Airplane ear

Symptoms Of Airplane Ear

The typical symptoms of airplane ear include:

• Discomfort in the ear/s
• Pain in the ear/s
• Fullness in the ear/s
• Mild to moderate hearing loss

In severe cases, an individual may experience:

• Severe pain in the ear/s
• Moderate to severe hearing loss
• Tinnitus (ringing sound in the ear)
• Vertigo
• Hemotympanum (presence of blood in the middle air cavity)

Causes Of Airplane Ear

To understand the cause of airplane ear, it is important to know the normal structure of the ear and how the ear works at ground level

Structure of the ear

The structure of the ear is divided into three parts:

Outer ear: The part of the ear that is seen from the outside is the outer ear. The external auditory canal connects it to the middle ear. There is a separation between the middle ear and outer ear with a structure called the eardrum.

Middle ear: A tube-like structure called the eustachian tube connects the middle ear to the back of the nose. It plays a very important role in maintaining air pressure on either side of the eardrum.

Inner ear: The inner ear has several compartments that perform specific functions for the purpose of hearing and maintaining balance.

How does the ear work when we are at ground level?

At normal level, the pressure of the air is the same in the middle ear cavity and external ear canal. This equalization of pressure helps in normal functioning of the ear. 

What happens to the ears when we are in the flight?

• During take-offs and landings, the air pressure inside the middle ear reduces rapidly compared to the external cabin air pressure
• Due to this pressure difference, eardrum is pulled inside
• The eustachian tube is not able to react fast enough and gets flattened.
• This stretching of the eardrum and eustachian tube lead to the symptoms of ear barotrauma.

Other conditions that can cause ear barotrauma include:

• Scuba diving without proper gear
• Exposure to loud explosions, like in and around a war zone
• Hyperbaric oxygen chambers
• Riding in an elevator in a tall building 
• Driving in the mountains

Why doesn't everyone on the flight experience the same degree of an airplane ear?

Not everyone suffers from the same intensity of symptoms of airplane ear while flying. This is due to the differences in opening and closing of the eustachian tube. In most of cases, the eustachian tube opens periodically during swallowing, yawning and chewing and tries to maintain equal pressure between the outside and inside of the ear.

However, people with a narrow eustachian tube or any blockages associated with cold, throat infections etc are more prone to develop airplane ear or ear barotrauma. 

Risk Factors For Airplane Ear

Everybody on the flight has an effect of the pressure change happening there. But in some individuals the ear pain is worse than others. The following risk factors that block the eustachian tube or hamper its function are associated with airplane ear:

Age

Infants and toddlers are more susceptible to airplane air due to small eustachian tubes.

Medical conditions 

Some medical conditions make it hard for the ears to adapt to the rapid pressure changes, making one more prone to airplane air. These include:

• Common cold
• Sinusitis
• Allergic rhinitis (hay fever)
• Otitis media (middle ear infection)
• Certain hormonal changes (for instance, during pregnancy)

Sleeping or napping during air travel

The activities such as swallowing and yawning helps to equalize the pressure of ears. Since these activities are reduced during sleeping, the chances of airplane air increases if individuals take a nap on flight. 

Diagnosis Of Airplane Ear

The diagnosis of airplane ear is confirmed based on air travel history and symptoms experienced by the patient. In case of uncertainty about the symptoms, confirmation is done through:

Otoscopy

This involves examination of the inner ear through an instrument called an otoscope. The signs that are looked at with an otoscope involves:

• Bulging in the eardrum
• Tear in the eardrum
• Blood/fluid in the eardrum 

Audiometry

This test is performed when a person complains of loss of hearing. 

Specialist To Visit

Most of the symptoms of airplane ear are reduced after landing.

When to see a doctor?

A doctor consultation is required if you are experiencing:

• Dizziness and a feeling of falling right after flying
• Severe ear pain
• Bleeding from ear
• Drainage of fluid from ears
• Difficulty in hearing 

The specialty of doctors that may help in diagnosing and treating airplane ears include:

• General physician
• ENT specialists: These are the doctors that have a specialization in managing the conditions of eyes, nose and throat. 

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Prevention Of Airplane Ear

Airplane ear is a preventable condition. The prevention strategies can be divided into three categories:

A. Primary prevention

It involves measures that can be taken before or during any discomfort in the ears. 

