that those with moderate-to-severe symptoms should attempt to remain awake during pressure changes, especially airplane descent. This is a fact especially worth considering when helping young children and babies through air travel. “Your seatmates might prefer that your child sleeps,” jokes Dr. Gadomski, “but they’ll stay more comfortable if they’re awake and eating or drinking during descent.”

If you’ve tried all that and you’re still in pain...

You may have a more serious condition that requires further medical intervention. “Myringotomy tubes, more commonly known as ear tubes, can be used to treat chronic or more severe eustachian tube dysfunction,” says Dr. Gadomski. If your lifestyle requires frequent air travel and you seek relief, talk to an ear, nose and throat doctor about the treatment options that will work best for you.

Updated December 29, 2017