Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they may result in temporary pain and hearing loss. Make air travel comfortable by learning how to equalize the pressure in the ears instead of suffering from an uncomfortable feeling of fullness or pressure.

Eustachian Tube Function

Normally, swallowing causes a little click or popping sound in the ear. This occurs because a small bubble of air has entered the middle ear, up from the back of the nose. It passes through the eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and re-supplied through the eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is not equal the ear feels blocked.

The eustachian tube can be blocked, or obstructed, for a variety of reasons. When malfunctioning, the middle ear pressure cannot be equalized. The air behind the eardrum is absorbed creating a vacuum which pulls the eardrum inward. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked. If the tube remains blocked, fluid will seep into the area from behind the eardrum in an attempt to overcome the vacuum. This is called “fluid in the ear” or serous otitis media. Uncommon problems include developing a hole in the ear drum, hearing loss and dizziness. The most common cause for a blocked eustachian tube is the common cold. Sinus infections and nasal allergies are also common causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the eustachian tube.

Air Travel and Hearing Loss

Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher. The speed of descent is typically the problem and can occur in other situations such as riding in elevators or diving to the bottom of a swimming pool. Deep sea divers, as well as pilots, are taught how to equalize their ear pressure.

Equalizing Ear Pressure

Swallowing activates the muscles that open the eustachian tube. Swallowing occurs more often when chewing gum or when sucking on hard candies. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. During descent, if yawning and swallowing are not effective, pinch the nostrils shut, take a mouthful of air, and direct the air into the back of the nose as if trying to blow the nose gently. You should feel a pressure buildup. The ears have been successfully unblocked when a pop is heard. This may have to be repeated several times during descent.

Even after landing, continue the pressure equalizing techniques and the use of decongestants and nasal sprays. If the ears fail to open or if pain persists, call for an appointment. We may need to release the pressure or fluid with a small incision in the ear drum. For some people, these techniques may not work.  If you fly frequently and have chronic issues with pressure or pain, we may recommend placing small pressure equalization tubes in your ears.

Children and Flying

Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed the baby during the flight, and do not allow him or her to sleep during descent. Children are especially vulnerable to blockages because their eustachian tubes are narrower than in adults.

Decongestants and Nose Sprays

Many experienced air travelers use a decongestant pill or an over the counter nasal spray (Afrin) an hour or so before descent. This will shrink the nasal tissue and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight. Avoid making a habit of over the counter nasal sprays as after a few days they may cause more congestion than relief.

Decongestant tablets (pseudophed) and sprays (Afrin) can be purchased without a prescription. They should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or anxiety. People with these conditions or who are pregnant should consult their primary care physicians.

Tips to prevent discomfort during air travel

  • If you have recently had ear surgery, consult with our clinic to ensure it is safe to fly.
  • Postpone an airplane trip if a cold, sinus infection, or an allergy attack is present.
  • Patients in good health can take a decongestant pill or nose spray approximately an hour before descent to help the ears pop more easily.
  • Avoid sleeping during descent.
  • Chew gum or suck on a hard candy just before take-off and during descent.
  • When inflating the ears, do not use excessive force. The proper technique involves only pressure created by the cheek and throat muscles.