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General Travel Health

When Ears Have an Altitude Problem.
-- Frank Gillingham, MD

The human body didn't evolve to accommodate air travel at 33,000 feet. So, it's not surprising that high altitude flying can cause a variety of physical symptoms, despite the high quality pressurization systems available on modern aircraft. In-flight ear pain is certainly one of the most common problems fliers report. Steep takeoffs and landings, used more frequently now in an effort to reduce airport noise, exacerbate the problem, as do springtime allergies.

To understand in-flight ear pain, you must first understand a little ear anatomy. The middle ear, which is located just behind your ear drum, is an air pocket inside the head that is vulnerable to air pressure changes. Normally, the Eustachian tube, which connects the middle ear to the back of the nose, helps equalize pressure between the middle ear and the outer ear. Eustachian tube size and function varies from person to person, and children tend to have narrower tubes than adults.

When the eustachian tube is blocked, during a common cold or from allergies, pressures cannot equalize, and a painful vacuum develops inside the middle ear. Often this will clear with time, but sometimes fluid builds up, blood vessels burst, infection occurs or the ear drum ruptures. Hearing is usually muffled, and in severe cases, can be affected permanently. Vertigo, a sensation of the world spinning, can also occur. Some experts call the syndrome "Aerotitis."

Swallowing and yawning can help open the eustachian tubes and equalize pressure - so chewing gum or letting a mint or lifesaver melt in your mouth during take offs and landings may help. Be sure not to sleep during descents - you'll miss your opportunity to yawn.

Every traveler should learn to unblock (or "inflate") their ears using the following three steps (reluctantly taught to me by a British Airways flight attendant when I was 15):

  • Pinch your nostrils shut.
  • Take a breath of air.
  • Using your cheek and throat muscles, force the air into the back of your nose as if you're trying to blow your nose. Start gently - then slowly increase the effort. Don't use force - proper technique requires only pressure created by your cheek and throat muscles.

Avoid milk products for a day or two before fly, as they can be mucous producing. If possible,avoid flying when you have a cold or severe allergies. If you must fly when you're congested, decongestants can be extremely useful - they shrink the membranes and help the ears pop more easily. To be most effective you must start treating the problem the day before travel, with decongestant medications like Sudafed combined with a long-acting nasal spray like Afrin or Neosynephrine, as directed (some ENT specialists recommend pediatric strength Neosynephrine for adults). Use of decongestant like Sudafed two hours before landing, and nasal spray such as 0.5% Neosynephrine 45 - 60 minutes before landing can be a terrific combination. Be sure to blow your nose before using the nasal spray, or the mucous will prevent it from working.

Remember, these medications can cause problems for folks with heart disease, high blood pressure and other medical conditions. Decongestant nasal sprays can be addictive and, if used for more than a day or two, can actually increase nasal congestion. To be safe, check with your doctor before using these medications.

If you've had any kind of surgery on your sinuses recently, be sure to check with the surgeon who performed the procedure before flying.

"Earplanes" are a new ear plug product which cost about $5 a pair and regulate air flow in and out of the ear. They have not been studied carefully and results have been mixed (let me know if you've had any experience with them).

It's always a good idea to travel with the name of a reliable Internist, Family Practitioner or Otolaryngologist (ENT) specialist in your destination - just in case the simpler methods don't help. And be sure to see an Otolaryngologist if you suffer chronically from ear symptoms. There are tried-and-true surgical procedures available that may be of great benefit to you.