Medical News

Why travelling by plane can cause ear problems?

Last update on Jun 17th, 2021

Why do ears pop on a plane?

Air transport occurs at high altitude, usually around 10,000 meters. At higher altitudes, the air pressure decreases, which can cause ear problems. Inside the middle ear, the pressure is usually equal to the one of the outer ear. When the cabin pressure drops suddenly, a pressure difference is created between the middle ear and the outer ear. This blocks the Eustachian tube and can cause the sensation of plugged ear, an auditory discomfort called barotrauma. When this happens, the passenger may notice a strong pressure inside the ear and sometimes pain.

Why do my ears hurt in a plane?

Earache in an aeroplane can occur especially during take-off or landing: you usually experience a 'plugged ear' sensation and sounds become muffled, you may also experience ringing or buzzing (tinnitus) and more or less intense pain. That sensation, which we commonly call 'plugged ears', is called barotrauma in medical terms.

The mechanism that creates earache is linked to the air pressure inside the aircraft cabin, which increases rapidly without the Eustachian tube, the small duct that connects the middle ear with the nose, being able to react efficiently to the sudden change in pressure. The consequence is a retraction of the tympanic membrane and consequent muffling and pain.

Under normal conditions, the pressure on both sides of the eardrum (the part towards the pinna corresponds to the external pressure and the part towards the middle ear corresponds to the air pressure inside the ear) is the same and this balance is maintained by the action of the Eustachian tube, which opens 3-4 times a minute (e.g. while yawning or swallowing), allowing air to pass through.

Sudden changes in atmospheric pressure can create an imbalance that causes an increase in pressure on the tympanic membrane. Hence the pain and other related symptoms.

How to avoid ear pressure problems during flights?

The risk can be reduced with actions that facilitate the opening of the Eustachian tube, such as:

Yawning, chewing, swallowing some food or drinking small amounts of liquids during takeoff and landing to mobilise the muscles of chewing and swallowing.
Perform the Valsalva maneuver: take air and blow gently with your mouth and nose closed.
Use ear protection or ear plugs during the flight.

Earplugs for use in a plane

The use of earplugs during air travel is an excellent practice to prevent discomfort caused by pressure variations. Earplugs not only protect the hearing from excessive pressure on the ear, but also help to better compensate for differences in air pressure. This reduces the sensation of pain in the ears during take-off and landing, thus ensuring a more comfortable journey.

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How to unplug your ears

There are also many manoeuvres to perform that can be effective in compensating for internal pressure, such as:

The Valsalva manoeuvre. You take a deep inhalation and, keeping your nose plugged with your fingers and your mouth closed, try to push the air out through your nose, gently without forcing it (you run the risk of feeling more pain). If it works, a slight pop is heard and the ear becomes functional again.
The Toynbee manoeuvre, which uses swallowing with the mouth and nose closed, to achieve compensation of the pressure differential between the inner ear and the external acoustic meatus.

Also effective is the use of the Otovent, a special balloon with a nasal nozzle that can be purchased in pharmacies. One inserts the nozzle into one nostril and, keeping the other nostril plugged, attempts to inflate the balloon. When the balloon is inflated like a large orange, one swallows with the mouth closed and nose plugged. In this way, the air inside the balloon, which has a certain pressure, opens the Eustachian tube and restores the internal pressure, which becomes equal to the external pressure. The operation is carried out from both sides, until the liberating pop is heard.

The same symptoms felt during flight can occur, although often in a milder form, when ascending or descending a mountain.

What to do if plugged ears sensation persists

If the sensation of plugged ears persists for hours after the flight, consult a doctor or an ENT specialist. The information contained in this post is purely informative, not substituting, in any case, the advice of your doctor.

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When is air travel inadvisable?

Can I fly with an ear infection?

Flying with an ear infectionis not ideal, but who wants to postpone or even cancel their holiday because of it? If you or your child have to fly with an earache, earplugs for flying for take-off and landing, nasal spray and warm clothing such as hats, scarfs, sweaters and warm socks are the ideal flight equipment.

Can I fly when you have otitis?

When you have otitis media, it is inadvisable to travel by air because during take-off and landing, the pressure inside the aircraft cabin changes rapidly. Usually, it is possible to balance the pressure by yawning or swallowing. However, if the Eustachian tube is obstructed, these methods are ineffective. Even after recovery, it is advisable to undergo a medical examination to check the integrity of the eardrum.

Can I fly when you have a cold?

Yes, you can travel by plane when you have a cold. It is necessary to reiterate the concept that during a flight, your ears can become plugged due to pressure variations and this problem can be accentuated if you have a cold or nasal congestion. A cold causes swelling and mucus production in the airways, making it difficult for air to flow through the Eustachian tubes and regulate the pressure in the middle ear.

It is important to distinguish between plugged ears due to pressure changes and those related to a cold, which is a viral infection of the respiratory tract. If the ears remain plugged after flying or are accompanied by other symptoms, it is advisable to consult a doctor for an evaluation.

How to protect children's ears

Children also get plugged ears during flights, especially if they are not breathing well because they have adenoids or are cold. To prevent discomfort and pain, it is important to try to keep them awake during take-off and landing. A sweet or a lollipop can encourage frequent swallowing. For toddlers, a dummy can be used or they can drink water or milk from a baby bottle.

It is a good idea to have your paediatrician recommend a decongestant nasal spray or ear drops: they can be very useful during the flight, especially if your child has cold or phlegm problems.