Ear pain and discomfort are common experiences for many air travelers, often leading to concern about developing a serious ear infection. The rapid change in cabin pressure during ascent and especially descent causes significant pressure on the eardrum, resulting in ear barotrauma, or “airplane ear.” While flying itself does not typically cause a bacterial or viral infection, the severe pressure imbalance can mimic infection symptoms or create conditions that increase the risk for complications.
How Air Pressure Affects the Middle Ear
The discomfort felt during a flight is a direct result of pressure differences between the middle ear and the external environment. The middle ear is an air-filled space connected to the back of the nose and throat by the Eustachian tube. This tube regulates and equalizes the air pressure on both sides of the eardrum, allowing it to move naturally.
During the rapid descent of an aircraft, cabin air pressure increases quickly, but the air pressure trapped inside the middle ear remains lower. If the Eustachian tube cannot open fast enough, this pressure differential creates a vacuum effect. The resulting pressure imbalance forces the eardrum to stretch inward, causing pain, a sensation of fullness, and muffled hearing. Congestion from a cold, allergies, or an upper respiratory infection can block or inflame the Eustachian tube, making it difficult for the ear to manage these rapid pressure changes.
Essential Prevention Techniques
Travelers can proactively manage pressure changes by encouraging the Eustachian tubes to open during the flight. Swallowing helps open the tubes, which can be prompted by chewing gum or sucking on hard candy during takeoff and landing. For infants or young children, offering a pacifier, bottle, or sippy cup during these times encourages frequent swallowing.
A more direct technique is the Valsalva maneuver, which involves gently blowing air through the nose while pinching the nostrils shut and keeping the mouth closed. This action forces air into the Eustachian tubes, helping to equalize the pressure behind the eardrum. Perform this maneuver gently and repeat it several times, especially as the plane begins its final descent.
Using over-the-counter medications strategically helps prevent congestion. Taking an oral decongestant containing pseudoephedrine about 30 to 60 minutes before the flight can reduce swelling in the nasal passages and improve Eustachian tube function. Specialized earplugs, which contain ceramic filters, are designed to slow the rate at which air pressure changes reach the eardrum. These earplugs manage the pressure differential, providing relief for frequent flyers or those with sensitive ears.
When Flying Poses a Risk
Flying presents a heightened risk when a person already has an active middle ear infection, known as otitis media. In this condition, the middle ear space is already filled with fluid and pus, which cannot easily drain if the Eustachian tubes are blocked by swelling. The change in altitude causes the air inside the middle ear to expand, and the trapped fluid prevents the pressure from equalizing with the cabin environment.
This intense pressure buildup can lead to severe, worsening pain during the flight. In more serious instances, the stress on the eardrum can cause it to rupture, or perforate, resulting in a sudden release of fluid and temporary pain relief, followed by leakage. For individuals with recent ear surgery or a pre-existing eardrum perforation, pressure changes can also complicate healing or introduce external contaminants. Avoid flying with a severe, active infection or if symptoms include extreme pain, fever above 101°F, or severe dizziness. Postponing travel or consulting a medical professional for guidance before the flight is the safest course of action.