Is it safe to fly with intermittent ear clogging?

Flying with Intermittent Ear Clogging: Safety Considerations

Air travel with intermittent ear clogging can be safe but requires precautions, as it may lead to ear pain or damage to the eardrum depending on how much fluid is present in the middle ear.

Understanding the Risks

• Air travel exposes passengers to pressure changes that can affect the middle ear, especially during descent when cabin pressure increases 1
• At cruising altitude (typically 8,000 feet), the partial pressure of oxygen drops, creating a pressure differential between the middle ear and cabin environment 1
• Intermittent ear clogging often indicates eustachian tube dysfunction, which impairs the ability to equalize pressure between the middle ear and external environment 2
• In severe cases, inability to equalize pressure can lead to:
  • Acute middle ear inflammation (aerotitis/barotrauma)
  • Intense ear pain
  • Tympanic membrane perforation
  • Hearing loss
  • Vertigo 3, 4

Pre-Flight Assessment

• If you experience intermittent ear clogging, consider the following before flying:
  • Severity and frequency of your symptoms
  • Presence of any current upper respiratory infection or allergies
  • History of previous ear problems during air travel 1
• If you have a history of air travel intolerance with respiratory symptoms (dyspnoea, chest pain, confusion or syncope), formal pre-flight assessment is recommended 1

Preventive Measures

• For mild intermittent ear clogging:

  • Stay awake during descent and practice active swallowing to help equalize pressure 1
  • Avoid sleeping during descent as this reduces swallowing frequency 1
  • Consider using the Valsalva maneuver (pinching nose and blowing gently) to help equalize pressure 3

• For moderate to severe ear clogging:

  • Consider postponing travel if you have an active upper respiratory infection, as this significantly increases risk of barotrauma 3, 4
  • Some evidence suggests oral decongestants may help prevent symptoms:
    • One randomized controlled trial showed pseudoephedrine reduced ear pain in adults with recurrent ear pain during air travel 5, 4
    • However, another study found oxymetazoline nasal spray was not statistically effective 4

Special Considerations

• If you have diagnosed middle ear effusion (fluid):

  • When the ear is completely full of fluid, there is usually less risk of pain during descent 1
  • Partial fluid or fluid mixed with air poses higher risk of pain during descent 1
  • A tympanogram can help determine if the ear is completely full (flat reading) 1

• For recurrent or severe problems:

  • Consult with an otolaryngologist before flying 2
  • In cases of persistent eustachian tube dysfunction, specialized treatments may be needed before air travel is advisable 2

During the Flight

• Remain hydrated and avoid excess alcohol, which can worsen congestion 1
• Use preventive measures before descent begins rather than waiting until symptoms occur 4
• If pain develops, continue attempting pressure equalization techniques (swallowing, yawning, Valsalva) 3

When to Avoid Flying

• With active ear infection or severe congestion 1
• With recent tympanic membrane perforation 1
• Within 6 weeks of major ear surgery unless cleared by your physician 1

After Landing

• If you experience severe ear pain, hearing loss, or vertigo after flying, seek medical attention 3
• Persistent symptoms may indicate barotrauma requiring medical treatment 4

Remember that while most cases of ear discomfort during flying are temporary and resolve spontaneously, taking preventive measures can significantly reduce your risk of complications 6.