How can ear pain be prevented during air travel?

Preventing Ear Pain During Air Travel

To prevent ear pain during air travel, the most effective approach is to actively equalize ear pressure through swallowing, yawning, or the Valsalva maneuver during takeoff and especially during descent. These techniques help open the Eustachian tubes and equalize pressure between the middle ear and cabin.

Understanding the Cause of Ear Pain

Ear pain during flights occurs due to barotrauma (pressure injury) when the Eustachian tubes fail to equalize pressure between the middle ear and the aircraft cabin during altitude changes. This condition is particularly problematic during descent when cabin pressure increases rapidly.

• Approximately 1-2% of air travelers report ear pain, often classified as airplane headache (AHA) 1
• Pain typically occurs during landing or descent, though it can also happen during takeoff
• The pain is usually unilateral in the fronto-orbital region with jabbing, stabbing or pulsating characteristics

Effective Prevention Strategies

Before Your Flight:

1. Stay hydrated - Drink plenty of fluids before and during the flight to keep mucous membranes moist
2. Avoid flying with congestion - If possible, postpone travel when you have a cold, sinus infection, or nasal allergies
3. Consider chewing gum - Have gum ready for takeoff and landing to encourage swallowing

During Takeoff and Descent:

1. Active pressure equalization techniques:
   • Swallow frequently (drinking small sips of water helps)
   • Yawn deliberately
   • Perform the Valsalva maneuver: pinch your nostrils closed, close your mouth, and gently attempt to blow air through your nose
   • Chew gum or suck on hard candy
   • Extension of the earlobe has also been found to provide relief 1

For Children:

• Encourage swallowing during takeoff and landing by offering a bottle, pacifier, or snack
• Keep children awake during landing to ensure they actively swallow 1
• For infants who have had neonatal respiratory problems, consult a pediatrician before flying 1

Medications and Their Effectiveness

The evidence for medication use is mixed:

• Oral decongestants (pseudoephedrine):

  • One study showed effectiveness in adults with recurrent ear pain 2
  • However, a pediatric study found no benefit in children and increased drowsiness 3
  • Not recommended for routine use in children due to lack of efficacy and potential side effects

• Nasal decongestant sprays:

  • Research shows oxymetazoline nasal spray taken before descent did not significantly reduce symptoms 4

• Analgesics and anti-inflammatories:

  • May be effective for prophylaxis of airplane headache 1
  • Consider taking before the flight if you have a history of severe ear pain

Special Considerations

For People with Existing Ear Conditions:

• If you have a current ear infection or recent ear surgery, consider postponing air travel
• Those with a history of ear problems should consult their healthcare provider before flying

For People with Respiratory Conditions:

• Patients with asthma or COPD should carry preventative and relieving inhalers in their hand luggage 1
• Portable nebulizers may be used at the discretion of cabin crew 1

When to Seek Medical Attention

Seek medical attention if:

• Ear pain persists for more than a few hours after landing
• You experience hearing loss, severe vertigo, or fluid drainage from the ear
• You have fever or severe pain suggesting infection

By following these preventive measures, most travelers can avoid or minimize ear discomfort during air travel. Remember that active pressure equalization techniques are the most reliable methods for preventing ear pain.