Flying after an ear infection is a common concern because rapid changes in cabin pressure can cause significant pain and potential ear damage. An active or recently resolved ear infection interferes with the ear’s natural ability to regulate pressure. This failure to equalize air pressure between the middle ear and the cabin leads to discomfort and complications during ascent and descent.
Understanding Barotrauma
The sensation of ear pain or fullness during a flight is caused by a condition known as barotrauma, or “airplane ear.” Barotrauma results from an imbalance between the air pressure in the middle ear space and the surrounding atmospheric pressure in the cabin. The middle ear is a small, air-filled cavity located behind the eardrum.
Air pressure in this cavity is normally regulated by the Eustachian tube, a narrow passage connecting the middle ear to the back of the throat. Swallowing, yawning, or chewing typically causes this tube to open, allowing air to move in or out to equalize the pressure on both sides of the eardrum. An ear infection (otitis media) causes inflammation and fluid buildup that can partially or completely block the tube.
When the Eustachian tube is blocked, rapid pressure changes during flight cannot be properly managed. During ascent, air pressure in the middle ear expands and cannot escape, causing the eardrum to bulge outward. During descent, the cabin pressure increases rapidly, and the middle ear pressure cannot increase to match it, causing the eardrum to be sucked inward. This strain is the source of pain and, in severe cases, can lead to fluid leakage, vertigo, or a ruptured eardrum.
Recommended Waiting Period for Safe Flying
There is no universal, fixed waiting period for flying after an ear infection because recovery time varies greatly among individuals. The primary goal is to wait until the Eustachian tube is fully functioning again, which means the inflammation has resolved and any residual fluid has cleared. A general guideline suggests waiting at least one to two weeks after all symptoms of the acute infection have completely disappeared.
Flying with an active or recent infection carries a high risk of middle ear barotrauma, which can lead to intense pain and eardrum damage. Even after the infection is treated, residual fluid, known as otitis media with effusion, can persist for days or weeks. This fluid acts as a barrier, preventing pressure equalization and significantly increasing the risk of barotrauma during air travel.
Special Considerations
For children, who have narrower and more horizontally oriented Eustachian tubes, the risk is often higher, and medical clearance from a pediatrician is especially important. If the infection was severe, involved inner ear symptoms like dizziness, or resulted in a perforated eardrum, the recovery time before flying should be extended considerably. A physician, particularly an ear, nose, and throat specialist (ENT), can examine the eardrum to confirm the absence of bulging or fluid, ensuring the middle ear is clear for safe travel.
In-Flight Techniques to Minimize Discomfort
If travel cannot be postponed and a physician has cleared the flight, several techniques can help encourage pressure equalization. Strategies focus on opening the Eustachian tube during takeoff and landing. Swallowing is a simple action that engages the muscles opening the tube; chewing gum, sucking on hard candy, or frequently drinking water encourages this. Another method is the Valsalva maneuver, performed by gently pinching the nostrils closed, keeping the mouth shut, and attempting to exhale through the nose. This action forces air into the Eustachian tubes to equalize pressure, but it must be done gently to avoid causing further damage. A decongestant nasal spray containing oxymetazoline 30 minutes before takeoff and again before descent can reduce swelling near the Eustachian tube opening.
Techniques for Infants and Children
For infants and young children, encouraging them to suck or swallow is the best approach. Giving them a bottle, pacifier, or encouraging breastfeeding during ascent and descent helps achieve the necessary muscle movement. Specialized filtered earplugs designed for flying are also available, which slow the rate of pressure change reaching the eardrum.