Ear pain during flights is caused by a pressure mismatch between the air sealed inside your middle ear and the rapidly changing cabin pressure, and you can prevent most of it by actively equalizing that pressure with a few well-timed techniques. Swallowing, yawning, and a gentle blowing maneuver called the Valsalva are the first line of defense, while an oral decongestant taken before the flight roughly cuts the risk of barotrauma in half for people prone to it. The key is timing: your ears need the most help during descent, and starting these techniques too late is the most common mistake travelers make.
Why Your Ears Hurt in the First Place
Your middle ear is a small air-filled space behind the eardrum, connected to the back of your throat by a narrow tube called the Eustachian tube. On the ground, the pressure inside your middle ear matches the pressure outside. When a plane climbs, the cabin pressure drops, and the air trapped in your middle ear expands. Most of the time that expanding air vents out through the Eustachian tube on its own, which is why takeoff is usually the easier part of the flight. During descent, the cabin pressure rises again, and the air in your middle ear needs to be replenished. The Eustachian tube doesn’t open as easily in this direction, so the eardrum gets pushed inward by the higher outside pressure. That inward stretch is what you feel as pain, fullness, or muffled hearing.
During a typical flight, your middle ear has to equalize roughly 20 percent of its gas volume to keep up with the cabin pressure change, and it has to do so within about 15 to 20 minutes of ascent or descent to avoid injury.1PubMed. Barotrauma vis-a-vis the “chronic otitis media syndrome”: two conditions with middle ear gas deficiency Modern aircraft cabins are pressurized to the equivalent of roughly 6,000 to 8,000 feet of altitude, which creates enough of a swing in pressure to overwhelm the Eustachian tube if it isn’t actively helped along.2PubMed. Barotrauma during air travel: predictions of a mathematical model
The Techniques That Actually Work
The most reliable way to equalize pressure is to physically open your Eustachian tube so air can flow in or out. You have several options, and the best strategy is to combine more than one.
- Swallowing: Every swallow activates the small muscles that tug the Eustachian tube open for a split second. This is why chewing gum, sucking on hard candy, or sipping water during descent is classic advice. It works because the act of swallowing, not the gum itself, is doing the job.
- Yawning: A full yawn opens the Eustachian tube wider and longer than a swallow does. If you can’t yawn on cue, opening your mouth wide and moving your jaw side to side can mimic part of the effect.
- The Valsalva maneuver: Pinch your nostrils shut, close your mouth, and gently blow as if you’re trying to blow your nose. The pressure you build in the back of your throat pushes air up through the Eustachian tube into the middle ear. This is particularly useful during descent when the tube resists opening on its own. Research confirms this technique produces a measurable increase in middle ear pressure.3Brazilian Journal of Otorhinolaryngology. Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects
- The Toynbee maneuver: Pinch your nostrils shut and swallow at the same time. This can lower middle ear pressure during ascent when the air inside needs to escape rather than enter. It’s gentler than the Valsalva and useful for people who find blowing uncomfortable.
The Valsalva is by far the most effective of these for descent, but it requires a light touch. Blowing too hard can damage the inner ear. Think of it as a gentle, sustained push rather than a forceful blast. If you feel a soft pop or click in both ears, you’ve equalized successfully. If nothing happens, swallow while maintaining gentle pressure and try again.
Timing Matters More Than Technique
The biggest mistake people make is waiting until their ears already hurt before trying to equalize. By that point, the pressure difference has pushed the eardrum far enough inward that the Eustachian tube is mechanically harder to open. Think of it like a door that swings open easily when balanced but sticks once something heavy is leaning against it. Start your chosen technique as soon as the captain announces the descent, or even a few minutes before if you notice the engines change pitch. Repeat every 15 to 30 seconds during the descent phase. Being proactive is far more effective than being reactive.
Ascent is usually gentler because the expanding air in your middle ear pushes the Eustachian tube open from the inside. Most people equalize on takeoff without even trying. But if you do feel fullness on the way up, a swallow or a Toynbee maneuver is usually enough.
