Your ears hurt on a plane because the air pressure in the cabin changes faster than your body can adjust. A narrow tube connecting your middle ear to the back of your throat, called the eustachian tube, is responsible for keeping pressure equal on both sides of your eardrum. During climb and especially during descent, cabin pressure shifts so quickly that this tube can’t keep up, and the resulting imbalance pushes or pulls on your eardrum, causing anything from mild fullness to sharp pain.
How Pressure Creates Pain
Your eardrum is a thin, highly sensitive membrane packed with nerve endings that detect pressure changes. Behind it sits a small air-filled space, the middle ear, that needs to stay at the same pressure as the air around you. The eustachian tube acts as a tiny release valve, opening briefly when you swallow or yawn to let air flow in or out and keep things balanced.
When a plane descends, cabin pressure rises relatively quickly. If your eustachian tube doesn’t open fast enough, the higher pressure outside pushes your eardrum inward. That mechanical stretch activates the nerve endings in the membrane, and you feel it first as fullness, then as increasing discomfort, and eventually as genuine pain if the imbalance isn’t corrected. The same process can happen during ascent, though descent is usually worse because the tube has a harder time letting air back into the middle ear than letting it escape.
Who Is Most at Risk
Anything that narrows or blocks the eustachian tube makes you more likely to experience ear pain in flight. A head cold, sinus infection, or hay fever can swell the tissue around the tube’s opening, effectively sealing it shut. A middle ear infection adds fluid that further blocks airflow. Even sleeping during takeoff or landing raises your risk, because you’re not swallowing or yawning enough to help the tube open.
Children are especially vulnerable. Their eustachian tubes are shorter, narrower, and more horizontal than an adult’s, making the movement of air and fluid more difficult. One study found that 40% of child passengers had negative middle ear pressure after a flight, compared to 20% of adults. Roughly 22% of children showed visible signs of eardrum stress on examination afterward, versus about 10% of adults. So if your toddler screams during descent, it’s not just fussiness. They’re likely in real discomfort.
What It Feels Like at Each Stage
Mild cases start with a sense of fullness or muffled hearing, as if your ears are plugged with cotton. If the pressure difference grows, this shifts into distinct pain. You might notice some hearing loss or a feeling of fluid behind the eardrum. In rare, more severe cases, the pressure difference becomes large enough to rupture the eardrum. People who experience this typically describe worsening pain that suddenly improves at the moment of rupture, followed by reduced hearing, ringing, or even dizziness and nausea.
Eardrum perforation from flying is uncommon, but it does happen. Most small perforations heal on their own within three to six weeks, though larger ones can take several months. If you step off a flight with persistent sharp pain, hearing loss, ringing, or any fluid draining from your ear, those are signs of something beyond ordinary discomfort.
How to Equalize the Pressure
The goal is simple: get your eustachian tube to open so air can flow into (or out of) the middle ear. Several techniques work, and you can try them one after another until you feel the pressure release.
- Swallowing or yawning. Both actions naturally pull the eustachian tube open. Chewing gum, sucking on hard candy, or sipping water during descent all encourage repeated swallowing. For babies, nursing or bottle-feeding during takeoff and landing serves the same purpose.
- The Valsalva maneuver. Close your mouth, pinch your nostrils shut, and gently blow as if trying to exhale through your nose. This forces air up through the eustachian tubes. Keep the pressure gentle. Blowing too hard can cause problems of its own.
- The Toynbee maneuver. Close your mouth, pinch your nostrils, and swallow. This creates a mild vacuum that helps pull the eustachian tubes open rather than forcing air through them, making it a softer alternative to the Valsalva technique.
Start these techniques as soon as you feel the first hint of fullness, not after the pain has already set in. Once the tissue around the eustachian tube swells from the pressure difference, it becomes harder to equalize. During descent, try swallowing or performing one of the maneuvers every few seconds until you land.
Do Decongestants Help?
If you have a cold or allergies and can’t avoid flying, an oral decongestant taken before your flight can make a meaningful difference. Clinical trials found that oral pseudoephedrine roughly halved the number of people who experienced ear pain and hearing loss during flight, compared to a placebo. This was specifically studied in adults with a history of ear pain while flying, and the benefit was consistent across multiple trials. People with high blood pressure or heart disease should avoid pseudoephedrine, and its effectiveness in children hasn’t been established (it may also cause drowsiness in kids).
Nasal spray decongestants are widely recommended anecdotally, but the clinical evidence for them is weaker. Studies haven’t clearly demonstrated that topical sprays prevent ear barotrauma the way oral decongestants do.
Pressure-Regulating Earplugs Don’t Work
You’ll find “pressure-equalizing” earplugs sold in airport shops and drugstores, marketed to prevent ear pain during flights. A controlled study tested one popular brand on 27 volunteers prone to ear barotrauma and found no benefit. Seventy-five percent of participants still experienced ear pain during descent. There was no measurable difference in middle ear pressure between the active earplugs and placebo earplugs. In fact, ears wearing the active earplugs scored slightly worse on examination afterward. The earplugs did reduce noise, which participants liked, but they cannot be recommended for preventing ear pain based on the available evidence.
Why Descent Is Worse Than Ascent
During ascent, the air in your middle ear expands as cabin pressure drops. This higher-pressure air can passively push the eustachian tube open from the inside, which is why your ears might “pop” on their own as the plane climbs. Descent is the opposite situation. Cabin pressure rises, creating a relative vacuum in the middle ear that pulls the eustachian tube closed rather than pushing it open. Your body has to actively force the tube open through swallowing, yawning, or one of the equalization techniques. That’s why most people feel the worst discomfort in the last 20 to 30 minutes of a flight, when the plane is dropping toward the runway.
If you’re only going to use a decongestant or practice equalization techniques during one phase of flight, make it the descent.