Ear Drums And Air Pressure: A Plane Sleeper's Guide

If you've ever felt pain or discomfort in your ears while flying, you're not alone. This condition, known as airplane ear or aerotitis, is caused by changes in air pressure during ascent and descent, leading to a pressure imbalance between the middle ear and the external environment. This can result in stretching or bulging of the eardrum, causing pain and even temporary hearing loss. While it usually affects around 10% of adults, there are simple steps you can take to prevent and manage airplane ear, such as yawning, swallowing, or chewing gum to equalize the pressure. However, severe cases may require medical attention and can result in rare complications like permanent hearing loss or chronic tinnitus. So, the next time you're on a flight, remember to stay awake during take-off and landing and practice those self-care techniques to keep your ears happy!

The mechanics of 'airplane ear'

Airplane ear, or ear barotrauma, occurs when there is a change in air pressure in the environment that is not matched by a change in air pressure in the middle ear. This can happen when an airplane is climbing after takeoff or descending for landing. The change in air pressure occurs faster than the eustachian tube can react, causing the symptoms of airplane ear.

The eustachian tube is a narrow passage that regulates air pressure in the ear. It connects the middle ear to the back of the nose and upper part of the throat. When the plane climbs or descends, the air pressure in the ear cavity decreases, while the cabin pressure increases compared to the outside air pressure. This pressure imbalance can cause the eardrum to stretch or bulge outwards, leading to pain and discomfort. The eardrum may also be pulled inward due to the pressure gradient, causing it to be stretched inwards. This can result in reduced hearing abilities and muffled sounds as the eardrum is unable to vibrate normally.

Airplane ear can occur in one or both ears and is characterised by moderate discomfort or pain, a feeling of fullness or stuffiness, and muffled hearing or slight to moderate hearing loss. In severe cases, individuals may experience increased ear pressure, moderate to severe hearing loss, ringing in the ears (tinnitus), a spinning sensation (vertigo), and bleeding from the ear.

To prevent airplane ear, it is recommended to yawn and swallow during ascent and descent, as this helps to open the eustachian tubes and equalise air pressure. Chewing gum or sucking on candy can also help with swallowing. It is also advised to not sleep during takeoffs and landings, as you won't be able to perform the necessary self-care techniques when you feel pressure in your ears. If you are prone to severe airplane ear, your doctor might surgically place tubes in your eardrums to aid fluid drainage and equalise pressure.

How to avoid 'airplane ear'

Airplane ear, or aerotitis media, is the stress on your eardrum that occurs when the air pressure in your middle ear and the cabin pressure are out of balance. This can cause discomfort or pain, a feeling of fullness, muffled hearing, or even more severe symptoms such as vertigo or tinnitus.

• Yawn and swallow: During ascent and descent, yawning and swallowing can help to open the Eustachian tube and equalize the pressure in your ear. Chewing gum or sucking on hard candy can help trigger swallowing.
• Pinch your nose and blow gently: This is known as the Valsalva maneuver. Pinching your nostrils closed and gently blowing air into your nose helps to open the Eustachian tube and equalize the pressure.
• Use earplugs: Earplugs such as EarPlanes can act as pressure 'baffles', reducing the pressure on the eardrum and improving symptoms.
• Use decongestants: If you have a cold or sinus congestion, decongestant nose sprays can help to reduce swelling at the opening of the Eustachian tube, improving your ear's ability to equalize pressure. Oral decongestants such as Sudafed can also help, but these may contribute to high blood pressure, so check with your doctor first.
• Take antihistamines: If you have allergies, medications like Claritin, Zyrtec, or Allegra may help with air pressure regulation.
• Avoid sleeping during takeoff and landing: If you're awake, you can practice the self-care techniques mentioned above when you feel pressure in your ears.
• Reschedule if you're sick: If possible, avoid flying when you have a cold, sinus infection, nasal congestion, or an ear infection, as congestion can interfere with airflow to your ear and make it harder to equalize pressure.
• See a doctor: If you experience severe or prolonged symptoms, or if home remedies are not helping, see a doctor for advice.

The Valsalva manoeuvre

The technique is named after 17th-century Italian physician Antonio Maria Valsalva. To perform the Valsalva manoeuvre, one must first close their mouth and pinch their nose shut. Then, they should press the air out as if blowing up a balloon or having a bowel movement. This can be done for 10 to 15 seconds, either sitting or lying down.

