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Window of a passenger with airplane ear.

What is Airplane Ear or Barotrauma?

Flying is one of my favourite forms of transportation, but this was not always the case. When I was about six, I would get very sore ears while the plane took off or landed. My parents didn’t know what to do about it. Nor did the cabin crew. This was in the 80s, when flying by plane was beginning to be more accessible to everyone. Airplane Ear is when there is a imbalance between the pressure in your middle ear and the atmosphere.

The commercial flying industry may have been about 60 years old at the time, but the advice for managing these symptoms wasn’t good enough.

I was later offered to blow through my nose and a stick of bubble gum to chew, which gradually made things better until we levelled off at cruising altitude for our destination.

My earache increased at the same rate the plane ascended. First it was one ear and then the other ear which made things worse. I couldn’t hear properly and the pain was unbearable.

Fast forward another 30 years and I’m writing about how to control these symptoms and why they happen.

This article explains why airplane ear, also known as barotrauma, happens, how airplane ear can be prevented and how to best manage airplane ear once the symptoms start.

Read this article straight through or scroll down to the most relevant sections to you. Some things I mention here can be found in greater detail in other sections of the site, such as Why Do I Get Plane Sickness?

Why Does Airplane Ear or Barotrauma Happen?

There is a loss of balance of the air pressure between each side of the eardrum. Another name for eardrum is tympanic membrane. On one side of the eardrum is the middle ear, and on the other side is the outer ear.

The outer ear opens out to your surroundings. For the sake of the article, your surroundings are the atmosphere. It is the outer most portion of the ear. It’s the part of the ear you can see, and touch with an ear swab.

On the other hand, the middle ear is enclosed behind the eardrum. Pressure inside the middle ear can only be regulated by a tube called the Eustachian tube. If this tube is clogged in any way, then pressure in the middle ear won’t be able to balance correctly with the outer ear.

When there is a loss of balance between the two, as it occurs when the pressure in the middle ear is higher than the air pressure in the outer ear, you will experience discomfort. The same occurs if the pressure in the middle ear is lower than the outer ear.

Another name for airplane ear is barotrauma. There are a few other names for it but these are outdated.

The two most common symptoms of airplane ear are hearing loss and pain. I’ll explain why they occur.

Why is Hearing Affected When You Get Airplane Ear or Barotrauma?

When the balance of air pressure between the middle ear and the outer ear is lost, the eardrum does not vibrate properly and the way we perceive sound changes.

The middle ear is a hollow box containing three bones which transmit sound from the eardrum directly to the inner ear. If you would like to understand how it works, read about How The Ear Works.

The further away you are from the surface of the earth, the less dense air will be. This means that the air pressure around us will also be lower. In layman’s terms you can say the air is thinner the higher you go.

As the airplane ascends, the pressure outside of the aircraft and the pressure inside of the aircraft will become lower. When this occurs, the air inside of your middle ear will expand, similar to how a balloon expands. It affects the way sound is conducted from the tympanic membrane to the middle ear and gives you a sensation of loss of sound. Remember the job of the middle ear is to transmit sound from the eardrum to the inner ear through a chain of three bones. It helps transmit vibrations caught by the eardrum to the inner ear where it is latter turned into the sound we hear.

What does a the Eustachian Tube do?

A normal ear will regulate the pressure in the middle ear by releasing the pressure through a special tube called the Eustachian Tube which drains into your throat. Your ears are connected to your throat. If this tube that helps release excess air pressure from the middle ear isn’t working correctly, because it is clogged in some way, then the excess pressure won’t be released, and hearing will be affected.

Modern day aircraft are equipped to keep the cabin pressure as normal as possible, but it isn’t perfect. There will still be difference between the cabin pressure when you are up above the clouds and the pressure you are used to when you are on the ground.

It is normal for a healthy person to feel their ears become blocked when ascending or descending during flight, and also while in a car driving up or down a mountain or a deep sea diver as they change change their depth underwater. For the purpose of this article we will talk about what happens during flight.

A fit and healthy person can have symptoms that last a few seconds to a few hours. Very rarely does it last days or weeks, but this can also occur.

Hearing is affected when the tympanic membrane does not vibrate properly because of an imbalance between the pressure in the middle ear and the outer ear.

Why Do I Get Ear Pain When I Have Airplane Ear or Barotrauma?

Pain is caused when the eardrum is distended or stretched by the change in pressure between the middle ear and the outer ear. Pain is perceived by three different nerves that send pain signals to the brain. These are the same nerves that detect pain when you have an ear infection.

The sense of pain occurs when the nerve pain receptors are stimulated. This creates a chemical reaction at the nerve ending which sends a message to the brain expressing damage to that part of the body.

The nerves involved in sensing pain of the ear are the auriculotemporal nerve (CN V3), the nervus intermedius (a branch of CN VII), and the auricular branch of the vagus nerve.

These nerves can also cause pain outside of the ear as far as the side of your face and head. This helps explain why pain is not always limited to just the ear when flying.

What Can Make Airplane Ear or Barotrauma Worse?

