How to Prevent Ears From Hurting on a Plane

Ear pain during a flight is caused by a pressure imbalance between the air inside your middle ear and the rapidly changing cabin pressure, and the good news is that a handful of simple techniques can prevent or minimize it. The discomfort is most common during descent, when cabin pressure rises and your Eustachian tube struggles to let air back into the middle ear space. Swallowing, yawning, gentle pressure-equalization maneuvers, and sometimes an over-the-counter decongestant taken before the flight can keep the pressure balanced and your ears comfortable.

Why Your Ears Hurt During Descent

Your middle ear is a small, air-filled chamber separated from the outside world by your eardrum. It connects to the back of your throat through a narrow passage called the Eustachian tube, which is normally closed. When cabin pressure changes, air needs to move through that tube to keep the pressure equal on both sides of the eardrum. During climb, the air inside your middle ear expands and usually vents out through the tube without much trouble. During descent, though, the cabin pressure increases, and air has to push back in through the tube, which is harder because the tube’s soft walls tend to stay shut under pressure.

When air can’t get in fast enough, the eardrum gets pushed inward, stretching the tissue and causing that familiar stuffiness, muffled hearing, and sometimes sharp pain. In aviation medicine, this is called otic barotrauma. It occurs due to the pressure difference between the middle ear and the ambient environment, and it’s the reason prevention strategies focus almost entirely on helping air move through the Eustachian tube during descent.

The Best Techniques to Equalize Pressure

Several methods can coax the Eustachian tube open. None of them is dramatically more effective than the others across studies, which means the best strategy is knowing a few and switching between them if one isn’t working.

Swallowing: Every time you swallow, the muscles around your Eustachian tube briefly pull it open. Chewing gum, sucking on hard candy, or sipping water during descent all encourage frequent swallowing. This is the easiest and most passive method.
Yawning: A full yawn opens the Eustachian tube more widely than a regular swallow. If you can’t yawn on command, mimicking the jaw motion with your mouth wide open can produce a similar effect.
Valsalva maneuver: Pinch your nostrils shut, close your mouth, and gently blow as if trying to push air out through your nose. This forces air up the Eustachian tube and into the middle ear. The key word is “gently.” Blowing too hard can damage the eardrum or inner ear structures. If it doesn’t work on the first soft push, try swallowing while you blow.
Toynbee maneuver: Pinch your nostrils shut and swallow at the same time. The swallowing opens the tube while the pinched nose directs the pressure change inward. Some people find this more comfortable than the Valsalva because it doesn’t involve forced blowing.

A study of 60 ears comparing the Valsalva maneuver, the Toynbee maneuver, and a mechanical inflation device found roughly similar success rates across the techniques, with no statistically significant difference in how much middle-ear pressure each one shifted. In about half the cases where one technique failed, one of the other two succeeded, which reinforces the value of having more than one tool in your kit.¹ Flight attendants, who face pressure changes on every shift, appear to develop stronger equalization ability over time: a study of 115 participants found that flight personnel were significantly better at equalizing ear pressure after performing the Valsalva maneuver than non-flying controls.² The takeaway for occasional flyers is that practice helps, and you can rehearse these techniques on the ground before your trip.

When to Start Equalizing

Timing matters more than most people realize. The captain typically announces the descent, and cabin crew begin preparations, but pressure changes can begin well before you feel the plane physically tipping forward. Start swallowing or performing gentle Valsalva maneuvers as soon as you notice the first hint of ear fullness or when the seatbelt sign comes on for landing. Waiting until the pain is already sharp means the Eustachian tube has already been pushed closed by the pressure difference, and it becomes much harder to open.

On ascent, you usually don’t need to do much because air escapes the middle ear passively. But if you feel any fullness during climb, a swallow or yawn is typically enough to clear it. The real work happens on the way down.

Over-the-Counter Decongestants

If you’ve had ear pain on previous flights or you’re flying with mild congestion, an oral decongestant taken before the flight can reduce swelling around the Eustachian tube opening and make equalization easier. Pseudoephedrine is the most studied option. In a controlled trial of 190 travelers, ear discomfort occurred in about a third of those who took 120 mg of pseudoephedrine at least 30 minutes before the flight, compared with about 62% of those who took a placebo.³ Side effects were minimal, though a small number of participants experienced drowsiness.

