Otalgia (ear pain) post-flight?

From the Guidelines

Ear pain after plane travel, also known as ear barotrauma, can be managed with over-the-counter pain medications such as acetaminophen (650-1000mg every 4-6 hours) or ibuprofen (200-400mg every 4-6 hours) for up to 48 hours 1.

Important Considerations

• Nasal decongestants like pseudoephedrine (30-60mg every 4-6 hours) or oxymetazoline (0.05% nasal spray, 2-3 sprays per nostril every 12 hours) can help alleviate eustachian tube dysfunction, which often contributes to ear barotrauma 1.
• If symptoms persist or worsen, further evaluation by a healthcare professional is recommended 1.

Prevention and Management

• To prevent ear barotrauma during air travel, it is recommended to keep the child awake during landing and encourage them to swallow to even out the pressure 1.
• The Valsalva maneuver, which involves pinching the nose shut and blowing gently through the nose, can also help to equalize the air pressure in the ears and alleviate discomfort 1.
• Chewing and yawning have also been found to provide relief of symptoms 1.

When to Seek Medical Attention

• If the ear pain is severe, persistent, or accompanied by other symptoms such as fever, discharge, or hearing loss, medical attention should be sought promptly 1.

From the Research

Causes of Otalgia Post-Flight

• Otalgia (ear pain) post-flight is often caused by otic barotrauma, which occurs when there is a pressure difference between the air in the middle ear and the external atmosphere 2.
• This pressure difference is usually caused by the failure of the eustachian tube to equilibrate middle ear and atmospheric pressures during ascent or descent 2.

Prevention and Treatment of Otalgia Post-Flight

• Oral pseudoephedrine decongestants have been shown to reduce otalgia in adults with recurrent ear pain during air travel 2, 3, 4.
• However, one study found that oral pseudoephedrine did not decrease in-flight ear pain in children 2.
• Oxymetazoline decongestant nasal spray has been found to be little more effective than placebo in reducing ear pain and discomfort associated with changing ambient pressures 2, 4.
• Nasal balloon inflation has been shown to be effective in preventing delayed ear barotrauma after altitude exposure while breathing pure oxygen 5.
• The use of nasal decongestants and oral pseudoephedrine has been found to be effective in preventing middle-ear pain during air travel, although the quality of evidence for these interventions is variable 6.

Symptoms and Complications of Otalgia Post-Flight

• Symptoms of otalgia post-flight can include ear fullness, otalgia, and deafness 2.
• Severe cases of otic barotrauma can result in tympanic membrane perforation and even round window membrane rupture 2.
• Delayed ear barotrauma can occur several hours after altitude exposure, with a high prevalence of ear pain reported in military pilots 5.