Joseph R. Anticaglia MD
Medical Advisory Board
We’ve been there. Check in at the airport, pick up our boarding passes at the check-in-counter, board the plane, spot our assigned seat and place the carry-on-luggage in the overhead compartment. We sit down and fasten our seat belts.
The flight attendant reviews the safety precautions with us, then walks the aisle to make sure the back of our seats are in the upright position. The captain gets permission to take off, taxis the plane onto the runway — zoom — and we’re air bound.
On this trip, the woman in the window seat next to mine leans forward, looks past me and says, “Oh, gosh. It’s a three hour and fifteen minute flight to Dallas. Across from us, in the same row, is a mother with a child who is probably less than four years old. It’s going to be a long, loud, grumpy ride.” … “It depends.” I said… “What do you mean?“ … “Let’ see how the Mom handles the ‘ups and downs’ of this flight.”
What followed was an on and off conversation with questions by Patricia, the lady seated next to me, about ears, altitude and airplanes.
Ear troubles are the number one medical complaint of airplane travellers. Most often the passengers are bothered by pressure or fullness in the ears. The complaints of loss of hearing, ear discomfort and pain are usually temporary and go away without doing anything or after you “pop” your ears. (1)
Why do the ears feel blocked?
The ear works best when the air pressure on the outside of the eardrum is about equal to the air pressure on the inside of the eardrum. Take offs and landings can upset this pressure equilibrium and cause the ears to feel blocked and cause other problems. The pain, damage or “trauma” caused by the pressure differences between the inside and outside of the eardrum is labeled barotrauma. However, the root of the problem is Eustachian tube dysfunction.
What is the Eustachian tube (E-tube, Auditory tube)?
The E-tube is the opening that connects the middle ear (inside the eardrum) to the upper part of your throat behind your nose. It’s about one and a half inches in length and the opening is about the width of the lead in a pencil. It normally is closed but it “pops” open when we swallow or yawn to allow air to enter the middle ear equalizing the pressure inside and outside the eardrum.
The E-tube doesn’t work well when it becomes narrowed or blocked due to sudden changes in atmospheric pressure, infections, allergies or growths. This dysfunction causes pressure imbalance, since the E-tube cannot get air into or out of the middle ear. Besides ear fullness and pressure, E-tube blockage can lead to an accumulation of fluid (mucus or pus) in the middle ear with or without pain, loss of hearing and dizziness. (2)
It turned out that the little boy next to us was a happy, friendly four year old named Jeb. His mother kept him busy while the airplane was reaching its 28,000 feet cruising altitude.
“This is Jeb’s nap time,” she told us and when the flight attendant passed by she said, “Can you tell me when the Captain will start the descent of the airplane?” … “Of course.” About 15 minutes later, Jeb was sleeping like a baby.
What are the Ups and Downs of air travel?
Whether you’re in a plane that’s climbing upward to 28,000 feet or you’re climbing a mountain, the atmospheric pressure decreases as you go higher. The ears may feel full because the pressure inside the ear is greater compared to the outside. The body tries to equalize the imbalance by allowing air to exit the middle ear through the E-tube, much like letting air out of a balloon. It also has a way of absorbing air within the middle ear itself.
The opposite is true when the pilot puts the plane in its downward, landing pattern. Whether the plane you’re on is descending or you’re scuba diving, the outside pressure increases as you go lower.
In this instance, the ears feel blocked because there is — air hunger — less air and pressure inside ear compared to the outside. The body wants more air to enter the middle ear to equalize the pressure…
When the plane is descending, adults are familiar with attempts to get air to enter the middle ear by “popping” the ears. (1) But what do you do with four year old Jeb?
Kids and airplanes
Babies and kids are more susceptible to ear problems because their E-tubes are narrower than adults. Of course, very young children cannot pop their ears like adults. But there are precautions parents can take to prevent, unplug the ears and ease the discomfort of their children when travelling in airplanes.
The flight attendant informed Jeb’s Mom that the plane was preparing to descend. She woke up Jeb and gave him water and children’s ibuprofen. She explained, “He tends to get ear pain when the plane is landing.”
Jeb was sleeping when we had our lunch but Mom was now feeding him his lunch as the plane was slowly descending. After lunch, she gave Jeb chewing gum (since he was over four years of age) and soon afterwards the plane had landed smoothly and safely.
Takeaways
- If you have had ear surgery, consult your doctor before flying
- Use analgesics, if you anticipate or have pain (acetaminophen, ibuprofen).
- “Pop” your ears as needed. Do not use excessive force
- If a baby is on board, use a pacifier or bottle especially on the plane’s descent
- Insertion of ear tubes have helped frequent flyers with E-tube problems
The common cold, sinusitis, allergic rhinitis can increase the risk of E-tube obstruction and ear barotrauma. Passengers in good health can use decongestants, antihistamines or nasal sprays to reduce E-tube congestion and obstruction. It’s useful to take the medications about an hour before the plane’s descent. Consider postponing the flight if the above conditions are significant.
MoreTakeaways
- Stay awake during takeoffs and landings
- Yawn, chew gum, suck on hard candy to encourage swallowing
- Ear plugs “might” help
- Drink plenty of fluids on long flights, water is preferable
- Seek medical assistance if your ear problems persist after exiting the plane.
Flying is a common cause of ear barotrauma. Travelers experience most of their ear problems when the plane is descending. The above suggestions might make a difference in the enjoyment of your next flight. It made my trip to Dallas seem short, quiet and pleasant. (3)
References
- “Pop” your ears; the Valsalva maneuver. This technique is used to allow air to enter the middle ear to unblock the ears.
- Breathe in
- Pinch your nose
- Close your mouth
- Blow your nose — exhale through your nose. You might hear a screeching or popping sound. Repeat as needed, but do not use excessive force.
- Ears and Altitude; Amer. Acad. Otolaryngology — Head & Neck Surgery
- A future article will discuss remedies for in-flight ear problems
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.