Ear problems are common among airplane travelers. Frequent flyers report ear fullness, pressure and occasional difficulty “popping” their ears. While this is usually a minor annoyance, some instances cause significant injury.
What causes the ears to pop?
You may notice your ears pop when you swallow or yawn. This occurs whenever the air pressure behind the eardrum equalizes with atmospheric pressure through the eustachian tube. Even at a constant altitude, the air in the middle ear is slowly absorbed into the bloodstream, reducing the pressure in the middle ear. Your ear feels blocked when the air pressure becomes unequal.
How can air travel cause hearing problems?
Even modern commercial jets lose a little bit of air pressure when flying at high altitudes. The air easily escapes the middle ear through the Eustachian tube, so most people do not notice the change of pressure during ascent. As the plane descends during the last 15 to 30 minutes of the flight, cabin air pressure increases. If the Eustachian tube does not open frequently during descent, the cabin air pressure pushes in on the eardrum, creating pressure, and possibly pain. As the plane descends lower, the increasing cabin air pressure squeezes the Eustachian tube closed, making it increasingly difficult to equalize the air pressure. SCUBA divers are particularly familiar with this problem, and will ascend to a shallower depth if necessary to equalize their ears. Unfortunately, air passengers do not have any control over the pressure in the plane.
What are the treatment options?
Swallowing is the simplest way to clear your ears, especially when flying. Yawning, chewing gum or sucking on hard candies may help stimulate swallowing. Infants may be encouraged to swallow by feeding. These maneuvers involve muscles in the throat that act to pull the Eustachian tube open. Avoid sleeping during descent as you do not swallow frequently while sleeping.
Valsalva maneuver: If yawning or swallowing is unsuccessful, close your mouth, blow your nose gently with your nostrils pinched shut, and swallow at the same time.
Decongestant tablets or nose sprays may help you equalize your ears if you are flying with a stuffy nose. If you have allergies, take your regular medications. If you are pregnant, have heart disease, irregular heart rhythm, high blood pressure, thyroid disease, or excessive nervousness, consult your physician before using any decongestant. Extended use of nasal decongestant sprays can cause rebound nasal congestion and addiction.
Adenoidectomy reduces soft tissue fullness and bacteria at the Eustachian tube orifice. This minor surgery is normally performed on children and can reduce the frequency and duration of otitis media, improve nasal congestion, reduce snoring, and improve Eustachian tube function.
Eustachian tube balloon dilation is a new option for adults with chronic Eustachian tube blockage. Using techniques similar to balloon sinus dilation, the surgeon passes a balloon catheter through the nose and dilates the Eustachian tube. Although this is described as dilating or stretching the Eustachian tube, the benefit is more likely due to crushing residual adenoid tissue that grows within the Eustachian tube. The procedure may be performed on adults in the office, but many insurance plans still consider this procedure to be “investigational.”
What is a Patulous Eustachian Tube?
If you can hear yourself breathe, and your own voice sounds as if you are talking through a kazoo, you may have a wide open, or “patulous” Eustachian tube. Your eardrum may pop inward and outward with each breath, like the plastic windows wrapped around a screened porch in the wintertime. This annoying but harmless condition is most common in patients who are particularly slender or athletic, and often occurs during aerobic exercise. The symptom is usually relieved by lowering the head, which increases venous congestion in the head. Some patients will feel an incessant need to sniff the eardrums inward, which can stretch the eardrums and make them even floppier.
A patulous eustachian tube is harmless and requires no treatment. If symptoms are particularly bothersome, we recommend evaluation and management of allergies. Some patients find partial relief with myringotomy (ear tube). Balloon dilation is not an option, because it would only make a patulous eustachian tube worse.
Tips to prevent discomfort during air travel:
- Avoid air travel when sick
- Avoid sleeping during descent
- Swallow or yawn frequently during descent
- Ask your surgeon if you had recent ear surgery
- When equalizing your ears, blow gently while swallowing
© 2020 Richmond ENT by Mike Armstrong MD and Michaela Bailey, Spanish translation by Michael Reymundi