Ear Problems and Flying

Some patients have difficulty with flying because their ears block. This is usually due to eustachian tube or auditory tube blockage. The auditory tubes connect the middle ear to the back of the throat. Any obstruction to this tube prevents air from equalizing the pressure on both sides of the eardrum, resulting in a blocked feeling caused by change in barometric pressure. This is very similar to taking an elevator up fairly rapidly in a tall building and feeling your ears block. The causes of the obstruction is usually related to an upper respiratory virus, an allergy condition of the nose, or a bacterial infection of the maxillary sinus. Occasionally a deviated septum by itself will cause auditory tube obstruction to such a severe degree that barometric trauma causes pain on flying. Although the condition is not permanent or long-lasting, it is quite uncomfortable during descend of an airplane on landing. What precautions can you take to prevent ear blockage and pain on descent while flying?

1. You can learn to inflate your ears by what is termed “Valsalva maneuver”. That is, gently pinching your nostrils together, taking a mouthful of air and swallowing with your nose closed. This will usually force enough air in your eustachian tube to equalize the pressure.

2.  Some people learn to puff their cheeks out and blow gently creating enough positive pressure in the back of the nose to open the eustachian tubes. It is important not to overdo this and forcefully blow because it could cause an ear infection or, it could cause a perforation of the eardrum if done excessively. If you hear a “pop” in your ears, you have succeeded in ventilating your middle ear, and then you can repeat that same gentle maneuver several times during descent or until the plane has landed.

If you have cold, sinus infection or allergy attack when you are scheduled to fly, try to postpone your trip. If that is not possible, get over-the-counter medicines such as Afrin, and spray your nose prior to getting on the airplane. Actually the most important time is the one hour prior to descent. If you are going to take a trip of six hours or less, spraying your nose prior to getting on the airplane is usually sufficient. However, if you are on a long transatlantic or transpacific flight where you may be in the air for ten hours or more, it is best to wait until you are midway in your flight to spray your nose. That will give you the maximum decongestion on descent several hours later. Another over-the-counter medicine that is quite effective is Pseudoephedrine. It is sold under the trade name Sudafed and it usually comes in 30mg tablets. Small adults and children could take one tablet or adults over 150 pounds can take two tablets at a time. However, Sudafed has side effects in that it can make you jittery sometimes and also it aggravates hypertension and heart trouble. If you have those two conditions, you need to check with your regular physician prior to taking any over-the-counter medicines.

If you have tried all the above measures, and still are blocked when you land, you may have to see a physician to get stronger medications and/or steroids to reduce the edema. Occasionally you may have to have a minor operation called Myringotomy to relief the pressure but that is quite unusual. Physicians at the Ear, Nose and Throat & Facial Plastic Surgery, P.A. would be happy to discuss these factors in detail if you have any questions concerning them. They are annoying problems, but do not usually last. However, try telling that to a flyer who has just had a miserable 24-hour after landing.