Anything that affects the way the middle ear regulates its pressure can contribute to having airplane ear. A common cause for airplane ear are infections of the throat and/or of the ear.

Because the Eustachian tube drains into the throat, if you have a sniffly nose or an ongoing throat infection, it is more likely for it to become obstructed, which will impede the flow of air. The degree in which one person or another is affected by an infection can vary greatly. Some people will be more prone to have symptoms of ear fullness during fight when they have an infection, while others may not even notice it at all.

…if you have a sniffly nose or an ongoing throat infection, it is more likely for it to become obstructed…

Seasonal allergies increase the amount of secretion in your nose and throat. It can also cause swelling. In the same way this will cause symptoms related to inadequate regulation of the pressure in the middle ear.

What are the main causes of airplane ear?

Here are a list of causes, but there are more, I have added some that can be used interchangeably.

  • Ear infections: like otitis media, otitis externa, also known as bacterial and fungal infections of the ear.
  • Throat infections, such as tonsillitis or pharyngitis.
  • Seasonal Allergies, Hay fever and Rhinitis, these conditions will increase secretions and swelling within the throat and nose.
  • Sinusitis, this is an infection of your sinuses which causes pain and abundant discharge into your throat and nose.
  • Cancer or tumours affecting the upper airways.
  • Any viral, bacterial or fungal infections affecting what is known as the upper airways, which is made up of the ears, nose and throat.

How to Prevent Airplane Ear or Barotrauma

Most of the time there is mot much that can be done to prevent these episodes. As your ears adjust to the change in altitude of the aircraft, naturally you will feel some discomfort which is mild and resolves without having to do anything.

Prolonged or intense symptoms can be related to problems with your eustachian tube, so preventing anything that may block it in the first place would be the best thing to do to avoid getting prolonged and intense symptoms.

If you have an upper respiratory tract infection of any kind, such as a sore throat, an ear infection, sinusitis, a common cold, etc you should avoid flying until you have treated it or seek medical advice with your doctor if you are unsure. Flying with an infection can make you more vulnerable to having airplane ear. So it would be helpful if you could delay your flight are choose an alternative form of transportation.

Most people with allergies in the form of hay fever, allergic rhinitis, nasal congestion, etc, are ok to fly, but some may feel discomfort during their flight. Over the counter treatments such as antihistamines are usually effective in controlling the symptoms of allergies. Seek medical advice if you believe you have airplane ear caused by your allergies. Your doctor will be able to offer you treatment alternatives to help manage your allergies.

Some people will not have any underlying conditions and naturally have very severe episodes of airplane ear or barotrauma. In this case you should discuss your doctor to assure there has not been a cause that has been missed. Also consider seeking alternative forms of transportation.

Prevention aims to resolve any underlying conditions that make airplane ear worse.

How to Treat Airplane Ear or Barotrauma

Mild cases are not as bothersome and most just wait for their bodies to take control of the situation naturally.

Swallow

When we swallow, we move the muscles of the throat in a way that helps open the Eustachian tube so air can path through freely. Swallowing the saliva that your body produces naturally can help relieve the symptoms.

As the plane continues to ascend or descend you may find the symptoms recur, because the pressure of the atmosphere changes while the pressure in your middle ear remains the same. You may need to swallow multiple times during this period to relieve your symptoms.

You can try the following to improve airplane ear during takeoff and landing:

  • Candy – sour flavours usually produce more saliva than sweat flavours.
  • Drink fluids – the downside of this is having to use the toilet sooner.
  • Eat something you like.
  • Chew gum – I personally didn’t not find this one as effective.

Yawn

The same muscles used for swallowing – the tensor veli palatini and the levator veli palatini – both contract and open the Eustachian tube allowing are to pass through. This equalises the pressure and helps relieve symptoms.

Pinch your nose and blow

This technique is the one that is personally most helpful, because I feel it works quickly and effectively, however we are all different and some people may find relief by other means.

Pinch your nose, take a breath and slowly blow into your nose without letting air out. The pressure in your nose and throat will gradually build until you hear your ears pop, sometimes one first and then the other. If one of your ears continues to be clogged attempt again, and gradually build pressure. Stop if you feel unwell at any moment, lightheaded, or pain.

Medication for Pain

Pain relief is not usually effective for this condition. This is because ti does not treat the underlying cause. To achieve relief you must equalise the pressure between your middle ear and the outer ear or atmosphere. Medication used to treat pain will not aid this process, but will only ease the ‘pain signals or messages’ your ear is sending to your brain. If you believe that you need medication to relieve pain during flight, you should seek medical advice.

Treat Any Underlying Condition

We discussed this in How to Prevent Airplane Ear or Barotrauma and it would be more of a preventive measure.

How to Manage Airplane Ear or Barotrauma when Nothing Works

It may not be serious problem, but you should seek medical advice if you have tried to manage your symptoms and they are either not improving, getting wore, or you are getting other new symptoms with your episodes.

Your doctor will find helpful to know what has worked in the past, and what hasn´t, If you have any underlying conditions.


Next Article Review Date: June 2024