Painful Ears When Flying
Aeroplane Ear

What is aeroplane ear?

Some people experience ear pain when flying in a plane. Usually this happens as the plane descends to land. The pain is worse the lower the plane gets and can be quite severe on landing.

What causes the pain?

The pain is caused by unequal pressure that develops between the air in the middle ear and the air outside the ear.

The small space in the middle ear behind the eardrum is normally filled with air. This air space is connected to the back of the nose by a tiny channel called the Eustachian tube. The air on either side of the eardrum should be at the same pressure. As a plane descends the air pressure becomes higher nearer the ground. This pushes the eardrum inwards which can be painful. To relieve this, the pressure inside the middle ear has to rise quickly too. Air needs to travel up the Eustachian tube into the middle ear to equalise the pressure.

Why are some people affected more than others?

The Eustachian tube is normally closed but opens from time to time when we swallow, yawn or chew. In most people, just normal swallowing and chewing quickly causes air to travel up the Eustachian tube to equalise the pressure. Some airlines offer sweets to suck and eat when the plane is descending to encourage you to chew and swallow.

However, the Eustachian tube in some people does not open as easily and so the pressure may not be equalised so quickly. For example, some people may have a more narrow Eustachian tube than normal. Also, if you have any condition that causes a blockage to the Eustachian tube, then the air cannot travel up to the middle ear. The common cause of a blocked Eustachian tube is from mucus and inflammation that occur with colds, throat infections, hay fever, etc. In fact, any condition causing extra mucus in the back of the nose can cause this problem.

How can I prevent ear pain when I fly?

Ideally, anyone with a cold, respiratory infection, ear infection, etc, should not fly. However, not many people will cancel their holiday trips for this reason. The following may help people who develop ear pain when flying.

• Suck sweets when the plane begins to descend. Air is more likely to flow up the Eustachian tube if you swallow, yawn or chew. For babies, it is a good idea to feed them or give them a drink at the time of descent to encourage them to swallow.
• Try doing the following. Take a breath in. Then, try to breathe out gently with your mouth closed and pinching your nose (the Valsalva manoeuvre). In this way, no air is blown out but you are gently pushing air into the Eustachian tube. If you do this you may feel your ears go 'pop' as air is pushed into the middle ear. This often cures the problem. Repeat this every few minutes until landing - whenever you feel any discomfort in the ear.
• Do not sleep when the plane is descending to land. (Ask the air steward to wake you when the plane starts to descend.) If you are awake you can make sure that you suck and swallow to encourage air to get into the middle ear.

The above usually works for most people. However, if you are particularly prone to develop aeroplane ear, you may wish to also consider the following in addition to the tips above.

• Antihistamine tablets (available at pharmacies). Take the recommended dose the day before and the day of travel. This may help to limit the amount of mucus that you make.
• A decongestant nasal spray can 'dry up' the mucus in the nose. For example, one containing Xylometazolene - available at pharmacies. Spray the nose about one hour before the expected time of descent. Spray again five minutes later. Then spray every 20 minutes until landing.

What is the treatment for aeroplane ear?

If the measures above fail to prevent aeroplane ear, although the pain may be severe, it normally goes quickly. Take painkillers such as paracetamol until it does go. Fluid sometimes accumulates in the middle ear for a few days after the flight which may make hearing rather dull for a while. See a doctor if the pain or dulled hearing does not clear within a few days.

© EMIS and PIP 2006   Updated: December 2006

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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