Flying and Your Ears
26 November 2007

Many of us have felt that weird ear-popping sensation when we fly. For kids (especially babies and young children), it can seem especially odd and even scary at first. But you can reassure your child that it's a common, normal part of flying.

This sometimes uncomfortable sensation is related to pressure changes in the air space behind the eardrum (the middle ear). But how does that work, exactly?

The eustachian tube is a narrow, one and a half inch long channel connecting the middle ear with the nasopharynx, the upper throat area just above the palate, in the back of the nose.

The eustachian tube functions as a pressure equalizing valve for the middle ear which is normally filled with air. When functioning properly the eustachian tube opens for a fraction of a second periodically (about once every three minutes) in response to swallowing or yawning. In so doing it allows air into the middle ear to replace air that has been absorbed by the middle ear lining (mucous membrane) or to equalize pressure changes occurring on altitude changes. Anything that interferes with this periodic opening and closing of the eustachian tube may result in hearing impairment or other ear symptoms.

Individuals with a eustachian tube problems may experience difficulty equalizing middle ear pressure when flying.

When an aircraft ascends atmospheric pressure decreases, resulting in a relative increase in the middle ear pressure. When the aircraft descends, just the opposite occurs: atmospheric pressure increases and there is a relative decrease in the middle ear pressure. Either situation may result in discomfort in the ear due to abnormal middle ear pressure if the eustachian tube is not functioning properly. Usually this discomfort is experienced upon aircraft descent.

In children, however, the relatively narrow eustachian tubes may not function as effectively, especially if they're clogged by inflammation and mucus from an ear infection or cold, or blocked by enlarged or swollen adenoids (lumps of immune system tissue located near the openings of the eustachian tubes).

Whether you're flying, scuba diving, climbing a mountain, or even riding in an elevator, air pressure decreases as you go higher and increases as you go lower. If the pressure isn't equalized, the higher air pressure pushes on one side of the eardrum and causes pain. That explains why so many babies cry during those last few minutes of the flight, when the air pressure in the cabin increases as the plane prepares to land.

But the pain is only temporary — it won't cause any lasting problems for your little one and will usually subside within a few minutes as the eustachian tube opens to let the air pressure equalize on both sides of the eardrum.

If you has an ear infection, your doctor may recommend delaying flying, if possible, until the infection is gone to avoid this problem. If your child has had tubes inserted in the eardrums because of ear fluid problems, the artificial tubes will help the air pressure equalization happen more easily.

To avoid middle ear problems associated with flying you should not fly if you have an acute upper respiratory problem such as a common cold, allergy attack or sinus infection. Should you have such a problem and must fly, or should you have a chronic eustachian tube problem, you may help to avoid ear difficulty by observing the following recommendations:

• Obtain from your druggist (a prescription is not necessary) the following items: Sudafed tablets; plastic squeeze bottle of ¼% Neo-Synephrine nasal spray.
• Following the container directions, begin taking Sudafed tablets the day before your air flight. Continue the medication for 24 hours after the flight if you have experienced any ear difficulty.
• Following the container directions, use the nasal spray shortly before boarding the aircraft. Should your ears "plug up" upon ascent, hold your nose and swallow. This will help suck excess air pressure out of the middle ear.
• 45 minutes before the aircraft is due to land again use the nasal spray every five minutes for 15 minutes. Chew gum to stimulate swallowing. Should your ears "plug up" despite this, hold your nose and blow forcibly to try to blow air up the eustachian tube into the middle ear (Valsalva maneuver).
• Remember that it is unwise to fly if you have an acute upper respiratory infection. Should flying be necessary under these circumstances do not perform the Valsalva maneuver mentioned above..

If your child is taking medications that contain antihistamines or decongestants, talk to your child's doctor about whether to continue them during the flight.

In some cases, a child may continue to have ear pain for longer periods (up to several hours) if the ears don't "pop." You can continue to give your child pain relievers according to the package directions until the pain subsides. If it continues for more than several hours, call your doctor for advice.

With a little patience and some simple precautions, though, you can make your next family flight less stressful and more comfortable for both you and your child.