Overview

Airplane ear is the stress exerted on your eardrum and other middle ear tissues when the air pressure in your middle ear and the air pressure in the environment are out of balance. You may experience airplane ear at the beginning of a flight when the airplane is climbing or at the end of a flight when the airplane is descending. These fast changes in altitude cause air pressure changes and can trigger airplane ear.

Airplane ear is also called ear barotrauma, barotitis media or aerotitis media.

Usually self-care steps — such as yawning, swallowing or chewing gum — can prevent or correct the differences in air pressure and improve airplane ear symptoms. However, a severe case of airplane ear may need to be treated by a doctor.

Symptoms

Airplane ear can occur in one or both ears. Airplane ear signs and symptoms may include:

  • Moderate discomfort or pain in your ear
  • Feeling of fullness or stuffiness in your ear
  • Muffled hearing or slight to moderate hearing loss

If airplane ear is severe or lasts more than a few hours, you may experience:

  • Severe pain
  • Pressure in your ear similar to being underwater
  • Moderate to severe hearing loss
  • Ringing in your ear (tinnitus)
  • Spinning sensation (vertigo)
  • Vomiting resulting from vertigo
  • Bleeding from your ear

When to see a doctor

Usually you can do things on your own to treat airplane ear. If discomfort, fullness or muffled hearing lasts more than a few hours or if you experience any severe signs or symptoms, call your doctor.

Causes

Airplane ear occurs when an imbalance in the air pressure in the middle ear and air pressure in the environment prevents your eardrum (tympanic membrane) from vibrating as it should. Air pressure regulation is the work of a narrow passage called the eustachian tube. One end is connected to the middle ear. The other end has a tiny opening where the back of the nasal cavity and the top of the throat meet (nasopharynx).

When an airplane climbs or descends, the air pressure in the environment changes rapidly, and your eustachian tube often doesn't react quickly enough. Swallowing or yawning activates muscles that open the eustachian tube and allow the middle ear to replenish its air supply, often eliminating the symptoms of airplane ear.

Ear barotrauma also may be caused by:

  • Scuba diving
  • Hyperbaric oxygen chambers
  • Explosions nearby

You may also experience a minor case of barotrauma while riding an elevator in a tall building or driving in the mountains.

Risk factors

Any condition that blocks the eustachian tube or limits its function can increase the risk of airplane ear. Common risk factors include:

  • A small eustachian tube, especially in infants and toddlers
  • The common cold
  • Sinus infection
  • Hay fever (allergic rhinitis)
  • Middle ear infection (otitis media)
  • Sleeping on an airplane during ascent and descent

Frequent or severe airplane ear may damage the tissues of the inner ear or eustachian tube, which increases your chances of experiencing the problem again.

Complications

Airplane ear usually isn't serious and responds to self-care. Long-term complications may occur when the condition is serious or prolonged or if there's damage to middle or inner ear structures.

Rare complications may include:

  • Permanent hearing loss
  • Ongoing (chronic) tinnitus

Prevention

Follow these tips to avoid airplane ear:

  • Yawn and swallow during ascent and descent. Yawning and swallowing activate the muscles that open your eustachian tubes. You can suck on candy or chew gum to help you swallow.
  • Use the Valsalva maneuver during ascent and descent. Gently blow, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times, especially during descent, to equalize the pressure between your ears and the airplane cabin.
  • Don't sleep during takeoffs and landings. If you're awake during ascents and descents, you can do the necessary self-care techniques when you feel pressure on your ears.
  • Reconsider travel plans. If possible, don't fly when you have a cold, sinus infection, nasal congestion or ear infection. If you've recently had ear surgery, talk to your doctor about when it's safe to travel.
  • Use filtered earplugs. These earplugs slowly equalize the pressure against your eardrum during ascents and descents. You can purchase these at drugstores, airport gift shops or your local hearing clinic.
  • Use an over-the-counter decongestant nasal spray. If you have nasal congestion, use a nasal decongestant about 30 minutes to an hour before takeoff and landing. Avoid overuse, however, because nasal decongestants taken over several days can increase congestion.
  • Use oral decongestant pills cautiously. Oral decongestants may be helpful if taken 30 minutes to an hour before an airplane flight. However, if you have heart disease, a heart rhythm disorder or high blood pressure, or if you've experienced possible medication interactions, avoid taking an oral decongestant unless your doctor approves. If you're a man older than age 50, you may experience serious side effects after taking decongestants containing pseudoephedrine (Actifed, Sudafed) such as urinary retention, especially if you have an enlarged prostate. If you're pregnant, talk to your doctor before taking oral decongestants.
  • Take allergy medication. If you have allergies, take your medication about an hour before your flight.

If you're prone to severe airplane ear and must fly often, your doctor may surgically place tubes in your eardrums to aid fluid drainage, ventilate your middle ear, and equalize the pressure between your outer ear and middle ear.

Helping children prevent airplane ear

These additional tips can help young children avoid airplane ear:

  • Encourage swallowing. Give a baby or toddler a beverage during ascents and descents to encourage frequent swallowing. A pacifier also may help. Have the child sit up while drinking. Children older than age 4 can try chewing gum, drinking through a straw or blowing bubbles through a straw.
  • Consider eardrops. Talk to your child's doctor about prescribing your child eardrops that contain a pain reliever and numbing agent for the flight.
  • Avoid decongestants. Decongestants aren't recommended for young children.
April 27, 2016
References
  1. Vernick DM. Ear barotrauma. http://www.uptodate.com/home. Accessed Feb. 10, 2016.
  2. Ears and altitude. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/ears-and-altitude. Accessed Feb. 10, 2016.
  3. Papadakis MA, et al., eds. Ear, nose, and throat disorders. In: Current Medical Diagnosis & Treatment 2016. 55th ed. New York, N.Y.: The McGraw-Hill Companies; 2016. http://www.accessmedicine.com. Accessed Feb. 10, 2016.