I have a viral upper respiratory infection with nasal and ear congestion and am planning to fly; what medications and measures should I take before and during the flight to prevent ear problems?

Pre-Flight Medication and Management for Viral URI with Ear Congestion

Take oral pseudoephedrine 120 mg 30 minutes before your flight departure to prevent ear barotrauma, stay awake during descent, and actively swallow frequently throughout the landing process. 1, 2

Recommended Medications

Oral Decongestant (Primary Prevention)

• Pseudoephedrine 120 mg taken 30 minutes before flight departure is the only medication with proven benefit for preventing ear pain during air travel in adults with nasal and ear congestion 1, 2
• Consider using a nasal decongestant spray just prior to descent as additional prophylaxis 3

Symptomatic Relief

• Carry ibuprofen or acetaminophen in your hand luggage for immediate access if ear pain develops during or after the flight 1
• These medications treat pain and fever but do not prevent barotrauma 4

Medications to AVOID

• Do NOT use antibiotics, antihistamines, intranasal steroids, or systemic steroids for prevention of ear symptoms during air travel—these have no proven benefit and carry unnecessary risks 1, 2
• Antibiotics are ineffective for viral URIs and do not prevent flight-related ear problems 4, 5

Critical Non-Pharmacologic Maneuvers

During Descent (Most Important Phase)

• Stay awake during the entire descent and landing—this is essential for active pressure equalization 1, 2
• Swallow frequently and actively throughout descent—this is the most effective non-pharmacologic intervention 1, 2
• Facilitate swallowing by chewing gum, drinking water, or sucking on candy 1

Risk Assessment

• You are at highest risk if you have partial middle ear fluid from your URI, as this creates the worst scenario for pressure equalization during descent 1, 2
• If your ears are completely full of fluid, paradoxically you may experience less pain, though this is not ideal 1

Important Caveats and Warnings

Serious Complications Can Occur

• Flying with an active URI and blocked eustachian tubes carries real risk of tympanic membrane rupture, severe permanent sensorineural hearing loss, and prolonged vertigo requiring permanent hearing aids 6
• One documented case showed a patient with a resolving URI who experienced bilateral tympanic membrane rupture, permanent hearing loss, and months of vestibular symptoms after flying 6

Additional Precautions

• Avoid alcohol before and during the flight—it worsens eustachian tube dysfunction and increases risk 1
• Consider postponing your flight if symptoms are severe, as the risk may outweigh the benefit of travel 6, 3

If Symptoms Develop

• If you develop severe ear pain, hearing loss, or vertigo during or after the flight, seek immediate medical evaluation 6
• Stage I-II barotrauma typically requires a 1-week course of topical nasal sprays, analgesics, and possibly a tapering course of oral steroids 3