Nasal spray decongestants, like oxymetazoline, have a more mixed track record. One trial found that oxymetazoline spray reduced barotrauma symptoms only modestly, with a relative risk reduction of about 10% compared to placebo, which led the authors to conclude that the spray was “little more effective than placebo.”⁴ A later meta-analysis pooling two trials on oxymetazoline found a modest overall benefit, but the results were inconsistent across symptom subgroups.⁵ A BMJ review put it more bluntly, concluding that we don’t know whether topical nasal decongestants can prevent barotrauma symptoms compared with placebo.⁶

So if you’re going to use a decongestant, oral pseudoephedrine has the stronger evidence behind it. Take it at least 30 minutes before takeoff, and keep in mind that it’s sold behind the pharmacy counter in many countries because of regulatory restrictions. People with high blood pressure, heart conditions, or anxiety disorders should check with a pharmacist first, since pseudoephedrine can raise heart rate and blood pressure.

Do Filtered Earplugs Work?

You’ll find earplugs marketed specifically for air travel, usually with a small ceramic filter or vent designed to slow the rate of pressure change reaching the eardrum. The idea is appealing: if the pressure shifts more gradually, your Eustachian tube has more time to adjust. These plugs are cheap, widely available, and harmless to try. But the clinical evidence is thin. A systematic review on barotrauma prevention found insufficient evidence to support the efficacy of pressure-equalizing earplugs for preventing otic barotrauma.⁷

That doesn’t mean the plugs are useless for every individual. Some frequent flyers swear by them, and there’s little downside to trying a pair. But if you’re prone to significant ear pain, relying solely on filtered earplugs is probably not enough. Use them alongside the swallowing and maneuver techniques described above.

Flying With a Cold or Allergies

A stuffy nose is the single biggest risk factor for ear pain on a plane. When the lining of your nasal passages and Eustachian tube is swollen from a cold or allergic reaction, the tube can’t open properly no matter how many times you swallow. Data from commercial pilots illustrates the problem: among pilots who flew despite having signs of an upper respiratory infection, the proportion experiencing otic barotrauma rose substantially, even though many were also taking decongestant medication.⁸

If you have a head cold and can postpone the flight, that’s the most reliable prevention. If you can’t reschedule, take an oral decongestant before the flight, use a saline nasal rinse an hour or so beforehand to clear mucus, and be aggressive with equalization techniques during descent. Allergy sufferers who fly regularly may benefit from taking their usual antihistamine or nasal corticosteroid spray in the days leading up to a flight, since these reduce baseline swelling in the nasal passages.

A study of aircrew members found that allergies roughly doubled the odds of experiencing otic barotrauma, and smoking also raised the risk.⁹ Smoking causes chronic irritation and swelling of the mucous membranes, which can impair Eustachian tube function even when you don’t feel “stuffed up.” If you smoke, this is one more reason the tube might not cooperate during descent.

Helping Babies and Young Children

Children are more vulnerable to airplane ear than adults because their Eustachian tubes are shorter, more horizontal, and more compliant, which makes the tube less efficient at opening and equalizing middle ear pressure during rapid altitude changes.¹⁰ An estimated 22% of children may show eardrum changes after a flight, compared with about 10% of adults.⁶ Kids can’t perform a Valsalva maneuver on command, and telling a toddler to “just swallow” rarely goes well, so the strategy shifts to indirect methods.

For infants, nursing or bottle-feeding during descent is the most effective approach because sucking and swallowing naturally opens the Eustachian tube. Offering a pacifier works too. For toddlers and preschoolers, a sippy cup of water, a lollipop, or a snack that requires chewing can all promote swallowing at the right time. Try to keep the child awake during descent if possible, since swallowing slows during sleep and the tube won’t equalize passively.

Evidence on oral decongestants for children before flights is limited. The same BMJ review that found pseudoephedrine helpful in adults noted that we don’t know whether it’s also beneficial in children, and it may cause drowsiness.⁶ If your child has a history of severe ear pain during flights or has active ear infections, talk to a pediatrician before traveling.

Other Risk Factors You Might Not Expect

Beyond colds and allergies, a few less obvious factors can predispose you to airplane ear. The aircrew study mentioned earlier found that female crew members with hormonal disturbances or those taking hormonal therapy had roughly two and a half to three times the odds of developing barotrauma.⁹ The connection is thought to relate to the way hormonal shifts can cause swelling in the nasal and Eustachian tube mucosa. People who fly heavily, logging more than 70 hours per month, also had significantly higher odds, suggesting cumulative exposure without adequate recovery plays a role.

