Airplane ear is the stress exerted on your eardrum (tympanic membrane) and other middle ear tissues when the air pressure in your middle ear and the air pressure in the environment are out of balance. You may experience airplane ear at the beginning of a flight when the airplane is climbing or at the end of a flight when the airplane is descending. These fast changes in altitude cause air pressure changes and can trigger airplane ear.

Airplane ear is also called ear barotrauma, barotitis media or aerotitis media.

Usually self-care steps — such as yawning, swallowing or chewing gum — can prevent or correct the differences in air pressure and improve airplane ear symptoms. However, a severe case of airplane ear may need to be treated by a doctor.

Airplane ear can occur in one or both ears. Airplane ear signs and symptoms may include:

• Moderate discomfort or pain in your ear
• Feeling of fullness or stuffiness in your ear
• Muffled hearing or slight hearing loss

If airplane ear is severe or lasts more than a few hours, you may experience:

• Severe pain
• Pressure in your ear similar to being underwater
• Moderate to severe hearing loss
• Ringing in your ear (tinnitus)
• Spinning sensation (vertigo)
• Vomiting resulting from vertigo
• Bleeding from your ear

When to see a doctor
Usually you can do things on your own to treat airplane ear. If discomfort, fullness or muffled hearing lasts more than a few hours or if you experience any severe signs or symptoms, call your doctor.

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Inside your ear

In order for your eardrum to vibrate as it should, the air pressure in the middle ear has to be the same as the air pressure of the environment. Air pressure regulation is the work of a narrow passage called the eustachian tube. One end is connected to the middle ear. The other end has a tiny opening where the back of the nasal cavity and the top of the throat meet (nasopharynx).

Normally, tissues in your middle ear slowly absorb air. This results in less air pressure on the inside of your eardrum than on the outside. When you swallow or yawn, you activate muscles that open the eustachian tube and allow the middle ear to replenish its air supply. This is why swallowing or yawning can often eliminate airplane ear symptoms.

Air pressure changes in flight
When an airplane climbs or descends, the air pressure in the environment changes rapidly, and normal function of the eustachian tube doesn't occur quickly enough.

Even though the cabins of airplanes are pressurized, the air pressure at a cruising altitude is still less than the air pressure on the ground. Therefore, when your airplane is climbing, pressure in your middle ear is greater than the pressure in the cabin. In order for the pressure to be balanced, air has to escape out the eustachian tube. This escape of air is relatively easy.

During your flight the air pressure on both sides of the eardrum usually becomes equalized again. During an airplane's descent, the air pressure is greater in the environment than in your middle ear. In order for this air pressure difference to equalize again, air has to enter the middle ear through the eustachian tube. Rapidly getting air into the middle ear doesn't happen so easily. Because of this, you're more likely to experience airplane ear during a descent.

Air pressure effects on your ear
When air pressure on one side of your eardrum is out of balance with that on the other side, a number of things can happen in the middle ear, depending on the severity and duration of the pressure difference.

• The eardrum stretches and doesn't vibrate correctly, resulting in muffled or impaired hearing.
• The stretching of the eardrum causes a feeling of pressure or pain.
• If the air pressure imbalance persists, fluids from the middle ear tissues may fill the space in an attempt to equalize the pressure.
• If the pressure is severe or prolonged, the eardrum may rupture.
• Small blood vessels (capillaries) in the middle ear may rupture and cause mild bleeding behind the eardrum.
• Either of the small membrane-covered openings of the inner ear (oval window and round window) may rupture.

Problems similar to airplane ear
Ear barotrauma is also a common problem with scuba diving, because the water pressure on the outside of the ear is greater than the air pressure of the middle ear.

You may also experience a minor case of barotrauma while riding an elevator in a tall building or driving in the mountains.

Being slapped or hit on the ear also can cause a rapid change in pressure within the ear. This type of barotrauma can, for example, affect a water skier hitting the surface of water at high speed.

Any condition that blocks the eustachian tube or limits its function can increase the risk of airplane ear. Common risk factors include:

• A small eustachian tube, especially in infants and toddlers
• The common cold
• Sinus infection
• Hay fever (allergic rhinitis)
• Middle ear infection (otitis media)
• Sleeping on an airplane during ascent and descent

Frequent or severe airplane ear may cause damage to tissues of the inner ear or eustachian tube that makes you more likely to experience the problem again.

Airplane ear usually isn't serious and responds to self-care. Long-term complications may occur when the condition is serious or prolonged or if there is damage to middle or inner ear structures. Rare complications may include:

• Permanent hearing loss
• Ongoing (chronic) tinnitus

If you experience severe pain or symptoms associated with airplane ear that don't go away with self-care techniques, you'll likely see your family doctor or a general practitioner first. However, in some cases when you call to set up an appointment, you may be referred immediately to an ear, nose and throat specialist (ENT, or otolaryngologist). Because appointments can be brief, it's a good idea to be prepared.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to ear pain, hearing impairment or related problems.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. If you're experiencing signs or symptoms of airplane ear, you might want to ask the following questions:

• Are these signs and symptoms likely related to my recent airplane travel?
• What is the best treatment?
• Do you think I will experience any long-term complications?
• How will we monitor for possible complications?
• How can I prevent this from happening again?
• When should I consider canceling travel plans?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor will ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• How severe are your symptoms?
• Do you have any allergies?
• Have you had a cold, sinus infection or ear infection?
• Have you experienced airplane ear in the past?
• Were past experiences with airplane ear prolonged or severe?

