Why do my ears hurt when I fly?

My partner was due to take a few days holiday abroad and asked me was it safe for her to fly whilst just recovering from a particularly heavy cold, she was concerned she might experience some discomfort or worse.
Coming into the holiday season her query reminded me of the number of times my colleagues and I have been asked the same question by many of our clients over the course of our careers in hearing aid audiology.

What’s happening to our ears when we fly?

Many people have experienced their ears ‘popping’ when flying, this is due to the eardrum trying to react to the change in air pressure around it. The eardrum provides a seal between the outer and middle ear Annotated Ear Diagramand under normal conditions any fluctuation in pressure is compensated for by an organ called the Eustachian Tube. This tube runs from the back of the nose and throat to the middle ear. The space in the middle ear is filled with air which is constantly being absorbed by the mucous membrane cells that line the middle ear. To stop the eardrum trying to retract and be ‘sucked in’ because of this negative pressure, the Eustachian Tube allows air into the middle ear cavity so the air pressure remains equal on both sides of the eardrum.

Why do my ears hurt more when descending?

When taking off or landing, changes in air pressure are more noticeable because the variation in air pressure is happening quicker than at ground level. It is more obvious during descent rather than take-off. This is because during descent the plane is coming from an area of low atmospheric pressure down to ground level where the air pressure is significantly higher, this causes the eardrum to retract and stretch and in some cases it can be painful. During take-off and ascent, the eardrum bulges outwards. This is because the pressure around you is dropping but it is easier for the middle ear to relieve the increased pressure via the Eustachian Tube (acting like an escape valve say on a pressure cooker) so most people do not experience any great difficulties as a plane climbs.

The Eustachian Tube is normally ‘patent’ (closed) and opens when we swallow, yawn or chew. However, common causes of a blocked Eustachian Tube arise from mucus and inflammation that can occur with colds, throat infections, hay fever, etc. The mucous membrane lining in the Eustachian Tube can become swollen and inhibit the flow of air through it. This in turns makes it more difficult for the air pressure in the middle ear to equalise to the environmental outside air pressure.

So, should you fly if suffering from a cold?

Ideally, anyone suffering from a cold, ear infection, or respiratory infection, etc, should not fly. However, for many reasons it is not always possible to change or delay pre-booked flight arrangements. If you do have to fly whilst suffering from the symptoms of a cold you should certainly take sensible precautions to try and reduce any possible side effects that may occur.

What can you do to alleviate any problems when flying?

Be awake when the plane begins descent procedures as you can then take precautionary measures such as:

Chewing or sucking a sweet during take-off or landing.

Try to force a yawn.

Pinch your nose shut and then try and to gently blow out through your nose (Valsalva manoeuvre, a technique divers use when submerging).

Try and avoid any substances that can increase mucus production such as milk and both cigarette smoke and alcohol irritate your mucus membranes, promoting more mucus that can block your Eustachian Tube.

There are a number of decongestants (tablets or sprays) that you take an hour or so before take-off or landing or antihistamines taken the day before and on the day of traveling. However, consult with your doctor if you suffer from heart disease, high blood pressure or any other cardiovascular conditions before taking any over the counter remedies.