The inner ear contains the organs responsible for balance and hearing, making it highly sensitive to changes in pressure. Air travel presents a challenge because an airplane’s rapid ascent and descent causes atmospheric pressure to shift quickly. While most people experience only temporary discomfort, pre-existing inner ear issues can amplify the effects, sometimes leading to severe pain or complications. Understanding pressure equalization and knowing which conditions pose a risk is important for any traveler.
How Cabin Pressure Affects the Inner Ear
The sensation of ear pressure during a flight, known as ear barotrauma, occurs when the air pressure outside the eardrum and the pressure inside the middle ear are unequal. The middle ear is connected to the back of the throat by the Eustachian tube. This tube opens periodically to allow air to flow, keeping the pressure balanced on both sides of the eardrum.
During the aircraft’s ascent, cabin pressure decreases, and the air trapped in the middle ear expands, pushing its way out through the Eustachian tube. The reverse process causes the most problems. As the plane descends, cabin pressure increases rapidly, creating negative pressure inside the middle ear space. The Eustachian tube must actively open to let air in and counteract this vacuum, which is difficult if the tube is swollen or congested.
If the Eustachian tube fails to open, the negative pressure causes the eardrum to stretch inward, leading to pain, fullness, and muffled hearing. This pressure imbalance can be painful and, in severe cases, may lead to damage like a ruptured eardrum. The discomfort is caused by the speed of the pressure change and the tube’s failure to equalize the pressure quickly enough.
Specific Conditions That Prohibit or Complicate Air Travel
Flying with certain pre-existing ear or sinus conditions increases the risk of severe complications and should be discussed with a healthcare provider. An acute middle ear infection (otitis media) is a concern because inflammation can completely block the Eustachian tube. The fluid buildup behind the eardrum, combined with flying pressure changes, increases the risk of tympanic membrane rupture. Experts advise against flying until two weeks after an ear infection has been fully treated and symptoms have resolved.
Recent ear surgery, particularly procedures involving the middle or inner ear, requires a mandatory waiting period before air travel. For example, after stapes surgery, a waiting period of two to six weeks is often required for the surgical seal to heal. Tympanoplasty, which repairs a perforated eardrum, generally requires four to six weeks of recovery before flying. The risk is that the pressure differential could disrupt the surgical repair or cause internal damage.
Severe sinus congestion, colds, or allergies can worsen ear barotrauma by causing the Eustachian tube lining to swell. A blocked tube cannot perform its pressure-equalizing function, making the traveler susceptible to painful pressure buildup. Active flare-ups of Meniere’s disease, a chronic inner ear disorder, present a challenge due to the risk of vertigo. Individuals with Meniere’s often avoid flying during an active episode.
Strategies for Managing Ear Pressure During Flight
For travelers with chronic but stable ear issues who are cleared to fly, several active techniques can help manage pressure during the flight. The most important action is to stay awake during the aircraft’s descent, as this is when the most intense pressure changes occur. Swallowing, yawning, and chewing gum or sucking on hard candy are simple, effective ways to encourage the Eustachian tubes to open and equalize pressure.
Active Maneuvers
A more direct method is the Valsalva maneuver, which involves closing the mouth, pinching the nostrils shut, and then gently attempting to blow air out. This forces air into the Eustachian tubes, often resulting in a “pop” that indicates successful pressure equalization. It is important to perform this maneuver gently, as blowing too forcefully can cause damage to the ear structures. The best time to use this technique is at the first sign of pressure discomfort during the descent.
Medications
Over-the-counter medications can be a helpful preventative measure, especially for those with congestion. Oral decongestants, such as pseudoephedrine, can be taken about one hour before the flight to reduce swelling in the nasal passages and the opening of the Eustachian tube. Topical nasal decongestant sprays, like oxymetazoline, should be administered about 30 to 60 minutes before takeoff and again before descent. These sprays should not be used for more than a few days to avoid rebound congestion.
Specialized Earplugs and Infant Care
Specialized filtered earplugs are designed to slow the rate at which air pressure changes reach the eardrum. They work by regulating the air exchange between the ear canal and the cabin environment. These should be inserted before takeoff and kept in until the aircraft has landed. For infants, the act of sucking and swallowing is the primary defense. Bottle-feeding or breastfeeding during ascent and descent encourages the necessary swallowing reflex to equalize the pressure.