The manoeuvre causes several rapid changes in heart rate and blood pressure. During the first phase, the pressure in the chest increases, causing a temporary spike in blood pressure. In the second phase, blood pressure steadily drops as a limited amount of blood in the veins returns to the heart. This results in a decreased amount of blood pumped from the heart, leading to a fall in blood pressure. The ANS senses this pressure drop and responds by increasing the heart rate and output and contracting the arteries. Blood pressure then returns to a normal range.

The risks of flying with a cold

Flying with a cold can be painful, and it's not just your sinuses that will suffer. The pressure changes that occur during a flight can cause severe discomfort in your ears, and even lead to more serious complications. So, before you fly, it's important to understand the risks and how to alleviate them.

During a flight, the air pressure in the sinuses and middle ear must equalize with the cabin pressure, which changes during ascent and descent. When you have a cold, your mucus membranes are inflamed and swollen, which can clog the Eustachian tube – the narrow passage that connects your inner ear with the back of your throat and regulates air pressure. When this tube is blocked, it's harder for your ears to "pop", and the pressure changes can cause pain and discomfort.

The results of clogged Eustachian tubes during a flight can range from painful and frustrating to severe. According to health experts, common symptoms include:

• Hearing loss, which can last for a few days
• A feeling of fullness or stuffiness in the ear
• Muffled hearing or slight to moderate hearing loss
• Vertigo, a sense of "spinning"
• Tinnitus, or "ringing" in the ears
• In extreme cases, a ruptured eardrum

If you're flying with a cold, there are several steps you can take to prevent or alleviate these painful symptoms:

• Consider postponing your trip, especially if your symptoms are severe and cannot be controlled with over-the-counter medications.
• Take decongestants, such as Sudafed, to reduce swelling and help equalize pressure. Longer-acting medications (12-hour or 24-hour) are recommended, taken about an hour before takeoff.
• Use a nasal spray, such as Afrin, to shrink swollen tissues and reduce congestion. Take it 30 minutes before takeoff and then again 30 minutes before descent.
• Chew gum or suck on hard candy to help equalize pressure by changing the pressure in your throat and opening the Eustachian tube.
• Stay hydrated, as this will help prevent nasal secretions from drying out and clogging the Eustachian tube.
• Try a hot shower once you reach your destination, as the steam can soothe inflamed mucus membranes.
• Learn the Valsalva maneuver, a technique that equalizes air pressure within the ears. To do this, hold your nose closed and attempt to exhale with a closed mouth. You'll hear a faint "popping" sound when you do this successfully.
• Use specialized earplugs, such as Ear Planes, which are designed to protect the eardrum from rapid pressure changes and slowly equalize pressure through a passage in the earplugs.

The risks of flying with an ear infection

Flying with an ear infection can be extremely uncomfortable and even dangerous. The change in air pressure during a flight can cause severe pain and, in some cases, long-term damage to your ears. Here are some of the risks you should be aware of:

Ear barotrauma

Also known as "airplane ear", this condition occurs when there is a stress on your eardrum due to an imbalance between the air pressure in the middle ear and the cabin pressure. This can cause a feeling of fullness or pain in the ear, muffled hearing, and even ringing in the ears (tinnitus). In severe cases, it can lead to a ruptured eardrum, which can result in permanent hearing loss.

Difficulty equalizing pressure

The change in cabin pressure during ascent and descent can be difficult for your ears to adjust to, especially if you have an ear infection. The infection can cause inflammation and fluid build-up, blocking the Eustachian tube that connects the middle ear to the throat. This blockage can make it hard for air to pass through and equalize pressure, leading to a build-up of pressure and discomfort.

Increased risk for children

Children are at a higher risk of experiencing ear problems when flying with an ear infection. Their Eustachian tubes are smaller and more narrow, making it more difficult for them to equalize the pressure. In addition, children tend to swallow less often than adults, especially when they are sleeping, which can further contribute to the blockage.

Long-term complications

While rare, there is a possibility of long-term complications from flying with an ear infection. These can include permanent hearing loss and chronic tinnitus. It is important to take this risk seriously, especially if you are travelling with children.

Discomfort and pain

Even if you do not experience any long-term damage, flying with an ear infection can be extremely uncomfortable and painful. The pressure imbalance can cause severe ear pain, and the feeling of fullness or stuffiness in the ears can be very unpleasant.

To reduce the risks associated with flying and ear infections, it is recommended to reschedule your travel if possible. If you must travel, consult a doctor beforehand and consider taking a decongestant or anti-inflammatory medication to help reduce pain and blockage. Staying awake during take-off and landing, chewing gum, and sucking on hard candy can also help to stimulate swallowing and equalize pressure.

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