How to Avoid Ear Pain on an Airplane Flight

Avoiding ear pain on an airplane flight is often challenging. The issue has to do with your Eustachian tubes. In this article, an explanation of what the Eustachian tube is, how it works, and what you can do to avoid having problems with it will be explained. The Eustachian tube reacting to changes in air pressure is something that everyone experiences and one such example is during an airplane flight.

Key takeaways:
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    Equalizing the air pressure behind the eardrum is key to reducing the symptoms of ear discomfort during airplane flights.
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    Methods to reduce ear discomfort during airplane flights may include Valsalva maneuvers or politzerization, and autoinsufflation (children).
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    Use of medications (decongestants, nasal sprays, antihistamines).
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    Myringotomy (opening the eardrum), and tube placement (rarely needed).

What is the Eustachian tube?

The Eustachian tube is also called the pharyngotympanic tube. It connects the middle ear, the part of the ear behind the eardrum, and the nasopharynx, or the area between the back of the nose and the throat.

At rest, the normal Eustachian tube collapses. In some cases, there may be a slight negative pressure like a vacuum in the middle ear. Think of the eardrum as any other drum and it may be either flat or slightly sucked in.

Repeated opening of the Eustachian tube actively maintains normal atmospheric pressure. When we take an airplane flight, the normal atmospheric pressure fluctuates and we must try to adjust the change in pressure, or our eardrums either get further sucked in or pushed out, causing pain and discomfort.

The Eustachian tube opens upon swallowing or yawning by contraction of specialized muscles called the tensor veli palatini muscle.

The role of the levator veli palatini muscle is unclear. Its contribution in opening the Eustachian tube has been questioned. And Eustachian tube ventilation is less effective in children than adults, so children can have even a tougher time on airplane flights.

The physiologic functions of the Eustachian are as follows:

  • Ventilation or pressure regulation of the middle ear.
  • Protection of the middle ear from nasopharyngeal secretions and sound pressures.
  • Clearance or drainage of middle ear secretions into the nasopharynx.

Normally, the Eustachian tube opens frequently, stably maintaining the middle ear pressure between +50 mm and -50 mm H2O. However, pressures above and below this range do not necessarily indicate middle ear disease. They do, however, occur frequently on airplane flights and that is why the airplane cabin is pressurized to prevent problems with the passengers.

About one mL of air or gas may be absorbed from the middle ear in 24 hours. The mastoid cell system, or the aerated bone behind the outer ear, is thought to function as a gas reservoir for the middle ear.

How do I protect my Eustachian tubes?

Again, the Eustachian tube is normally closed at rest, so we do not sense it unless there is a change in atmospheric pressure. The purpose of our Eustachian tubes from being closed is so that sudden loud noises are dampened before reaching our middle ear space through the nasopharynx.

In some people, the Eustachian tube is abnormally open all the time. This is called a patulous Eustachian tube. People who have this condition complain about echoing when they talk, something called autophony or ear fullness.

Rapid weight loss may lead some people to have a patulous Eustachian tube for a temporary period of time. These people can have more difficulty on airplane flights.

The Eustachian tube drains normal secretions of the middle ear. Repeated active opening and closing allows secretions to drain naturally into the nasopharynx.

If the eardrum has been perforated or has a hole in it from infection or surgery or other causes, the normal secretions of the middle ear do not drain properly, and they can drain through the hole in the eardrum. This is called otorrhea.

Forceful nose blowing causes a positive nasopharyngeal pressure and may also force nasopharyngeal secretions back into the middle ear space.

A negative pressure can be caused during an airplane flight or while scuba diving descent. The negative pressure can “lock” the Eustachian tube.

This can cause:

  • Intense pain from “otitic barotrauma” or barometric changes in the Eustachian tube itself.
  • Stagnation of secretions.

The best treatment for Eustachian tube “lock” is performing a forceful nose blowing, preferably while squeezing the nose closed. This is called a Valsalva maneuver or politzerization, which can break the negative pressure in the middle ear, clear any secretions, prevent fluid from building up behind the eardrum, and stop the Eustachian tube “lock” and pain.

To further the explanation of the Valsalva maneuver, it is really a breathing technique. It also can restore heart rhythm (slows the heart rate when your heart is beating too fast) and diagnose an autonomic nervous system.

To properly perform a Valsalva maneuver:

  • Close your mouth.
  • Pinch your nose shut.
  • Press air out like you are blowing up a balloon.

The Valsalva maneuver is a simple non-invasive test that can easily be performed. It is relatively safe and effective in assisting with changes in air pressure during routine airplane flights. It has other uses and should be avoided in patients who have existing health conditions such as cardiac or ophthalmologic such as retinopathy or intraocular lens implantation.

What else can I do during an airplane flight?

Eustachian tube dysfunction can be treated primarily with a combination of time, Valsalva maneuvers or autoinsufflation (eg, an Otovent). Otovents are small nasal devices that are attached to a balloon, which a child inflates through their nose. It can be purchased at most retailers.

Another option is the use of oral and nasal steroids (budesonide, mometasone, prednisone, methylprednisolone). Oral steroids require a doctor’s prescription. Over the counter nasal steroids are readily available but may not always be effective during or prior to the airplane flight.

Decongestants (eg, pseudoephedrine, oxymetazoline, phenylephrine) are also helpful, but not as useful for chronic Eustachian tube dysfunction. Some doctors recommend trying a decongestant an hour before the airplane flight takeoff and an hour prior to landing.

You must be cautious and consider the cardiovascular effects of oral decongestants and the early development of tachyphylaxis observed with the use of nasal decongestants; limit the use of the decongestant to short-term symptomatic relief (i.e., no more than three to five days). In other words, if your ears are bothering you after an airplane flight, do not take the decongestants long-term.

Nasal and oral antihistamines (Claritin or Zyrtec, for example) can also be beneficial in patients with allergic rhinitis. Leukotriene antagonists (eg, montelukast sodium such as Singulair) are helpful in some patients when oral steroids are not an option. All of these depend on if you have allergies or nasal congestion prior to your airplane flight.

Adequate control of laryngeal pharyngeal reflux (or heartburn) helps to resolve Eustachian tube dysfunction in patients with an associated inflammation of their Eustachian tube from ongoing reflux problems. Proton pump inhibitors such as esomeprazole magnesium (Nexium), rabeprazole (Aciphex), omeprazole (Prilosec) administered twice a day are often used on or around the time of the airplane flight.

Myringotomy (making an opening in the eardrum) with tube insertion is reserved for the refractory patient with debilitating symptoms. This is the ultimate solution for some people who just cannot withstand changes in atmospheric pressure during airplane flights.

It is rarely performed, although there are some patients who have persistent fluid or pressure develop behind the eardrum and they do require immediate relief because medications do not work.

Air pressure changes during an airplane flight can cause pain in your ears. Learn to equalize the pressure, or speak to your healthcare provider about medications or other methods to help you deal with pain in your Eustachian tubes.

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