Traveling with a child who has an ear infection (Otitis Media) is a common concern for parents planning flights. This condition involves inflammation or fluid buildup in the middle ear, complicating the body’s natural mechanism for managing air pressure. Flying under these circumstances can cause significant discomfort and carries a risk of potential harm. Parents should understand the physiological mechanism and consult a pediatrician before air travel.
Understanding Pressure Changes and the Middle Ear
The discomfort during air travel results from rapid changes in air pressure during ascent and descent. The middle ear is an air-filled cavity behind the eardrum, and its pressure must be equalized with cabin pressure to prevent pain. This equalization is handled by the Eustachian tube, a narrow passage connecting the middle ear to the back of the throat and nose.
An ear infection causes swelling and congestion in the middle ear lining and the Eustachian tube. When the tube is blocked, it cannot open properly, creating a pressure difference across the eardrum called barotrauma, which is the source of sharp pain.
Children are more susceptible than adults because their Eustachian tubes are shorter, narrower, and more horizontal. This orientation makes them easier to block with mucus and inflammation. The trapped air expands or contracts against the inflamed eardrum, leading to greater pain. Barotrauma is found in 22% of children after a flight, compared to 10% of adults.
When Flying Should Be Avoided
Flying should be avoided entirely if a child has a severe, acute ear infection, especially one with a bulging eardrum or significant pain. The pressure imbalance can intensify pain and, rarely, lead to eardrum perforation or rupture. If an acute infection is diagnosed within 48 hours of an unavoidable flight, parents must seek clinical evaluation and pain relief.
Flying is also contraindicated if the child has a recently perforated eardrum or recently placed ventilation tubes (grommets). Recent ear surgery requires caution, though stable, long-standing tubes handle pressure changes well. Physicians generally advise against flying following the insertion of tympanostomy tubes to allow for proper healing.
It is recommended that children wait approximately two weeks after an acute otitis media diagnosis before flying, if possible, to ensure the infection has fully resolved. If the infection is less severe, such as otitis media with effusion (fluid buildup without acute infection), flying may be possible, but consultation with a pediatrician remains paramount.
In-Flight Techniques to Ease Ear Pain
For a child with a mild or resolving ear infection who must fly, preparation and in-flight maneuvers can help minimize discomfort. Discuss the trip with a doctor beforehand; they may recommend timing a pain reliever like acetaminophen or ibuprofen. Administer these medications approximately 30 minutes before takeoff and landing to manage anticipated pain.
The most effective strategy involves encouraging actions that open the Eustachian tube, essential during ascent and descent. Infants should be encouraged to suck or swallow using breastfeeding, bottle-feeding, or a pacifier during these periods. Swallowing helps activate muscles that open the tubes, equalizing the pressure.
Techniques for Older Children
Older children can achieve the same result by chewing gum or sucking on a hard candy, if they are over age three. Another technique is the gentle Valsalva maneuver: pinching the nostrils shut, closing the mouth, and trying to exhale gently through the nose. This action forces air into the middle ear to equalize the pressure.
It is helpful to keep the child awake during takeoff and landing, since swallowing occurs less frequently during sleep. A physician may also recommend a topical nasal decongestant spray 30 minutes before these phases, which helps reduce swelling and assists the Eustachian tube’s function.