Pain in ears when flying

The ear pain you experience — barotrauma of the ear — is the most common medical problem reported by air travelers. “Barotrauma” refers to injuries caused by increased air pressure.

Here’s why it happens. Your ear has three parts: the outer ear (including the ear canal), the middle ear and the inner ear. The eardrum comes between the outer ear and the middle ear. The middle ear is connected to the back of your mouth by a thin canal called the Eustachian tube. Air is constantly moving through the Eustachian tube and into the middle ear. This balances the pressure in the middle ear with that in the inner ear.

Ear barotrauma can occur when one (or both) of two things happen: the Eustachian tube becomes blocked or partially blocked, and the air pressure around you changes suddenly.

Air pressure gets lower at higher altitudes. When a plane takes off, and when it descends for landing, the altitude changes rapidly. While the plane has systems to reduce the sudden changes that occur during takeoff and landing, some still occur.

When a plane’s air pressure changes suddenly, it can create a vacuum in the middle ear that pulls the eardrum inward. This can cause pain and muffle sounds. In more severe cases, the middle ear can fill with clear fluid. In the most severe cases, the eardrum can rupture. Fortunately, this is rare.

Barotrauma is much more likely if you’re flying with a cold, infection or allergies. If these conditions block the Eustachian tube, the natural way you have of balancing pressures in your ear is compromised.

So if you are ill and have any flexibility, reschedule your flight until you are better. If you must fly, take a decongestant one hour before your flight or use a decongestant nasal spray, or both. Antihistamines may also help if you have allergies.

Special earplugs can slow down the pressure change that affects the ear. These might give your ears additional time to adjust to pressure changes.

If you experience the symptoms of barotrauma during a flight, try the following — and before the symptoms start (for most people, landing is worse than takeoff):

• Chew gum or suck on hard candy.
• Yawn and swallow frequently, tightening the muscles in the back of your throat as you do (you often can feel and hear the Eustachian tube pop open).

If these methods don’t work, pinch your nose closed, inhale through your mouth, and then try to push the air out through your nose while keeping it pinched shut. Don’t push hard, and stop as soon as one ear pops. If you blow too hard, you can tear your eardrums, so do it carefully.

If you continue to experience ear pain and stuffiness after landing, a decongestant spray may help.