By Ns1ghter Provider: William Jantsch MD

What to do when your ears feel plugged and you have to fly…

A common question I am asked when seeing patients in our Urgent Care Center is “how can I fly in an airplane with this ear and sinus congestion?”

The space behind the ear drum is called the “middle ear”, and this space is vented through a small channel called the eustachian tube into the nasopharynx. You can feel the eustachian tube opening up when you swallow or yawn; this opening is the source of your feeling your ears “pop”. When you experience a change in air pressure, such as a commercial air flight, you need to keep balancing the pressure behind your eardrums with the outside pressure. Hence the need to yawn or chew gum while taking off and landing in an airplane.

However, the eustachian tubes can fail to function properly if inflamed or full of secretions, as happens with a cold, sinus infection, or upper airway allergies. If you try to fly under this circumstance, the air pressure in your middle ear will not balance with the outside pressure, and there will then be tension on the ear drum. This can be very painful, and lead to hearing loss, ringing in the ear, and even rupture of the eardrum. Damage due to air pressure differences is called barotrauma.

Multiple interventions have been proposed to avoid ear barotrauma, and to treat it once it has occurred.

Prevention:

- Don’t fly if you have nasal congestion due to upper respiratory infection or allergy, and you feel like you can’t “pop” your ears

- Oral Sudafed, taken 1 hour prior to flight

- Topical decongestant (e.g. Afrin, used just before boarding the plane)

- Ibuprofen (in anticipation of pain)

- OTC antihistamine (if your symptoms are allergy related)

- Earplugs

The benefit here is if you place an air-tight plug in your ear at ground level, there will be no need to equalize the pressure in your middle ear at altitude. This can work well, but the plug must be air tight- use a “sticky” moldable silicone plug (e.g. Mack’s or Ear Plane) available at the drug store

Treatment:

- Valsalva maneuver (Traditional, Frenzel, Toynbee)

Tradition says to take in a breath, then hold your nose closed by pinching with your thumb and forefinger; imagine then trying to force air out through your nose (even though it is blocked), and gradually increase the amount of force against your nose until one or both of your ears “pops”. Be careful not to try to hard, because you can damage your eardrums with this maneuver

Dr. Frenzel suggests holding your nose and repeated make the sound “kah” or “gah”

Dr. Toynbee seems to have gotten good results with holding his nose shut and trying to swallow repeatedly

- Steam from hot-water soaked paper napkins

Ask the flight attendant for a cup of hot water, and an extra empty cup, along with several napkins. Crumple a napkin in the bottom of the empty cup, and soak the napkin with some hot water. Hold the steaming soaked napkin up against the painful ear; I have not tried this, but people have reported substantial pain relief with this method

- Sucking on hard candy vs chewing gum

Hard candy is believed to work better, because it causes you to swallow more than with standard chewing gum

- Allowing a child to feed

Having a baby with an ear infection on the flight is no fun for the child or anybody else. The act of swallowing is the best way to vent the eustachian tube, so make sure you have plenty of fluids for the baby to drink

Seek Medical Care if:

- Severe pain

- Unable to hear after a flight, or persistent unusual ringing sound

- Bleeding or discharge from an ear

- Dizziness or “spinning” sensation

- Fever, headache, confusion

Have a good flight!