Each middle ear vents through one soft channel to the back of your nose, the Eustachian tube, which cracks open for a fraction of a second every time you swallow or yawn 1. Climbing, the higher inside pressure forces it open on its own. Descending, the outside wins and a soft tube under pressure clamps shut. Past a certain gap it won't open at all, so the trick is to never let the gap build 2.
It is common and mostly preventable. Right after landing, about one adult in ten and one child in five shows visible middle-ear irritation 3. If you fly with a cold, a decongestant carries most of the load: pseudoephedrine before takeoff cut ear pain and injury 4, and an oxymetazoline spray works about as well 5.
Start swallowing the moment the nose dips. Descent begins 20 to 30 minutes out, when the engine note drops. Start then, well before anything pinches, and keep the tube cracking open the whole way down.
Kids can't do the manoeuvres, so keep them swallowing. Under about seven the tube is shorter and flatter, and barotrauma runs roughly double the adult rate 3. Offer a baby a bottle, breast, or pacifier the moment the plane starts down, and a toddler a sippy cup or chewy snack. Crying counts too. Skip the decongestant here: in kids it did nothing 6.
The fine print — when to skip it, and what people get wrong
The pressure-equalising earplugs at the airport newsstand slow air on the ear-canal side, but your middle ear vents through the nose instead, so they change nothing; in a chamber study they matched sham plugs 7.
Recent ear or sinus surgery, or a fully blocked nose, raises rupture risk; move the trip if you can. Pseudoephedrine is out with uncontrolled blood pressure, heart disease, or MAO inhibitors.
Nearly every serious injury is a hard Valsalva against a tube already locked shut, driving pressure into the inner ear and risking lasting hearing loss or vertigo 2. If gentle attempts fail, accept the muffled hours.
- 1Bluestone CD, Doyle WJ (1988). Anatomy and physiology of eustachian tube and middle ear related to otitis media. Journal of Allergy and Clinical Immunology. link
- 2Mirza S, Richardson H (2005). Otic barotrauma from air travel. Journal of Laryngology and Otology. link
- 3Stangerup SE, Klokker M, Vesterhauge S, Jayaraj S, Rea P, Harcourt J (2004). Point prevalence of barotitis in children and adults after flight, and effect of autoinflation. Aviation, Space, and Environmental Medicine. link
- 4Csortan E, Jones J, Haan M, Brown M (1994). Efficacy of pseudoephedrine for the prevention of barotrauma during air travel. Annals of Emergency Medicine. link
- 5Jones JS, Sheffield W, White LJ, Bloom MA (1998). A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel. American Journal of Emergency Medicine. link
- 6Buchanan BJ, Hoagland J, Fischer PR (1999). Pseudoephedrine and air travel-associated ear pain in children. Pediatrics. link
- 7Klokker M, Vesterhauge S, Jansen EC (2005). Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude. Aviation, Space, and Environmental Medicine. link
დაკავშირებული სახელმძღვანელოში (2)
- — Airplane ear is worst when you're congested. Rinsing the nose before you fly clears the tube that has to equalise the pressure.
- — A decongestant for descent is worth packing, especially if you're flying with a cold.