Do you fly a lot? Does  your  ear  pain in  the aeroplane  ? Do  you have severe ear pain even after Flying? Can you prevent It?

The Good news:
Yes  you  can  prevent  it.

When my little girl was 1 year old we traveled to Jaipur by plane. Among many travel worries, I was especially thinking about ways to keep her awake and ear pain-free while traveling. I knew all the basics but it was still a  challenge. So that’s when I decided to write a post for all of you mommies who travel by plane with children. I think when we know why things happen we are much more effective at preventing unwanted events and prevention of airplane ear runs top of my list during air travel.

• What you will find here
  What is this condition?
• Why do your ears get blocked in an Aeroplane?
• Who is more likely to get Aeroplane Ear?
• What can  you do during the flight to prevent blocked ear?
• How can you prevent very young children from getting airplane ear?
• How can you unblock your ears after the Flight?
• When should  you  visit  a  Doctor?

What is Aeroplane Ear?

Pain in the ear, popping ear, blocked ear during air travel is  the most common medical  problem faced by flyers. Airplane ear is the better-known name for Barotitis media or  Aerotitis media. Airplane ear or Barotitis media is the condition where there occurs damage to the ear due to difficulty in adjustment of the air pressure between Middle ear and External ear.

Why do your ears get blocked in an Aeroplane?

I have to go into a bit of physics for a proper explanation. Please excuse the science Lecture! As  you know according  to Boyle’s  Law  : The pressure and the  volume of  an  enclosed mass  o  gas are  inversely  proportional. When  the  plane  rises in the  air, there  is  a  progressive  decrease  in    air/atmospheric  pressure. Basically at  18,000  ft  above  sea  level,  the  air  pressure  is  half  that  at  sea  level.During  the rise through  the  atmosphere , as the  pressure  falls ,a particular mass of  air in an  elastic  structure  expands .Similarly during  descent, the air contracts and the volume of  cash decreases.

So what happens in the ear during Flying?

Imagine your ear  is   made up of  3 rooms.The outermost  part of  the ear which connects the entryway with the other rooms is the  external ear.This is the part involving  your  ear  canal. The  ear drum separates  your  external  ear  from  the  middle ear, where the small bones (malleus, incus, stapes), which  help transmit sound  live.The  ear drum  is somewhat flexible  and  can  move  with  change in volume  of  air  in  the  middle  ear. Two   windows  oval  window (covered  by stapes  footplate) and  round window (covered  by  round window  membrane) connect  your middle ear and the inner ear.

The  inner  ear has  your  hearing and balance apparatus It’s called  the labyrinth.   A tube connects your middle ear with the part of your oral cavity behind the nose (nasopharynx) .It’s called the Eustachian tube.Easily the most important structure  which helps keep up the normal air volume inside  your middle ear. It’s through your Eustachian tube that air enters or exits to equalise air pressure between outside atmosphere and your middle ear.

What happens during Ascent?
Air pressure outside falls. Middle ear pressure falls. Air in your middle ear expands (following Boyle law) This excess air pushes the tympanic membrane outwards to its natural limit.This is normally followed by escape of air through your Eustachian tube. Movement of the ear drum may be restricted due to scarring (previous infection).This may cause ear pain during ascent.

What happens during Descent?
Air pressure outside rises. Middle ear pressure rises. Air in your middle contracts and volume decreases (Boyle law). The ear drum moves inwards. (retraction). The opening of your Eustachian tube must be opened to allow air from the nasopharynx to enter and adjust the volume.The Eustachian tube will open with swallowing movement. If this mechanism fails (if you fall asleep, or have a cold), or is delayed, the increasing pressure difference closes the naspharyngeal end of Eustachian tube.When the pressure difference is more than 90 mm,Hg, your tubal dilator muscles are unable to open the Eustachian tube and it stays locked.The ear then feels blocked.

Barotrauma occurs during flying due to:
Very rapid air pressure changes.Sudden ascent/descent. 2) Blocked Eustachian tube.

It may also occur in:

• Divers
• Hyperbaric oxygen chamber
• Decompression and compression chambers

Who is more likely to get Aeroplane Ear?
Anybody who has some nasal or Nasopharyngeal problem which blocks the Eustachian tube.
Acute infection in the nose.
Chronic infection in the nose
Rhinosinusitis
Nasal allergy
Vasomotor Rhinitis
Malformation of nose
Nasopharyngeal tumour.
Sleeping during ascent or descent
Small narrow Eustachian tube; infants toddlers.