Oral Decongestants vs. Nasal Sprays
If your Eustachian tube is sluggish, say from a cold, allergies, or just natural anatomy, a medication can shrink the swollen tissue around the tube’s opening and make equalization easier. The evidence here is surprisingly clear-cut for one option and disappointing for another.
Oral pseudoephedrine, taken at least 30 minutes before the flight, cut the rate of ear symptoms roughly in half across multiple trials. In one study, about a third of people who took pseudoephedrine reported ear discomfort compared with about two-thirds of the placebo group.4PubMed. Efficacy of pseudoephedrine for the prevention of barotrauma during air travel A separate trial found similar numbers, with about 34 percent of the pseudoephedrine group affected versus 71 percent of controls.5PubMed. A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel A meta-analysis pooling the available trials confirmed the pattern: pseudoephedrine reduced the overall risk of otic barotrauma by about 45 percent, with consistent reductions in ear pain, blockage, and temporary hearing loss.6Otology & Neurotology. Efficacy of Pseudoephedrine and Oxymetazoline in Preventing Otic Barotrauma: A Systematic Review and Meta-Analysis
Oxymetazoline nasal spray, the active ingredient in products like Afrin, performed much less impressively. The same meta-analysis found only a modest overall effect that barely reached statistical significance, and its benefits were inconsistent across symptoms like pain, blockage, and hearing loss.6Otology & Neurotology. Efficacy of Pseudoephedrine and Oxymetazoline in Preventing Otic Barotrauma: A Systematic Review and Meta-Analysis One earlier trial found oxymetazoline performed little better than a placebo.5PubMed. A double-blind comparison between oral pseudoephedrine and topical oxymetazoline in the prevention of barotrauma during air travel The reason likely comes down to reach: a nasal spray shrinks tissue mostly in the nasal passages, while an oral decongestant works systemically and affects the tissue deeper in the throat where the Eustachian tube actually opens.
Pseudoephedrine does have side effects worth knowing about: it can raise your heart rate and blood pressure, cause jitteriness, and interact with certain medications. In the United States it’s kept behind the pharmacy counter, though no prescription is needed. People with uncontrolled high blood pressure or certain heart conditions should talk to a doctor before using it. But for the average healthy adult who knows they struggle with ear pain on flights, a 120-milligram dose taken 30 minutes to an hour before departure is the best-studied pharmaceutical option available.
Do Pressure-Equalizing Earplugs Work?
You’ll find filtered earplugs marketed specifically for air travel, sometimes called “pressure-regulating” or “flight earplugs.” The idea is that a ceramic or silicone filter slows the rate at which cabin pressure changes reach your eardrum, giving the Eustachian tube more time to catch up. It sounds reasonable in theory. In practice, the evidence is not encouraging.
A controlled study comparing pressure-equalizing earplugs to dummy plugs during a simulated descent from 8,000-foot cabin altitude found no difference in how much middle ear pressure dropped between the two. In fact, the ears wearing the “active” earplugs actually scored worse on otoscopic examination afterward.7PubMed. Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude A systematic review of prevention methods reached a similar conclusion, finding insufficient evidence to support either pressure-equalizing earplugs or nasal balloon inflation devices for preventing otic barotrauma.8Otology & Neurotology. Prevention of Otic Barotrauma in Aviation: A Systematic Review
This doesn’t mean the plugs can’t provide any subjective comfort. Some travelers report they help, and the placebo effect of feeling prepared may reduce anxiety-related tension around the jaw and throat. But if you’re choosing between spending money on flight earplugs and spending it on a box of pseudoephedrine, the decongestant has far stronger evidence behind it.
Who Is Most at Risk
Not everyone is equally prone to airplane ear. Several factors stack the odds against you.
Having a cold or upper respiratory infection is the single biggest risk factor. The swelling narrows the Eustachian tube and makes equalization much harder. This applies to experienced aviators as well: a study of military aircrew found that even seasoned pilots developed barotrauma when they flew with a cold or upper respiratory tract infection.9Journal of Armed Forces Medical College, Bangladesh. Middle Ear Barotrauma in Military Aircrew: Analysis of Risk Factors If you’re congested and your flight is optional, delaying it is genuinely worth considering.
