Ear problems are common for many air travelers, but, when proper precautions are taken, they are seldom harmful. Most pain can be prevented or eliminated by using simple techniques and precautions. The underlying cause of ear pain while flying is unequal pressure between the outside and inside of your eardrums. This happens during climbs and descents as the air pressure inside the cabin changes.
Parts of the Ear
The outer ear leads to the auditory canal and eardrum, which separates the outside air from the middle ear, a small cavity in your skull. The middle ear also is connected to a Eustachian tube that leads to your throat. If the pressure is not equalized between the middle and outer ear, discomfort results. The sinuses, located behind the eyebrows and upper checks, can also be the source of pain.
Commercial aircraft are usually pressurized only above a set altitude. While an airplane is climbing to that altitude, the air pressure in the cabin decreases, while the air pressure inside your body remains constant. This can cause an imbalance and result in a slight bulging outward of the ear drum. The reverse is true during descents, when the middle ear pressure is at a lower pressure (once it has adjusted to a lower pressure at altitude) than the external ear canal. This causes a vacuum effect and the ear drum is sucked inward toward the middle ear. Rapid climbs and descents aggravate this problem as the ear doesn't have as much time to equalize.
Flying While Sick
Flying with a cold, sore throat or ear infection will aggravate ear problems. If the infection or allergy is serious enough to block the Eustachian tube, it could prevent the ear pressure from equalizing, leading to ear drum damage-especially upon descent. The use of over-the-counter medication to relieve congestion may help reduce symptoms to a comfortable level.
In addition to treating symptoms of congestion on the ground prior to air travel to reduce congestion around nasal openings, passengers can try a few tricks if experiencing ear problems in the air. The Valsalva maneuver is used to force air through the Eustachian tube into the middle ear to help equalize pressure. To do this, pinch your nostrils closed, close your mouth and lips and then exhale through the nose. Done gently, this might clear the blockage. Some people also find relief by yawning, chewing gum or swallowing, which may temporarily open the Eustachian tube and equalize the pressure. Ear plugs are not a recommended solution; they don't allow for air to flow through the ear to equalize.
Though mild nasal sprays and drops may help relieve congestion, be aware that most medications have not been tested for their effect at altitude. Medications that cause drowsiness will most likely cause even more drowsiness at cruising altitude since less oxygen is available at that level. Pilots, flight attendants, air marshals and others who work while at altitude should not take medications for congestion prior to flying since these will inhibit performance. As always, drinking alcohol while taking medications is not recommended. Use good judgment and common sense to determine whether you are fit to fly.