How can I prevent barotrauma while flying?

Preventing Barotrauma During Air Travel

To prevent barotrauma during air travel, perform the Valsalva maneuver, yawning, or swallowing during ascent and descent, and take oral pseudoephedrine 120 mg 30 minutes before flight if you have a history of ear pain while flying. 1, 2

Understanding Barotrauma in Air Travel

Barotrauma occurs due to pressure changes in gas-filled body cavities during ascent and descent. During air travel, the most common forms are:

• Middle ear barotrauma (aerotitis media): Occurs in 10-20% of adult passengers and up to 40% of children 3, 4
• Sinus barotrauma: Particularly affecting frontal and ethmoidal sinuses 5
• Airplane headache (AHA): Reported in 1-2% of air travelers, characterized by severe unilateral fronto-orbital pain during landing or descent 1

Prevention Strategies

1. Active Pressure Equalization Techniques

• Valsalva maneuver: Pinch your nose closed, close your mouth, and gently attempt to exhale against closed airways
• Swallowing, yawning, or chewing gum: Natural ways to open the Eustachian tubes
• Toynbee maneuver: Pinch your nose and swallow simultaneously
• Autoinflation devices: Otovent nasal balloon can reduce barotitis incidence from 15% to 6% when used during descent 4

2. Medication (For Those with History of Ear Pain)

• Oral decongestants:

  • Pseudoephedrine 120 mg taken 30 minutes before flight reduces ear discomfort by 52% compared to placebo 2, 6
  • More effective than topical nasal decongestants like oxymetazoline, which only reduces symptoms by 10% compared to placebo 6

• For airplane headache prevention:

  • Analgesics, NSAIDs, or triptans taken before flight 1

3. Special Considerations

For Passengers with Respiratory Conditions:

• Ensure proper management of underlying conditions before flying 1
• Avoid flying with active respiratory infections
• Patients with COPD should ensure they have their inhalers in hand luggage 1

For Passengers with Recent Surgery:

• Avoid flying for at least 6 weeks after pneumothorax resolution 1
• Delay air travel for at least 2 weeks after uncomplicated chest surgery 1
• Do not fly with a current closed pneumothorax 1

For Children:

• Children are at higher risk (22% vs 10% in adults) of barotitis after flights 3
• Have them drink or suck on a pacifier during takeoff and landing
• Consider using pediatric-sized autoinflation devices 3

Treatment for Barotrauma After Flying

If you experience ear pain or pressure after landing:

1. Try the Valsalva maneuver first - effective in 46% of adults and 33% of children 3
2. Use an autoinflation device if Valsalva fails - effective in approximately 70% of cases 3, 4
3. Seek medical attention if symptoms persist, especially if accompanied by:
   • Severe pain
   • Hearing loss
   • Vertigo
   • Bleeding from the ear

Common Pitfalls to Avoid

• Sleeping during ascent/descent: This prevents active pressure equalization
• Flying with congestion: Increases risk of barotrauma significantly
• Waiting until pain occurs: Begin equalization techniques early and frequently during pressure changes
• Using alcohol or sedatives: May reduce awareness of early discomfort and ability to equalize pressure
• Ignoring symptoms after flying: Untreated barotrauma can lead to infection or hearing loss

By following these preventive measures, most travelers can avoid the discomfort and potential complications of barotrauma during air travel.