Ear pain when flying? How to protect your ears when travelling
As the summer travel season gets underway, ear pain on flights is one of the most common complaints that brings patients to an ENT clinic in the weeks that follow. For most people, it passes. For some, it does not, and for a smaller number, it causes real damage. Understanding why it happens and what you can do about it is worth knowing before you board.
Why do your ears hurt when flying?
The culprit is pressure. As an aircraft climbs and descends, the air pressure in the cabin changes rapidly. The middle ear, the space behind the eardrum, needs to match the external canal pressure to function normally. It does this through the Eustachian tube, a narrow passage connecting the middle ear to the back of the nose and throat.
When the Eustachian tube is working well, it opens briefly during swallowing or yawning to equalise pressure, and you barely notice it. When it is not, pressure builds up on one or both sides of the eardrum, causing the familiar sensations of muffled hearing, fullness and pain. This is known as otic barotrauma, sometimes known as ‘aeroplane ear’. A study in the Journal of Laryngology and Otology identified it as one of the most common medical problems associated with air travel.
Around 1 in every 100 adults in the UK has Eustachian tube dysfunction, with the risk rising significantly in people with allergic rhinitis, chronic sinusitis, a current cold or upper respiratory infection. In these cases, swelling in the nasal passages can block the Eustachian tube entirely, making pressure equalisation much harder.
When it becomes more serious
For most travellers, the discomfort resolves within a few hours of landing. But for those with underlying Eustachian tube dysfunction or a middle ear effusion (fluid behind the eardrum), flying carries a greater risk.
Landing with Eustachian tube dysfunction and a middle ear effusion can cause severe pain and, in some cases, damage the eardrum, or cause potentially more serious inner ear problems. A perforated eardrum from otic barotrauma requires specialist assessment and, depending on severity, may need time and treatment to heal. Flying while congested or with an undiagnosed middle ear condition can result in an injury that needs medical attention.
How to relieve ear discomfort when flying
If you are prone to ear discomfort when flying, try swallowing, yawning or chewing gum. If you develop ear pain when descending to land in a plane, when pressure changes are greatest, you can try the Valsalva manoeuvre: close your mouth, pinch your nose and breathe out gently. This can help open the Eustachian tube, but do not do this forcefully if you have a cold, as this can push infection into the middle ear.
If possible, avoid flying with a heavy cold, active sinus infection or untreated middle ear problem.
When to see a specialist before or after flying
If you regularly experience significant ear pain on flights, or if your ears do not clear within a day or two of landing, it is worth getting a proper assessment before your next trip, including Eustachian tube function testing. A specialist can identify whether you have underlying Eustachian tube dysfunction or a blocked ear and can advise on the right course of action before you fly.
Tympanometry is an established test for measuring middle ear pressure, which may be low in patients with severe Eustachian tube dysfunction. It is a painless test, which involves inserting a rubber plug into the ear. However, most patients with Eustachian tube issues are not extreme cases, and many have normal middle-ear pressure on tympanometry. A better dynamic assessment of Eustachian tube function involves measuring the middle ear pressure and then the change in pressure on swallowing.
In addition, Eustachian tube function testing measures the ability to inflate the middle ear by blowing with the nose and mouth closed, the so-called Valsalva’s manoeuvre. Both these parameters are measured during Eustachian tube function testing.
If you are planning your first scuba diving adventure or considering your first skydive, it is always helpful to check the function of your Eustachian tube to avoid a potentially frustrating and painful experience.
If you have landed with ear pain that has not resolved, or if you are experiencing muffled hearing, tinnitus or dizziness following a flight, these can be signs of a pressure-related ear injury that needs prompt assessment.
At The Harley Street ENT Clinic, our ear specialists can assess and treat ear blockage, otic barotrauma and Eustachian tube dysfunction, with same-day and urgent appointments available. Call us on 020 7224 2350 to book a consultation before or after your travels.