How will you know whether you are developing airplane ear?
Symptoms ( most common)
Discomfort in the ear
Ear pain

Muffled hearing
Blocked ear/fullness of ear
Severe complaints
Excruciating pain in ear
Severely blocked ear
Ringing, buzzing sound in ear (Tinnitus)
Severe Hearing loss
Spinning sensation (Vertigo)
Bleeding from ear

When to see a doctor?

Aeroplane ear:when to see a doctor.Image courtesy David Castillo Dominic @freedigitalphotos.net
If you have any of the severe problems.Or if the symptoms persist even after …..hours “check..

What will your doctor See?
An ENT surgeon may do an otoscopic examinations to see your ear drum.

Signs on otoscopy:

• Invaginated/retracted ear drum
• Congested ear drum
• Solitary or multiple blood filled blisters on your ear drum
• Haemotympanum
• Signs of serous otitis media
• Ruptured ear drum, with blood clot.
  Otoendoscopy may also be done where you will also be able to see these findings along with your doctor.

Are there any long term complications ?

Rarely the ringing sound in ear or tinnitus may be permanent.

If inner ear barotrauma occurs hearing loss may not improve

What other tests can  you  do?

Pure tone audiometry: to check your hearing and rule out inner ear barotrauma   Tympanometry:To check the air pressure in the middle ear.and find out if there is any fluid.

 Aeroplane ear:How to prevent it during flights

• Don’t fall asleep during flying, specially during ascent or descent.
• Avoid flying if you are having a severe cold.If emergency then use a Nasal decongestant spray just before takeoff and landing.Also take a decongestant orally, before getting on the  .Dont use over the counter sprays .They may cause even more problem in the long run.
• Take plenty of chewing gum so that you can actively help in Eustachian tube opening during flight.The chewing and swallowing movement helps to open Eustachian tube.
• Try Valsalva   maneuvre.This is a pressure equalizing  technique which helps to pop the ear.You can try this if repeated swallowing and yawning doesn’t help.
• Pinch your nostril, take a mouthful of air,close your mouth and try to gently  direct the air into the back of your nose.Imagine you are trying to blow  your nose gently. You should feel  a  pressure buildup.But do not let the air out.If  you hear a pop you will know  the ear is  unblocked.You can also close your nose and mouth and try swallowing .Donot try to  do all this if you feel pain in ear.

What can young children do  to prevent aeroplane ear?

Very young children have difficulty during fflying.Often you will find them irritable crabby , pulling at their ears and may also cry incessantly. This is because the Eustachian tube in infants and very young children are not mature enough to handle the extreme change in pressure.

How to prevent Aeroplane ear in young children.Image courtesy Jeffrey Betts at MMT

• But you can help them  too.
• Dont let them fall asleep.
• Play with them.
• Carry  a few pacifiers so that the suck  and swallow reflex constantly works.
• Talk to your baby doctor whether a decongestant oral medicine is advice able for your child.
• A plain saline nasal drop given just before take off and landing helps to increase the swallowing movement and equalise pressure effectively.

What can you do to unblock the ear post flight?

Continue the Valsalva maneuvre/pressure equalizing technique
Normally it’s self healing and gets better within a few hours to few days.
If symptoms are uncomfortable and persists  , or the ear doesn’t pop you should visit a doctor specialised in  ear   diseases
If your nose is blocked , avoid forceful nose blowing and take steam through your nose.This helps to relieve nasal congestion and open up the Eustachian tube.

What your doctor may advice?

• Nasal spray; decongestants/steroids
• Oral decongestants
• Oral antihistamines
• Non steroidal anti inflammatory drugs for relieving pain
• Once medication have improved Eustachian tube function Valsalva maneuver helps to force open the blocked tube.Surgery is rarely needed.

If fluid in the middle ear persists even after 3 months myringotomy (incision in the ear drum) is done to drain the fluid.

If the perforation in ear drum does not improve after 3 months tympanoplasty  to repair the eardrum may be needed.   I hope next time you are flying you will be  carrying some chewing gum or hard candy with you.

Write to me at dramrita@healthwealthbridge.com or comment below to let me know how your ears fared this time.

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Disclaimer:The purpose of this article is for educational purpose and should not be taken as professional medical advice.When in doubt always visit your doctor.