Assure Specilaity Clinic May 22, 2025

Regardless of being a frequent flyer or flying once in a while, travelling in first class or economy, sitting in window seat or aisle, or the duration of the flight; something all air travellers have in common is ear pain. To some it is just a slight discomfort, to others it means severe pain. Usually the ears will settle soon after landing. Occasionally the symptoms may drag on.

WHAT ACTUALLY HAPPENS?

There is an imbalance in the air pressure in the middle ear and the air pressure in the environment. This prevents your eardrum from vibrating as it should. Air pressure regulation is the work of a narrow passage called the eustachian tube. One end is connected to the middle ear while the other opens at the back of the nasal cavity. When an airplane climbs or descends, the air pressure in the environment changes rapidly, and your eustachian tube often doesn't react quickly enough to equalise the pressure.

HOW DOES IT FEEL?

The symptoms may include:

• Moderate discomfort
• Pain in your ear
• Feeling of fullness in your ear
• Muffled hearing

Airplane ear can occur in one or both ears. If airplane ear is severe or lasts longer, there may be severe pain, moderate to severe hearing loss, tinnitus, vertigo, vomiting or ear bleed.

DOES IT HAPPEN TO EVERYONE?

The pressure change is happening to everyone, but in some people the pain or blockage is worse than others. Common risk factors include:

• A small eustachian tube, especially in infants and toddlers
• Common cold
• Sinusitis
• Allergic rhinitis
• Middle ear infection

WHAT CAN BE DONE?

The following may help people who develop ear pain when flying:

• Swallow as much as you can.
• Yawn.
• Chew gum.
• Suck on hard candy.

The trick is to ensure that the Eustachian tubes work overtime and open more frequently to accommodate the change in air pressure.

• Use decongestant nasal spray one hour prior to boarding or landing. Use nasal sprays only when truly needed, as they may cause more congestion.
• Use the Valsalva maneuver. (Not recommended if you are sick with a cold or allergies, as it may cause severe ear infection.)

WHAT ELSE CAN BE DONE TO PREVENT IT?

• Avoid sleeping during ascent or descent.
• Drink plenty of non-caffeinated fluids to stay hydrated.
• If you are very sick with a cold, flu, allergies, or congestion, consider changing travel plans if possible.
• If flying while sick is unavoidable, see your doctor before travel and start decongestant medicines as advised.

WHAT PRECAUTIONS CAN BE TAKEN FOR KIDS?

• Give them a beverage during ascent and descent to encourage frequent swallowing. Have the child sit upright while drinking.
• For older children, hard candy works well; for infants, a pacifier can help.
• Keep your child awake during ascent and descent.
• See a doctor before flying if you suspect an ear or nose infection and start medicines as prescribed.

WHEN TO SEEK MEDICAL HELP?

• If the symptoms are severe.
• If symptoms last several days after air travel.
• If you are prone to severe airplane ear and must fly often.

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