What you can do in the meantime
To treat pain, you may take a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), or an analgesic pain reliever such as acetaminophen (Tylenol, others).

Your doctor will likely be able to make a diagnosis based on questions he or she asks and an examination of your ear with a lighted instrument (otoscope). Signs of airplane ear might include a slight outward or inward bulging of your eardrum. If your condition is more severe, your doctor may see a tear in the eardrum or a pooling of blood or other fluids behind the eardrum.

If you're experiencing a spinning sensation (vertigo), there may be damage to structures of your inner ear. Your ENT may suggest a hearing test (audiometry) to determine how well you detect sounds and whether the source of hearing problems is in the inner ear.

For most people airplane ear is easily corrected with self-care strategies. When the symptoms persist, you may need treatments to equalize pressure and relieve symptoms.

Medications
Your doctor may prescribe medications or direct you to take over-the-counter medications to control conditions that may prevent the eustachian tubes from functioning well. These drugs may include:

• Decongestant nasal sprays
• Oral decongestants
• Oral antihistamines

Self-care therapies
Along with your drug treatment, your doctor will instruct you to use a self-care method called the Valsalva maneuver. To do this, you pinch your nostrils shut, close your mouth and gently force air into the back of your nose, as if you were blowing your nose. Once the medications have improved the function of the eustachian tubes, use of the Valsalva maneuver may force the tubes open.

Surgery
Surgical treatment of airplane ear is rarely necessary. However, your doctor may make an incision in your eardrum (myringotomy) to equalize air pressure and drain fluids.

Severe injuries, such as a ruptured eardrum or ruptured membranes of the inner ear, usually will heal on their own in time. Surgery may be needed in rare cases to repair them.

Follow these tips to avoid airplane ear:

• Yawn and swallow during ascent and descent. Yawning and swallowing activate the muscles that open your eustachian tubes. You can suck on candy or chew gum to increase how often you need to swallow.
• Use the Valsalva maneuver during ascent and descent. Gently blow, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times, especially during descent, to equalize the pressure between your ears and the airplane cabin.
• Don't sleep during ascents and descents. If you're awake during ascents and descents, you can do the necessary self-care techniques when you feel pressure on your ears.
• Reconsider travel plans. If possible, don't fly when you have a cold, sinus infection, nasal congestion or ear infection. If you've recently had ear surgery, talk to your doctor about when it's safe to travel.
• Use an over-the-counter decongestant nasal spray. If you have nasal congestion, use a nasal decongestant about 30 minutes to an hour before take-off and landing. Avoid overuse, however, because nasal decongestants taken over several days can increase congestion.
• Cautious use of oral decongestant pills. Oral decongestants may be helpful if taken 30 minutes to an hour before an airplane flight. However, if you have heart disease, a heart rhythm disorder or high blood pressure or if you've experienced possible medication interactions, avoid taking an oral decongestant unless your doctor approves. If you're a man over age 50, you may experience serious side effects after taking decongestants containing pseudoephedrine (Actifed, Sudafed), including a sudden enlargement of the prostate that requires immediate emergency care. If you're pregnant, talk to your doctor before taking oral decongestants.
• Take allergy medication. If you have allergies, take your medication about an hour before your flight.
• Use filtered earplugs. These earplugs slowly equalize the pressure against your eardrum during ascents and descents. You can purchase these at drugstores, airport gift shops or your local hearing clinic.
• Drink plenty of water to avoid dehydration. Staying well hydrated will help avoid irritation of the nasal passages and throat and help ensure better function of the eustachian tubes.
• Avoid alcohol and caffeine. Beverages with alcohol or caffeine can dehydrate you. They also constrict your blood vessels and may increase the risk of ruptured capillaries.

If you're prone to severe airplane ear and must fly often, your doctor may surgically place tubes in your eardrums to aid fluid drainage, ventilate your middle ear and equalize the pressure between your outer ear and middle ear.

Helping children prevent airplane ear
These additional tips can help young child avoid airplane ear:

• Encourage swallowing. Give a baby or toddler a beverage during ascents and descents to encourage frequent swallowing. A pacifier also may help.
• Prevent pain. To help control pain or discomfort, give a child acetaminophen (Tylenol, others) 30 minutes before descent. If you're on a long flight that allows enough time for two doses, you may give a child a dose before the ascent and descent. Usually doses must be four to six hours apart, and there are limits to how many doses can be taken in a 24-hour period. Read the label carefully and ask your doctor for recommendations.
• Avoid decongestants. Decongestants aren't recommended for young children.