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How Can I Help to Soothe My Baby's Ears When Flying?


Children, especially babies, seem to hate flying on an airplane more than adults. Children have underdeveloped Eustachian tubes, the tubes that connect the middle ear cavity, the space behind the eardrum, with the nasopharynx or back of the nose and upper throat.

Normal opening of the Eustachian tube equalizes atmospheric pressure in the middle ear space. Closing of the Eustachian tube protects the middle ear from unwanted pressure fluctuations and loud sounds.

Children have more difficulty than adults in adjusting to changes in air pressure, particularly on airplane flights. Even before the airplane flight, children are more susceptible to otitis media or middle ear infections.

Otitis media is the most common diagnosis made by physicians in their offices of children younger than 15 years. Otitis media is the most common reason a child is offered an antibiotic prescription and the most common reason they will undergo surgery.

How is the eustachian tube different in children versus adults?

In children, their Eustachian tube begins at birth at approximately 13 mm in length or about half the size of the adult Eustachian tube. As the child’s skull grows, the angle of the Eustachian tube changes gradually from horizontal to oblique.

The Eustachian tube has bony and cartilaginous portions. In children, the bony portion is longer and wider in diameter and is therefore always open. In other words, the child has difficulty controlling the Eustachian tube to adapt to changes in unwanted pressure fluctuations.

The result is the child has more difficulty, and usually more pain on airplane flights. The child has problems with:

  • Pressure regulation of the middle ear space.
  • Protection of the middle ear space from nasopharyngeal secretions and sound pressures.
  • Clearing middle ear secretions into the nasopharynx.

The problems are complicated by the relative inefficiency of the Eustachian tube combined with the higher incidence of repeated upper respiratory tract infections. Many children have enlarged adenoids and/or tonsils, which further blocks the natural drainage of the Eustachian tubes and nasopharynx.

The good news is that children grow. As they grow, their Eustachian tube function improves and they have fewer upper respiratory tract infections and incidences of otitis media.

The unwelcome news is that children have more susceptibility to pain and discomfort on airplane flights, particularly if they already have otitis media or an upper respiratory tract infection. There is no way to hasten their growth and development.

Why are airplane flights so painful for children?

The most challenging times for children, and adults for that matter, are during take-off and landing. This is when there is a notable change in air pressure. While adults can equalize the air pressure in their ears with a Valsalva maneuver, or blowing positive pressure into a pinched nose, children often cannot master this technique.

There are products on the market such as the Otovent, which allows for autoinflation that children can try. These are essentially balloons where the child holds the round part of the nosepiece firmly against the right nostril with the right hand. The left nostril is closed with the left hand. The child is instructed to inhale deeply, close the mouth, and inflate the balloon by blowing through the nostril.

The problems with this technique are several, however. Many children plain refuse to do it. Others find it impossible if they already have a heavy cold, nasal congestion, or an ear infection.

The Otovent is safe and effective if the child will try it.

What are some of the treatments for otitis media?

Otitis media can be treated with observation, antibiotics, or tympanostomy tube placement. Keep in mind, only a 14% increase in the resolution rate when antibiotics are given. Antibiotic suppression is not indicated for otitis media, and multiple courses of antibiotics have no proven benefit. Consider surgical intervention after three to four months of persistent fluid behind the eardrums and hearing loss. For airplane flights, it is not necessary to give a child an antibiotic if they have otitis media. Children who already have ear tubes will usually be fine during the airplane flight since they have middle ear ventilation.

Eustachian tube dysfunction can be treated primarily with a combination of time, autoinsufflation (eg, an Otovent), and medications such as decongestants (eg, pseudoephedrine, oxymetazoline, phenylephrine) are also helpful, but they do not always work.

Nasal and oral antihistamines can also be beneficial in children with allergic rhinitis, but they do not usually provide much benefit during takeoff and landing on airplane flights.

What can I do for my child to prepare for an airplane flight?

Be vigilant about allowing your child to take an airplane flight if they have an upper respiratory infection or ear infection. It may be better to wait on the trip.

Keep in mind, using cold medicines and decongestants may help with the child’s cold symptoms, but not prevent the child experiencing ear pain or developing a subsequent ear infection after the airplane flight.

Have your baby drink from a bottle at take off and landing, or if they are older, have them take a drink of juice or water.

Encourage older children to yawn, chew something, swallow, open and close their mouth or even use a device like the Otovent, if available. Kids love chewing gum and often love to have encouragement to do it.

Some children will be willing to blow through a small straw or try to spin a pinwheel as a game. This is an attempt to get them to do a Valsalva maneuver.

If the child can do a Valsalva, this should be tried. Older children can usually follow directions enough to blow forcefully with their noses pinched closed. Be careful in instructing the child not to do this too forcefully since the Valsalva maneuver itself can become painful.

A small bulb syringe is helpful to clear out nasal secretions in infants.

Conclusion

The bottom line is that an airplane flight will not damage your child’s ears.

Key takeaways

Taking off and landing in an airplane cause pressure changes in the inner ear.

Young children have shorter Eustachian tubes, which means they cannot easily adapt to changes in pressure fluctuations.

Be vigilant about taking your child on an airplane flight if they have an upper respiratory infection or ear infection.

Have your baby drink from a bottle at take off and landing, or if they are older, have them take a drink of juice or water.

Encourage older children to yawn, chew something, swallow, open and close their mouth.

Resources:

Children’s Hospital of Los Angeles. Help your child cope with ear pain on airplanes.

Nemours Kids Health. Flying and your child’s ears.

MedlinePlus. Traveling With Children.

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