Air travel and ear pain: why it happens

Do you ever experience pain, discomfort or temporary hearing loss in your ears during take-off or landing when you take a flight? This is actually a very common condition known as 'airplane ear' (or ear barotrauma), which happens because of the change in cabin air pressure.

Here, one of our top ENT surgeons Professor Owen Judd explains why some people may experience ear pain whilst flying and how it affects the ears exactly.

Is there such a thing as ‘airplane ear’?

Yes, these are the symptoms we get in our ears from pressure changes in an aeroplane cabin. It is very common. It is caused by normal pressure changes with regard to the Eustachian tube. The Eustachian tube is a narrow tube which runs from the back of the nose to the middle ear space, which is behind your eardrum.

The function of the Eustachian tube is to equalise the air pressure in the middle ear space and to keep the pressure in this space the same as in the air around us. This way the eardrum and tiny bones of hearing can move freely and conduct sound efficiently.

If the air pressure in the middle ear is not the same as outside, the drum and bones cannot move freely and this results in sound not conducting efficiently, which is perceived as a hearing loss.

On an aeroplane, the pressure in the cabin changes and this changes the pressure in our middle ear spaces. Typically this affects us during the rapid ascent and descent of the aeroplane when the cabin pressure rapidly changes and the Eustachian tube does not have sufficient time to equalise the pressure.
 

How can take-off and landing affect the ear?

At ground level, the atmospheric air pressure and the middle ear air pressure are the same and the Eustachian tube can cope with equalising relatively slow changes in pressure, such as driving up a steep hill or ascending in a lift/elevator.

During ascent in an aeroplane however, the pressure in the cabin drops far more rapidly and therefore the middle ear pressure is high by comparison. This causes the eardrum to bulge outwards and causes a pressure feeling and brief discomfort.

During descent the reverse happens and the middle ear pressure is lower than the cabin pressure, causing the eardrum to get sucked inwards also causing discomfort. The pressure difference will prevent the eardrum from vibrating normally and so can also result in a muffled blocked sensation in the ear and a sensation of hearing loss. As the Eustachian tube acts to equalise these pressure changes the eardrum will snap back to its usual position with a “pop” and symptoms of pressure or muffled hearing loss will resolve.
 

Why do some people – who normally have no ear pain – experience it when flying?

If our Eustachian tubes are working completely normally and efficiently, we can “pop” our ears and equalise the pressure. If we have Eustachian tube dysfunction (ETD) however, we find it very difficult to equalise the pressure and the pressure difference can lead to pain as the eardrum is stretched. In some cases, this can become quite severe.

ETD is a common condition caused by swelling or obstruction of the tube as it opens in the back of the nose. This can happen naturally following a cold or viral infection, sinusitis or allergy affecting the nose.

It is more common in smokers due to thickening of mucus, and in younger children due to the slightly different shape and length of the tube as they grow.
 

What can I do to relieve ear pain when I am on my flight?

Anything we can do to encourage the normal function of the Eustachian tube can help. The Eustachian tube is opened by action of tiny muscles attached to our jaw, palate and throat, therefore anything that helps to move these muscles helps to open the tube and equalise middle ear pressure.

Chewing, swallowing, yawning or simple stretching exercises, opening and closing the jaw can help. Sucking a sweet can help, and in babies sucking on a bottle during take-off and landing can prevent pain.

In those with ETD, this may not be sufficient and so more active exercises and medication can assist. This includes the use of a Valsalva manoeuvre. In this exercise, we take a deep breath and then pinch the nose and blow out the cheeks under pressure. This forces the air up the Eustachian tube into the middle ear and helps to equalise the pressure during landing.

Nasal sprays of saline or decongestants, or oral decongestant medicine or tablets that are taken 30 minutes before take-off or landing can also help.


Book an appointment today with Professor Judd if you’re suffering from any unusual ear-related symptoms.