What are the preventive measures for ear pain in a toddler with a history of otitis media (inflammation of the middle ear) and tympanostomy tube (ear tube) insertion during air travel?

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Last updated: March 19, 2025 • View editorial policy

From the Guidelines

To prevent ear pain in a toddler with a history of otitis media and ear tubes during air travel, it is recommended to have your child chew gum or drink fluids during takeoff and landing to equalize ear pressure, as functional ear tubes typically allow pressure to equalize naturally, reducing the risk of ear pain 1, 2.

Preventive Measures

  • Encourage your child to chew gum or drink fluids during takeoff and landing to help equalize ear pressure.
  • If concerned, consider giving acetaminophen (Tylenol) 30 minutes before takeoff at a dose of 10-15 mg/kg, following the package instructions for weight-based dosing.
  • Avoid using decongestants like pseudoephedrine in young children, as they are not recommended for those under 4 years old.
  • For children with ear tubes, consult an ENT doctor about using antibiotic ear drops before flying if there's any drainage, although routine prescription of postoperative antibiotic ear drops after tympanostomy tube placement is not recommended 2.

Additional Considerations

  • Ear tubes create an alternative pathway for pressure to equalize, usually preventing pain during flights.
  • If your child seems uncomfortable despite these measures, encourage them to yawn, swallow frequently, or try the Valsalva maneuver (gently blowing while pinching the nose and keeping the mouth closed) if they're old enough to understand.
  • Clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes 2, but it's essential to follow the ENT doctor's specific advice for your child's situation.

From the Research

Preventive Measures for Ear Pain in Toddlers with Otitis Media and Tympanostomy Tube Insertion during Air Travel

  • There are no specific studies that directly address preventive measures for ear pain in toddlers with a history of otitis media and tympanostomy tube insertion during air travel.
  • However, general management of otitis media and tympanostomy tube insertion can be considered: + Antibiotic treatment, such as amoxicillin, is often used to treat acute otitis media (AOM) in children under 2 years of age 3. + Tympanostomy tube insertion is a common surgical procedure used to treat recurrent AOM, persistent AOM, or chronic otitis media with effusion (OME) 4, 5, 6, 7. + Management of serous otitis media, which may follow AOM, often involves watchful waiting, as it resolves spontaneously in more than 90% of cases 4.
  • It is essential to note that the provided studies do not specifically address air travel, but rather the general management of otitis media and tympanostomy tube insertion.
  • Therefore, it is crucial to consult with a healthcare professional for personalized advice on managing ear pain in toddlers with a history of otitis media and tympanostomy tube insertion during air travel.

References

Guideline

clinical practice guideline: tympanostomy tubes in children (update).

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2022

Guideline

clinical practice guideline: tympanostomy tubes in children (update).

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2022

Research

What is new in otitis media?

European journal of pediatrics, 2007

Research

Otology: Ear Infections.

FP essentials, 2024

Research

Adenoidectomy and tympanostomy tubes in the management of otitis media.

Current allergy and asthma reports, 2006

Research

Otitis Media and Tympanostomy Tubes.

Pediatric clinics of North America, 2022

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.