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Ear pain during travel

By Dr Ramesh Mehay

Lots of people get ear discomfort when they fly.   It often happens when the plane is either taking off or landing.  And for most people, it’s just a temporary thing that corrects itself.  If you have had this before and know what it is like, there are things you can do to help reduce the chances of you getting it or getting things back to normal if it does happen.

What are the symptoms

The symptoms are usually ear pain, a blocked feeling in your ears or generally some sort of discomfort.  You can feel dizzy when you stand up and some people get ringing in their ears (called tinnitus).

But why does it happen?

ear anatomyTo explain this, you need to understand how the ear works.   As this ear picture shows, there are two main parts to the ear – the outer ear (which includes your ear lobe and ear canal) and the inner ear (which contains all sorts of complicated little things which help with your hearing and balance).  The two compartments are kept separate by your ear drum (which in this picture is called the tympanic membrane).  This thin flap of skin not only stops infections getting into the inner ear, but it also vibrates in response to sound thus helping you to hear things.

The two compartments have the same air pressure level in them when you’re going about your normal daily business.   The Eustachian tube (labelled in the pciture as Auditory tube) is the tube that makes sure that both sides have the same pressure.  Normally it is in a closed state but it will open when you swallow.

But when you are on a plane – especially when it takes off or lands, the air pressure in the cabin changes, which means that the outside pressure is different than your inner ear pressure – this can cause ear pain or a feeling that your ears are blocked.   For a lot of people, a simple swallowing action will cause the Eustachian tube to open up and equalise the pressure again and ease your ear pain, blocked feeling or any other discomfort.

HOWEVER, if you have recently had or starting off with a cold, sinusitis or blocked nose – the eustachian tube can get all sticky with the mucus and as a result won’t open up to equalise the pressure.   This results in the ear discomfort symptoms with or without the dizziness and ringing in the ears.

Now that I’ve got it, what can I do to sort it?

  • You’ll probably find that the ear symptoms simply settle soon after landing.   But sometimes, they can take 24 hours to settle.
  • The important thing is to keep swallowing – this can eventually open up the Eustachian tube and equalise the pressure and therefore lessen your symptoms.     Get some boiled sweets or chewing gum – this will encourage you to swallow (thus opening the Eustachian tube).  If you don’t have any gum, try yawning or swallowing.
  • The Val Salva Manoevre: This manouvre can force the Eustachian tube to open and equalise the pressure.  Pinch your nose tight at the bridge.   Gently blow into the nose until you feel your ears ‘pop’ (which is when the Eustachian tube opens).  Now swallow.  Here’s a youtube clip about it…
  • Use Otovent.  This is a special balloon device that you can buy from the chemist.   Do these exercises 2 or 3 times a day.
    Otovent Inflation Exercise
    Basically a ballon is attached to a small tube that you put against your nostril while keeping the other nostril closed with a finger.   You then blow up the balloon through the open nostril whilst keeping your mouth shut.  You then stop blowing and breathe normally, and the air goes out of the balloon.  You repeat the exercise with the other nostril.  You can repeat it 2-3 times a day. It can be quite hard to blow up the ballooon at first – and my recommendation would be to stretch it a few times first.   Remember, do it with gentle but gradual increasing pressure (and NOT a sudden hard blow – because this can burst your eardrum.).
  • Otovent Deflation Exercise
    Only do this exercise if Exercise 1 does not open up your Eustachian tube (you’ll know if it did because you’ll get a little crackle-pop sensation).  This one is a bit more aggressive and involved a swallowing action whilst letting an inflated balloon deflate through your nose.  You can repeat it once or twice a day.

What can I do to prevent it.

  • Decongestents – take a decongestent tablet or syrup before you fly (but only if you are an adult).  An example of a decongestion is pseudoephedrine – which is found in things like Sudafed and Galpseud.  Go to your pharmacist and ask them.   Take the tablet or syrup half an hour before take off.   Research says that if 100 people took pseudoephedrine before a flight, only 30 would get ear pain during the flight.   For those that didn’t somewhere between 50-70 people out of those hundred would get it!  Now that’s what I call a difference!  (PS Pseudoephedrine can make you feel a little drowsy).  Some people use decongestant nasal sprays like Oxymetazoline (Vicks Sinex) nad Xylometazoline (Otrive and Otradrops) – but there is no good research to say they help.
  • Chew gum or sucking on boiled sweets during take off and during landing.    This will encourgage you to swallow and that in itself will encourage the Eustachian tube to keep re-opening making sure the pressure on both sides of your ears are equal.  If you don’t have any gum, try yawning or swallowing.  The problem is just swallowing on your own might not be fast enough to keep the air pressure on both sides equal.
  • Get some travel ear plugs.   It’s important you get TRAVEL ear plugs and not any old ear plugs.  The travel ones are made out of silicone and designed to equalise the ear pressure.  These silicone ear plugs are very soft and as a result they are very comfortable to wear. As they are designed for plane journeys they are comfortable to wear for long periods of time.   But you can just put them in during take-off and during descent and landing – as that is the time it will most likely happen.
  • And if you know you have a cough, cold, flu-like thing, sinusitis or blocked ears  – it might be better not to fly as sometimes the symptoms can take months to settle and have a dreadful impact on your life.

One thing to watch out for… a perforated eardrum

The one thing to watch out for is a burst or perforated eardrum.     The flight can do this but IT IS QUITE RARE – the pressure can be so great that the thin flap of skin (called the eardrum) simply bursts and gets a hole in it.  If you think you have perforated your eardrum – go and seek advice from a doctor.  Often, you don’t need to worry too much because the small hole often heals over by itself over a few weeks/months.

Symptoms that might make you think that you have ruptured your eardrum…

  • Ear pain that doesn’t settle.
  • A clear mucus discharge from your ear.
  • A bloody discharge from your ear.
  • Hearing loss.
  • Ringing in your ear (tinnitus)
  • Spinning sensation (vertigo)
  • Nausea or vomiting

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