What causes otalgia after air travel?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: April 7, 2025 • View editorial policy

Differential Diagnosis for Ear Pain after Flying

  • Single most likely diagnosis + Middle ear barotrauma: This condition occurs when the air pressure in the middle ear is not equalized with the surrounding environment, leading to discomfort or pain. It is a common issue during flights due to changes in air pressure, making it the most likely diagnosis for ear pain after flying.
  • Other Likely diagnoses + Eustachian tube dysfunction: The Eustachian tube connects the middle ear to the back of the nose and throat, helping to regulate air pressure in the ear. Dysfunction of this tube can lead to ear pain, especially during flights. + Outer ear infection (otitis externa): This infection of the outer ear canal can cause pain, especially if the ear canal is irritated or inflamed, potentially exacerbated by the dry air on a plane. + Sinusitis: Sinus infections can cause referred pain to the ears, and the pressure changes during a flight might exacerbate sinus discomfort.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Temporal bone fracture: Although rare, a fracture in the temporal bone can cause severe ear pain and is a critical condition that requires immediate medical attention. + Malignant otitis externa: A severe infection of the outer ear that can spread to surrounding bone and tissue, particularly in individuals with compromised immune systems, such as those with diabetes or undergoing chemotherapy. + Perforated eardrum (tympanic membrane perforation): A hole in the eardrum can cause severe pain and potentially lead to infections or hearing loss if not properly treated.
  • Rare diagnoses + Patulous Eustachian tube: A rare condition where the Eustachian tube stays open, leading to hearing one's own breathing sounds, autophony, and potentially ear pain. + Barosinusitis: Inflammation of the sinuses caused by pressure changes, which can lead to ear pain due to the close anatomical relationship between the sinuses and the ears.

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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.

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