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with Rod Moser, PA, PhD

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Tuesday, November 18, 2008

Airplane Ears

As the holiday travel season approaches, people will be heading to the airport for destinations unknown, especially since it is too expensive to drive anywhere now. Most air travelers will not have problems with their ears when the cabin is automatically pressurized on take-off or depressurized on landings, but some will (especially children). It even happened to me.

I suspected that I had a cold. No big deal, since I get my share of upper respiratory infections dealing with sick people every day. Although I have become more of a white-knuckle traveler since 9/11, the flight from Washington, DC, to Detroit was surprisingly smooth. I was sitting in the worst seat in the plane – last row; no window, over the noisy engine, and by the bathroom. Henry Kissinger once said that there are only two reasons to sit in the back of the plane by the bathroom: either you have diarrhea, or you enjoy talking to others that do. I was sitting with an elderly woman who remained seated the entire flight, so I am guessing the Kissinger theory did not apply.

For some unknown reason, the plane suddenly descended on the approach to Detroit. Of course, I am thinking this is an evasive maneuver to avoid a mid-air collision, or the pilot couldn’t find the airport until the last minute. The plane rapidly dove a few thousand feet and I thought my ears would explode. The little old lady sitting next to me must have noticed my extreme discomfort, profuse sweating, and grimace on my face. At that point, I was glad I didn’t have diarrhea! She reached over and held my hand, lovingly stroked my arm and said, “Don’t worry, honey… everything will be just fine.” She then proceeded to share a few of her near-death experiences during air travel. I must say it took my mind off of the excruciating ear pain. My ear remained painful and stuffy for the next four days.

I am sure that everyone has noticed that some babies cry as the plane is landing. Although they have no verbal ability to tell us, they are most likely crying because of ear pressure-related pain. Not only is crying an indication of pain, crying is also therapeutic. Crying, like swallowing, will help open the eustachian tubes and relieve middle ear pressure. I do not recommend that adults cry and scream during plane flights. It worries the other travelers.

The eustachian tubes are tiny ventilation and drainage tubes that run from the middle ear space (the area on the other side of your eardrum) to the back of your throat. The primary function of the e-tubes is to make sure the pressure in the middle ear is the same as the outside atmosphere. Rapid changes in barometric pressure that can be experienced during take-off and landings can cause ear pain (otalgia) if the eustachian tubes are not functioning well. In children, the e-tubes are very tiny. In adults, the eustachian tubes are often compromised if you have a cold, allergies, or other types of inflammation in the nose, ears, or throat. People who smoke can have throat inflammation that can cause the eustachian tubes to malfunction. Of course, when your ears are painful it is a bit too late to worry about the cause.

There are a few things you can do BEFORE you fly:

Adults

  • If you have a cold or allergy problem, talk to your doctor about prescribing or recommending some medications that may help prevent “airplane ears”. These include oral or short-acting nasal decongestants, combination decongestant/antihistamines, or prescription nasal steroids sprays. Since many of these medications have side effects or problems for people with high blood pressure, heart disease, pregnancy, thyroid disease, etc., you should NOT self-prescribe (or treat others for that matter) without first consulting your medical provider.
  • Yawning and swallowing will open the eustachian tubes. Many seasoned travelers chew gum, suck on mints or candy, or slowly drink water during take-off or landings.
  • “Popping your ears”: If nothing has worked to prevent the ear pain, you may need to unblock your ears by this pressure equalization maneuver — Pinch your nose and close your mouth. Try to direct the air to the back of your throat and then gently blow (not too hard!) to increase the pressure, directing the air up the eustachian tube. If you hear or feel a “pop” your ears should “open”. This maneuver may need to be repeated throughout your descent. Do not blow TOO HARD or you can make the problem worse.
  • A special type of ear pressure-regulating earplug (EarPlanes) available at pharmacies or the airport convenience stores may be worth trying during ascent and descent. Personally, I have never used them, but some of my patients swear by them.

Infants and Children

  • Like adults, infants with ear infections really should not fly. If possible, the trip should be postponed for a few days to give the antibiotic a chance to work, although I realize that this is not always possible for many reasons.
  • With the permission of your medical provider, infant decongestant nasal sprays* can be safely used for children over the age of two. It is used about one hour before flying (or one hour before landing). For children younger than age two, decongestant cold medicines are no longer recommended, according to the guidelines of the American Academy of Pediatrics. Unfortunately, these are not miracle preventatives.

*Since cabin humidity is notoriously dry, the frequent use of saline (salt water) nasal sprays may also be helpful in the dry air of an airplane for people of any age. You should also fly “well-hydrated”. This means water, and not alcohol, carbonated, or caffeinated drinks.

  • During landing (and even take-off), babies should be encouraged to either breast or bottle-feed to encourage swallowing. Since babies are safer strapped in their car seats, using a bottle would be best. Pacifiers are not a substitute, since they do not encourage beneficial swallowing. Older children can sip from a cup or juice box. If you squeeze the straw a bit as they drink, this extra effort in sucking will be more beneficial in clearing their ears.
  • If the ear pain does not go away relatively soon after landing, your medical provider should be consulted. While not all ear pain is an ear infection, it is not unusual for infants and young children to develop middle ear infections after a recent plane flight, mostly due to the stagnation of fluid in the middle ear and the exposure from new pathogens.

Take your hygiene measures to the highest level. Whip off those tray tables and the arms of the seats with a disinfectant wipe, wash your hands often, and be especially careful when using the bathroom or changing diapers. Avoid touching your own eyes or nose – key entry points for germs. If the person sitting next to you is clearly ill, consider changing seats if possible.

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Posted by: Rod Moser, PA, PhD at 1:42 pm

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