Airplane ear

While everyone on a flight is affected by changes in air pressure, some individuals experience more severe ear pain than others. The following factors, which can obstruct or impair the function of the Eustachian tube, are associated with an increased risk of airplane ear:

Age

Infants and young children are particularly vulnerable to airplane ear due to their smaller Eustachian tubes.

Medical Conditions

Certain health conditions make it more difficult for the ears to adjust to rapid pressure changes, raising the likelihood of developing airplane ear. These conditions include:

• Common cold
• Sinusitis
• Allergic rhinitis (hay fever)
• Otitis media (middle ear infection)
• Hormonal changes (such as during pregnancy)

Sleeping or Napping During Air Travel

Activities like swallowing and yawning help equalize ear pressure, but these are less frequent during sleep. As a result, the chances of experiencing airplane ear are higher if a person sleeps or naps during the flight.

The diagnosis of airplane ear is typically made based on the patient's symptoms and their history of air travel. If there is any uncertainty, further confirmation can be done through:

Otoscopy

This involves inspecting the inner ear using an instrument known as an otoscope. During this examination, the doctor will look for signs such as:

• Bulging of the eardrum
• Tears in the eardrum
• Presence of blood or fluid in the eardrum

Audiometry

This test is conducted when the patient reports hearing loss.

Specialists to Consult

Most airplane ear symptoms tend to improve after the flight ends.

When to Seek Medical Help

Consult a doctor if you experience:

• Dizziness or a sensation of imbalance immediately after flying
• Intense ear pain
• Bleeding from the ear
• Fluid drainage from the ear
• Difficulty hearing

Doctors who can help diagnose and treat airplane ear include:

• General practitioners
• ENT specialists: These are doctors who specialize in treating conditions related to the ears, nose, and throat.

Airplane ear is a preventable condition, and there are various strategies to avoid it. These preventive measures can be categorized into three groups:

A. Primary Prevention

This involves actions that can be taken before or during any ear discomfort:

1. Self-care Practices: Activities such as yawning, swallowing, and chewing, especially during takeoff and landing, should be performed while flying. These actions help keep the Eustachian tubes open and prevent airplane ear. Sucking on lozenges and chewing gum during ascent and descent can also be beneficial.
2. Stay Awake: It is advisable to remain awake during takeoff and landing to actively perform actions like yawning, swallowing, and chewing. If necessary, passengers can ask flight attendants to wake them up before landing.
3. Use Air Pressure Regulating Earplugs: Special earplugs, which can be purchased at airports, pharmacies, or hearing clinics, are designed to help balance the pressure against the eardrum, preventing airplane ear.
4. Medication: Those with a cold can use decongestants about an hour before flight takeoff to reduce the risk of airplane ear.
5. Note: Always consult with a healthcare provider before using decongestants, especially if you have high blood pressure, heart conditions, arrhythmias, or are pregnant.
6. Over-the-Counter Nasal Sprays: Nasal congestion increases the risk of airplane ear. Using a nasal spray about 30 minutes before takeoff can help alleviate this.
7. Use an Autoinflation Balloon: These special balloons can be inflated through the nose by blocking one nostril and blowing through the other. Available at pharmacies, they can help relieve discomfort during flights or unblock the ears after landing.
8. Reschedule Air Travel: If possible, consider postponing air travel if you are suffering from a cold, sinusitis, nasal congestion, or recently had ear surgery or infection, especially if you've experienced significant airplane ear symptoms in the past.

B. Secondary Prevention

This involves measures to prevent severe ear pain once discomfort is felt:

Valsalva Maneuver: If you experience ear discomfort during a flight, this technique can help equalize the pressure in the middle ear, preventing airplane ear. It involves the following steps:

• Take a deep breath.
• Push the breath out while keeping the mouth and nose closed.
• Hold for 15 to 20 seconds.
• Open the mouth and nose and exhale.

Ear Packing: If bleeding occurs, immediate ear packing is necessary to prevent further damage.

C. Tertiary Prevention

This long-term approach involves surgically placing a tube in the eardrum to assist in fluid drainage and equalizing the pressure between the middle and outer ear. This option is typically recommended for frequent flyers who are prone to severe airplane ear.

Special Tips for Preventing Airplane Ear in Infants and Toddlers

Due to their smaller Eustachian tubes, infants and toddlers are more likely to experience airplane ear. To minimize symptoms, parents or guardians can try the following measures:

• Breastfeeding
• Bottle feeding
• Using a pacifier
• Drinking fluids with a sipper or straw

For children over 4 years of age, the following activities can help:

• Chewing gum
• Drinking fluids through a straw
• Blowing bubbles through a straw

Note: Decongestants are not typically recommended for children under 6 years old. Always consult a pediatrician before administering decongestants to a child.

Airplane authorities should provide preventive guidelines to raise awareness and help manage this condition. Airplane ear is typically treated with simple methods.

Yawning or swallowing is recommended as it helps open the Eustachian tube, balancing the pressure difference and easing symptoms.

For prolonged cold or allergy symptoms, medications like antihistamines (e.g., cetirizine, fexofenadine, loratadine) and decongestants (e.g., oxymetazoline, phenylephrine, pseudoephedrine) can be taken.

In cases of severe pain, over-the-counter pain relief medications like paracetamol can help.

In rare cases, a procedure called myringotomy may be performed, where a small incision is made in the eardrum to drain fluid and equalize pressure.

The symptoms of airplane ear typically resolve on their own with preventive measures and rarely lead to complications. However, in very rare cases, if the eardrum experiences excessive pressure and ruptures, it may result in:

• Acute ear infections
• Hearing loss
• Chronic tinnitus (ringing in the ears)
• Vertigo
• Eardrum perforation