Tips to avoid ear pain and injury while flying

Allergies & ENT

by Baylor Scott & White Health

Nov 14, 2021

Fly the friendly skies. Something special in the air. You are now free to move about the country… as long as you don’t have ear pain.

If you typically experience ear pain while flying, you’re not alone. D. Randall Pinkston, MD, otolaryngologist on the medical staff at Baylor Scott & White Clinic – Temple, discusses the causes of ear pain while flying and offers some tips to avoid it.

What causes ear pain while flying?

Ear injury from a change in pressure is called barotrauma. It’s caused when the ambient barometric pressure changes in relation to the pressure in your middle ear when you fly, Dr. Pinkston said

“Your eardrum is stretched—either pushed out or sucked in—during flight,” he said. “That change can cause ear pain and injury.”

When you ascend in an airplane, the pressurized cabin should take care of you. It’s usually the descent that hurts.

Avoiding ear pain on descent

Because airplanes generally descend quickly, you need to equalize the pressure in your ear to keep up with the rising pressure around you. To avoid ear pain on descent, Dr. Pinkston said you need to equalize pressure by allowing air to enter the middle ear via the Eustachian tube. Here are some ways you can do that:

  • Chewing gum at the start of the flight and all throughout; begin the minute you get on the plane; use sugar-free gum
  • Yawning and swallowing as you feel the pressure changing
  • Valsava Manuever—hold your mouth and nose closed and increase pressure against a closed airway to force air from your nose through the Eustachian tubes to open your ears
  • Frenzel Manuever—pinch your nose and put the tip of tongue on the back of your front teeth and swallow with your mouth closed, thereby opening the Eustachian tubes and allowing pressure equalization

If you fly regularly and you have a history of severe ear pain, Dr. Pinkston suggests these medications to help you feel more comfortable when you fly:

  • Oral decongestants that contain pseudoephedrine, such as Sudafed (watch blood pressure if you’re on high blood pressure medications)
  • Nasal decongestant sprays that contain oxymetazoline, such as Afrin, or phenylephrine, such as Vicks (be sure the spray goes all the way to the back of your nose)
  • Corticosteroids, such as prednisone, that require a prescription (as long as you’re not diabetic and you don’t have ulcer disease or other active infections)

Flying while you have a cold

If you fly with a head cold or seasonal allergies, Dr. Pinkston said it’s possible you may significantly stretch your eardrum because your Eustachian tubes wouldn’t be working properly to equalize pressure. If the stretching of the eardrum is considerable, these problems may occur:

  • Capillaries in the ear break
  • Bleeding into the middle ear
  • Fluid accumulation behind the eardrum
  • Swelling
  • Significant pain
  • Dizziness

Dr. Pinkston said that all of these together would give you the sensation of hearing loss. You shouldn’t actually lose your hearing permanently from minor barotrauma—you’d just feel like you lost your hearing because your eardrum and middle ear functions would be impaired by the temporary injury and fluid accumulation.

“If you have a cold or seasonal allergies, don’t fly. Your Eustachian tubes will not be able to handle it,” Dr. Pinkston cautions. Try to get your ticket changed to an alternate date when you can enjoy those friendly skies pain free.

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