1. Practice self-care measures: The activities such as yawning, chewing, and swallowing especially during take off and landing should be performed during flying. These activities help in keeping the eustachian tubes open and thus prevent airplane ear. 

Sucking lozenges and chewing gum while the plane begins to ascend and descend is also helpful. 

2. Stay awake: Individuals should avoid sleeping or napping during ascent and descent of flights so that they can practice activities such as yawning, chewing, and swallowing. Individuals can also request the attendees of the flight to wake them up when the plane is about to land. 

3. Use of air pressure regulating earplugs: There are specialized ear plugs that are often sold at airports, pharmacies, or a hearing clinic. They are helpful in equalizing pressure against the eardrum and thus help in preventing airplane ear. 

4. Take medications: Individuals suffering from cold can prevent airplane air by taking decongestants an hour before the take off of the flight.

Note: It is important to take consent from your healthcare provider before taking a decongestant in case of high blood pressure, a heart ailment, a heart rhythm disorder or pregnancy.

5. Use over-the-counter (OTC) nasal sprays: Nasal congestion increases the chances of airplane ear. So, it is recommended to use a nasal spray about 30 minutes before take-off. 

6. Blow a special autoinflation balloon: These special balloons have to be blown up through the nose, by blocking off one nostril at a time and blowing through the other. These can be bought from pharmacies, and help people manage pain during flying or unblock ears afterwards.

7. Reschedule air travel plans: If possible, try to reschedule the travel plans by air if you are suffering from common cold, sinusitis, nasal congestion, recent ear surgery or infection, particularly if you have experienced considerable airplane ear symptoms during prior air travel.

B. Secondary prevention

It involves strategies to prevent severe ear pain in case of ear discomfort. 

1. Valsalva manoeuvre: It is an activity that is performed by passengers feeling ear discomfort during the flight. The technique helps in equalizing pressure in the middle ear and thus help in preventing airplane ear. It involves the following steps:

• Take a breath.
• Push that breath out against the closed mouth and nose
• Hold for 15 to 20 seconds.
• Open the nose and mouth
• Breathe out. 

2. Ear packing

In case of bleeding, immediate ear packing should be done to prevent further damage.

C. Tertiary prevention

It involves long-term preventive techniques. A tube is placed surgically in the eardrums to help in the fluid drainage and equalize the pressure between the outer and middle ear. It is used for frequent fliers who are prone to severe airplane ear. 

Special tips to prevent airplane ear in infants and toddlers

Infants and toddlers are more prone to airplane ears due to small eustachian tube. 

As a parent or guardian with whom kids are flying, the following measures may help minimize symptoms of airplane ear:

• Breastfeeding
• Feeding with a bottle 
• Sucking a pacifier
• Drinking fluids through a sipper or a straw 
  
  

Children more than 4 years of age can try the following:

• Chewing gum
• Drinking fluids through a straw 
• Blowing bubbles through a straw
  
  

Note: Decongestants are usually not recommended for children under 6 years of age. Always consult the child’s pediatrician before giving them to the child.

Treatment Of Airplane Ear

Preventive instructions should also be given by airplane authority about this phenomenon. This will help in spreading awareness and combating the condition. Airplane ear is managed by simple techniques. 

• Yawning or swallowing is recommended as it opens the eustachian tube and reduces the pressure difference. This helps in easing the symptoms. 
• In case of prolonged cold or allergies medications such as antihistamines (egs. cetirizine, fexofenadine,loratadine)  and decongestants (egs.oxymetazoline, phenylephrine, and pseudoephedrine) can be taken.
• In case of severe pain, pain relief medications such as paracetamol can be taken.
• A minor surgery known as myringotomy is performed in rare cases. In this, a surgical cut is made in the eardrum to drain accumulated fluids and allow equalization of pressure.

Complications Of Airplane Ear

The symptoms of airplane ear are mostly self-limiting responds well to preventive measures and usually does not pose any complications. In very rare instances, when eardrum is put under so much pressure that it bursts, it can lead to:

• Acute ear infections
• Hearing loss
• Chronic tinnitus (ringing in ears)
• Vertigo
• Perforation in the eardrum