Some people develop ear pain when descending to land during a plane journey. It is caused by unequal pressures that develop on either side of the eardrum as the plane descends. Sucking sweets and gently blowing against a closed nose and mouth will usually push air into the middle ear, equalise the pressure and ease the pain. Some people who are prone to this problem take antihistamines or decongestants during the flight.
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 may get worse the lower the plane gets and can be quite severe on landing. The pain usually goes away soon after 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. Air pressure is highest nearer the ground. So as a plane descends, the air pressure becomes higher. 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 cause 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. 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 an ear infection, cold or respiratory 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 or dummy 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 or stewardess 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 also to 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 xylometazoline - 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. These are only for use for a short time.
- Decongestant tablets or syrup. For example a medication called pseudoephedrine. This can be obtained from a pharmacy without a prescription. Take the dose recommended half an hour before take-off, and if necessary repeat according to the instructions.
- Air pressure-regulating ear plugs. These are cheap, reusable ear plugs that are often sold at airports and in many pharmacies. These ear plugs slow the rate of air pressure change on the eardrum. (It is the rapid rate of pressure change on the eardrum that is the problem and these earplugs slow this down.) Follow the instructions that come with them. Basically, you put them in before the door of the aircraft is shut. Some people then wear them for the entire flight. Some people take them out when the plane reaches cruising height, and then place them in again just before the plane starts to descend to land.
- Blowing up a special balloon. Products such as Otovent® are balloons which you blow up through your nose, by blocking off one nostril at a time and blowing through the other. These can be bought from pharmacies, and some people find they help stop the pain during flying or unblock ears afterwards.
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 or mucus sometimes accumulates in the middle ear for a few days after the flight, which may make hearing rather dull for a while. This happens if the Eustachian tube is still blocked, and is more likely if you had a cold before flying. To clear it, you could try one of the measures in the section above. For example, the Valsalva manoeuvre, a decongestant or the balloon. You should see a doctor if the pain or dulled hearing does not clear within a few days.
Further reading & references
- Eustachian Tube Dysfunction; Baylor College of Medicine
- Ear pain during travel; BMJ Group, 2013
- International travel and health. Cabin air pressure; World Health Organization (WHO)
- Air travel and children's health issues; Paediatr Child Health. 2007 Jan;12(1):45-59.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Mary Harding
Dr Helen Huins