Frequent ear infections, a history of ear surgery, and conditions like a deviated septum or nasal polyps can all make equalization harder. If you’ve been told you have poor Eustachian tube function, or you regularly experience ear barotrauma despite using all the standard techniques, an ear-nose-throat specialist can evaluate whether there’s a structural issue that a minor procedure could address.

What to Do if Prevention Fails Mid-Flight

Sometimes, despite your best efforts, your ears lock up during descent and the pain intensifies. If gentle Valsalva attempts aren’t working, try the Toynbee maneuver instead, or combine approaches: pinch your nostrils, take a sip of water, and swallow while maintaining gentle nasal pressure. Yawning widely can sometimes break the seal when blowing won’t. Some people find that tilting the affected ear upward helps, though there’s no clinical data on this particular trick.

If the pain is severe and nothing is working, avoid the temptation to blow harder. Aggressive Valsalva maneuvers can damage the round window membrane in the inner ear or cause a small hemorrhage in the middle ear lining. A hot towel pressed against the ear (flight attendants will sometimes prepare one for you) can provide comfort through warmth, but it doesn’t address the underlying pressure problem.

After landing, most discomfort resolves within minutes to hours as the pressure gradually equalizes on its own. Persistent muffled hearing, continued pain beyond a few hours, dizziness, or any fluid draining from the ear are signs of more significant barotrauma. These warrant a visit to a doctor. Eardrum perforation from air travel does happen, though it’s rare. When it does occur, it usually heals on its own within weeks, but it needs to be monitored.

Cabin Pressure and Newer Aircraft

Commercial aircraft cabins are pressurized, but not to sea-level pressure. They’re typically maintained at an equivalent altitude of roughly 6,000 to 8,000 feet. During descent, the cabin pressure rises from that cruising equivalent back toward the airport’s actual altitude. The rate at which this happens depends on the descent profile and the aircraft’s pressurization schedule. Some newer wide-body aircraft are designed to maintain a lower cabin altitude, meaning the total pressure swing during the flight is smaller, and the rate of change during descent can be gentler.¹¹

You won’t always know what aircraft you’ll be on, but if you’re booking a long-haul flight and you’re particularly susceptible to ear pain, it’s worth noting that newer composite-fuselage jets generally offer a slightly more ear-friendly cabin environment. The difference isn’t dramatic enough to override other booking considerations for most people, but it’s a factor that frequent flyers with chronic Eustachian tube problems sometimes take into account.

Putting a Pre-Flight Routine Together

If you’re someone who dreads the descent portion of every flight, a simple pre-flight checklist can make a real difference. First, assess your nasal congestion level. If you’re congested from a cold or allergies, take 120 mg of pseudoephedrine at least 30 minutes before boarding, assuming you have no contraindications. Second, bring something to chew or sip during descent: gum, hard candy, or a water bottle. Third, stay awake during landing, or at least set an alarm for 20 minutes before the scheduled arrival so you’re conscious and actively equalizing during the pressure change.

During descent, start equalizing at the first sign of ear fullness. Alternate between swallowing, yawning, and gentle Valsalva or Toynbee maneuvers every 15 to 30 seconds until the plane is on the ground. If one technique stops working, switch to another. For children, start the bottle, sippy cup, or snack as soon as the descent announcement is made and keep it going until landing. The goal is continuous, gentle pressure relief rather than one big correction after the pain has already built up.

1
PubMed. A comparative study on efficiency of middle ear pressure equalization techniques in healthy volunteers
2
Europe PMC. Eustachian Tube Function in Flight Attendants
3
PubMed. Efficacy of pseudoephedrine for the prevention of barotrauma during air travel
4
PubMed. A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel
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Otology & Neurotology. Efficacy of Pseudoephedrine and Oxymetazoline in Preventing Otic Barotrauma: A Systematic Review and Meta-Analysis
6
PubMed Central. Middle-ear pain and trauma during air travel
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Otology & Neurotology. Prevention of Otic Barotrauma in Aviation: A Systematic Review
8
PubMed Central. Upper Respiratory Infections and Barotrauma Among Commercial Pilots
9
International Journal of Life Science and Pharma Research. THE PREVALENCE AND RISK FACTORS OF OTIC BAROTRAUMA AMONG AIRCREW MEMBERS
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Europe PMC / AIMS Public Health. “Airplane ear”-A neglected yet preventable problem.
11
ScienceDirect. Travel Medicine (Fourth Edition) – Chapter 47: The Aircraft Cabin Environment