What causes ear pain due to changes in ear pressure during diving and flying?

From the Guidelines

Changes in ear pressure during diving and flying can cause pain due to the inability of the middle ear to equalize pressure with the surrounding environment, and to prevent this, it is essential to equalize pressure frequently by yawning, swallowing, or performing the Valsalva maneuver. This condition, known as barotrauma, occurs when the Eustachian tube fails to open properly 1. To prevent ear pain, equalize pressure frequently by yawning, swallowing, or performing the Valsalva maneuver (pinching your nose closed while gently blowing against it with your mouth closed). Start equalizing before pain begins, especially during descent in both diving and flying. Some key points to consider:

• If you have congestion, consider using a decongestant like pseudoephedrine (30-60mg) or oxymetazoline nasal spray 30-60 minutes before diving or flying 1.
• For children, encourage swallowing with drinks or candy.
• Avoid diving or flying if you have an ear infection or severe congestion. The pain occurs because air in the middle ear contracts during descent, creating negative pressure that pulls on the eardrum. Without equalization, this can lead to fluid accumulation, bleeding, or even eardrum rupture. Regular equalization prevents this pressure differential from becoming painful or damaging. Additionally, some individuals may experience ocular pain, classified as an airplane headache (AHA), which can be attributed to sinus barotrauma or vasodilatation in cerebral arteries due to changes in cabin pressure 1. It is crucial to prioritize equalization and take preventive measures to avoid barotrauma and other related complications during diving and flying.

From the Research

Changes in Ear Pressure

Changes in ear pressure can cause pain and discomfort during diving and flying. This is due to the difference in air pressure between the outside environment and the inside of the ear.

• The Eustachian tube plays a crucial role in regulating ear pressure by connecting the middle ear to the back of the throat 2.
• During air travel, the air pressure change can cause the Eustachian tube to become blocked, leading to a buildup of pressure in the ear and resulting in pain 2.
• A study found that treatment with 120 mg of pseudoephedrine at least 30 minutes before flying can decrease the incidence of barotrauma by 52% 2.

Causes of Ear Pain

Ear pain during diving and flying can be caused by several factors, including:

• Blockage of the Eustachian tube [(2,3)]
• Changes in air pressure [(2,4)]
• Obstructive Eustachian tube dysfunction (OETD) 3
• Patulous Eustachian tube (PET) 3

Prevention and Treatment

Several methods can be used to prevent and treat ear pain caused by changes in ear pressure, including:

• The Valsalva maneuver, which involves pinching the nose shut and blowing gently to equalize the air pressure in the ears [(3,4)]
• Use of decongestants such as pseudoephedrine 2
• Topical oxymetazoline 2
• Computed tomography (CT) with Valsalva maneuver (VM) to assess the Eustachian tube 3