An ear infection, medically known as acute otitis media, is an inflammation of the middle ear space, typically caused by viruses or bacteria. This condition causes fluid to build up behind the eardrum, which in turn leads to pain and pressure. While it is physically possible to board an airplane with an ear infection, doing so carries a significant risk of severe pain and potential complications because rapid changes in cabin pressure can drastically worsen the symptoms.
Understanding Ear Pressure and Barotrauma
The reason flying affects the ears is due to the body’s need to equalize air pressure between the middle ear and the outside environment. This is managed by the Eustachian tube, a narrow canal connecting the middle ear to the back of the nose and upper throat. The tube opens periodically to allow air to flow in or out, ensuring the pressure on both sides of the eardrum remains balanced.
When an individual has an ear infection, the Eustachian tube often becomes swollen and blocked with fluid, severely limiting its ability to open and equalize pressure. During flight, particularly during ascent and descent, the cabin pressure changes rapidly, creating a pressure imbalance. This painful condition is known as ear barotrauma, or “airplane ear,” which is a physical injury caused by the pressure difference.
The blockage means the pressure disparity cannot be corrected, leading to a vacuum effect where the eardrum is stretched inward or pushed outward. This failure causes the sharp pain and discomfort associated with flying while infected. The risk of barotrauma is particularly high during the descent, when the cabin pressure increases and air needs to be drawn into the middle ear.
Specific Health Risks of Flying with Infection
The common consequence of flying with an active ear infection is intense, escalating pain due to unrelieved pressure on the eardrum. This pressure can cause a severe earache, temporary hearing loss, and a sensation of fullness that may persist after landing. The force exerted by the pressure imbalance can also lead to the accumulation of clear fluid in the middle ear, a condition called serous otitis.
A more serious complication is the rupture, or perforation, of the tympanic membrane. The extreme pressure difference can tear this thin membrane, resulting in sudden, sharp pain followed by a bloody or clear discharge. While most ruptured eardrums heal on their own within several weeks, the injury temporarily impairs hearing and increases the risk of a secondary infection.
In severe cases, the pressure can damage inner ear structures, potentially leading to permanent sensorineural hearing loss, vertigo, or persistent ringing in the ears (tinnitus). Children are at a higher risk for these complications because their Eustachian tubes are narrower and positioned more horizontally, making them more prone to blockage.
Strategies for Safer Flying
If a flight cannot be postponed, travelers can employ several strategies to mitigate the risks associated with an ear infection. Oral decongestants containing pseudoephedrine should be taken 30 to 60 minutes before takeoff, and again an hour before descent. These medications shrink swollen mucous membranes, potentially improving Eustachian tube function. Nasal sprays, such as oxymetazoline, can also be used 30 minutes before takeoff and landing, but use should be limited to a few days to avoid rebound congestion.
In-flight, remaining awake during takeoff and descent is important because swallowing and yawning help activate the muscles that open the Eustachian tubes. Chewing gum or sucking on hard candy promotes frequent swallowing, which assists in pressure equalization. Travelers can also perform the Valsalva maneuver by pinching their nostrils shut, closing their mouth, and gently attempting to blow air out of their nose. This action forces air into the Eustachian tubes, helping to “pop” the ears, but it must be done with gentle force to avoid injury.
The timing of these maneuvers is crucial; they are most effective if performed before the pressure difference becomes significant. Start these actions shortly before the plane begins its descent and repeat them frequently until landing. Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, before the flight can also manage discomfort by reducing inflammation and pain.
Consulting a Physician Before Travel
A medical consultation is required before flying, particularly when dealing with an active ear infection. A doctor can accurately assess the severity of the otitis media and determine if the eardrum is intact, which guides the decision to fly. If the infection is accompanied by a high fever, extreme pain, or significant hearing loss, a physician may advise against air travel completely.
Flying is strongly discouraged if a traveler has a pre-existing perforated eardrum or has recently undergone ear surgery, as this can create pathways for severe barotrauma. The doctor may prescribe antibiotics if the infection is bacterial, or recommend stronger anti-inflammatory medications. Seeking professional clearance ensures the structural integrity of the ear is checked and prevents risking long-term damage.