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.
