A sinus infection (sinusitis) is characterized by inflammation and swelling of the tissue lining the sinuses. This swelling often blocks the small openings that allow the sinuses to drain into the nasal passages. While flying with a mild sinus infection is technically possible, it is frequently uncomfortable and carries risks that can sometimes lead to serious complications. The decision to fly depends on the severity of your symptoms and the potential for pain.
Understanding Pressure Changes and Discomfort
The intense discomfort during air travel stems from the inability of blocked passages to equalize pressure with the changing cabin environment. As the aircraft ascends or descends, ambient air pressure changes rapidly. Normally, the air in your sinuses and middle ear adjusts to match the surrounding pressure through small channels.
When a sinus infection causes inflammation, the openings (ostia) connecting the sinuses to the nasal cavity become obstructed. This blockage prevents the trapped air inside the sinuses from expanding or contracting freely. During descent, this creates a vacuum effect known as barosinusitis, or sinus squeeze, which pulls on the sensitive mucosal lining. The resulting pain is felt as severe pressure around the forehead, cheeks, and eyes, sometimes accompanied by a nosebleed.
The same mechanism affects the middle ear via the Eustachian tubes, which connect the middle ear space to the back of the throat. When these tubes are blocked by swelling, pressure cannot be equalized across the eardrum. This pressure imbalance, known as barotitis media or ear barotrauma, causes pain and a muffled hearing sensation. The pain is typically most noticeable during the plane’s descent when the external pressure increases.
Potential Complications of Flying While Sick
The pressure differences created by a flight can cause more than just temporary pain; they carry a risk of physical injury to the tissues. Barosinusitis involves stretching and injury to the sinus walls, causing significant pain and sometimes temporary bleeding. This tissue damage can prolong the recovery from the initial infection.
The complications affecting the ear are generally more concerning. Severe barotitis media can result in temporary hearing loss, dizziness, or vertigo. In rare but severe cases, the sustained negative pressure can cause fluid to build up behind the eardrum or even lead to a rupture of the eardrum membrane. A ruptured eardrum requires medical attention and can take weeks to heal completely.
Furthermore, a failure to equalize pressure can contribute to the worsening of the underlying infection. Trapped fluid and mucus in the blocked middle ear and sinus cavities create an ideal environment for bacteria to multiply. This can lead to a more intense or prolonged infection.
Strategies for Safer Travel
For those with a mild infection who must fly, preparation is important to mitigate pressure injury risks. Taking a decongestant medication before the flight can help reduce swelling in the nasal passages and Eustachian tubes. Oral decongestants like pseudoephedrine are often recommended about an hour before takeoff, and again an hour before landing on longer flights.
Topical nasal sprays containing oxymetazoline can also be used approximately 30 minutes before takeoff, as they are fast-acting and target the nasal lining directly. However, nasal sprays should be used sparingly for only a few days to avoid rebound congestion, which can worsen symptoms. Using a saline nasal spray throughout the flight helps to keep the mucous membranes moist, countering the effect of the dry cabin air.
During the ascent and descent, actively working to equalize pressure can help prevent barotrauma. Simple actions like chewing gum, yawning, or frequently swallowing water can prompt the Eustachian tubes to open. The Valsalva maneuver, which involves pinching the nostrils shut and gently attempting to exhale through the nose, can also force air into the middle ear. This maneuver should be done gently and repeatedly during the plane’s descent, before pain becomes severe.
Deciding If You Should Fly
While mild congestion can often be managed with preparation, certain symptoms indicate that flying should be postponed. You should avoid air travel if you have severe facial pain, a high fever, or significant pain in the ears before boarding. These symptoms suggest a substantial blockage that is unlikely to be resolved by over-the-counter medications and maneuvers.
It is also advisable to postpone a flight if you are experiencing vertigo or a severe earache, as these symptoms indicate a high risk for severe barotrauma or eardrum injury. Individuals who have recently undergone ear or sinus surgery should consult a physician, as their internal structures are more susceptible to pressure changes. When severe symptoms are present, delaying travel until the infection improves is the safest course of action.