Children are more vulnerable than adults because their Eustachian tubes are shorter and positioned at a less efficient angle, and the muscle that opens the tube has a smaller surface area.10PubMed Central. Eustachian tube-tensor veli palatini muscle-cranial base relationships in children and adults: an osteological study Roughly 22 percent of children may show eardrum changes after a flight, compared with about 10 percent of adults.11PubMed Central. Middle-ear pain and trauma during air travel For babies and toddlers who can’t perform a Valsalva on command, offering a bottle, pacifier, or sippy cup during descent encourages swallowing and helps their ears equalize.
Allergies and chronic sinus problems also contribute by keeping the tissue around the Eustachian tube chronically swollen. A deviated nasal septum may modestly increase risk as well: one study of military trainees found septal deviation raised the risk of barotrauma by about 23 percent, though the finding didn’t quite reach statistical significance.12Medical Journal of Indonesia. Septal deviation and other factors increase the risk of barotitis media in high altitude high opening training People with a history of ear surgery or chronic ear infections sometimes have altered middle ear anatomy that changes the equalization equation, though not always for the worse. A smaller mastoid cavity actually requires less gas exchange to equalize, so some people with “chronic ears” tolerate pressure changes more easily than expected.1PubMed. Barotrauma vis-a-vis the “chronic otitis media syndrome”: two conditions with middle ear gas deficiency
Sleeping Through Descent Is a Trap
One of the most common scenarios for severe ear pain involves falling asleep before the plane begins its descent. While you’re asleep, you aren’t swallowing frequently, you aren’t yawning, and you certainly aren’t performing a Valsalva. The pressure differential builds gradually as the plane drops altitude over 15 to 20 minutes, and you wake up with intense pain, muffled hearing, or both. By the time you realize what’s happening, the Eustachian tube may be locked shut by the pressure difference, and the techniques that would have prevented the problem now barely work.
If you know you’re a sleeper, set an alarm for about 30 to 40 minutes before your scheduled landing time. On most flights the seatbelt sign comes on during the initial descent, and cabin crew often make an announcement, but neither is guaranteed to wake you. Alternatively, ask a neighbor to nudge you if the plane starts descending. This one piece of planning prevents more cases of airplane ear than almost any other intervention.
When Ears Don’t Clear After Landing
Mild ear fullness or slightly muffled hearing after a flight is common and usually resolves on its own within hours or at most a few days.11PubMed Central. Middle-ear pain and trauma during air travel Continuing to do gentle Valsalva maneuvers and swallowing frequently after landing helps speed the process. A decongestant can also help if congestion is keeping the tube closed.
See a doctor if you experience sharp pain that persists beyond a day, fluid draining from the ear, significant hearing loss, or dizziness. These can indicate a more serious barotrauma, such as a ruptured eardrum or, in rare cases, a perilymph fistula, which is a leak of inner ear fluid that can cause persistent vertigo and progressive hearing loss. In a case series of suspected perilymph fistulas from barotrauma, surgical exploration revealed evidence of leaking fluid around the inner ear membranes in the large majority of patients.13PubMed Central. Effects of early surgical exploration in suspected barotraumatic perilymph fistulas These serious outcomes are rare in normal commercial flying, but they’re worth knowing about because early treatment matters.
What Frequent Flyers Can Learn From Flight Attendants
There’s an interesting wrinkle in who suffers from airplane ear: people who fly frequently seem to develop better Eustachian tube function over time. A study comparing flight attendants to non-flying controls found that the cabin crew had measurably larger ear volumes and were significantly better at equalizing pressure after performing a Valsalva maneuver.14PubMed Central. Eustachian Tube Function in Flight Attendants The finding suggests the Eustachian tube may respond to repeated pressure challenges the way muscles respond to exercise, becoming more responsive over time. For occasional travelers, this means the first few flights may be the worst, and the problem can ease with experience. It also means that if your ears suddenly start bothering you after years of pain-free flying, something has probably changed, likely a cold, new allergies, or sinus congestion, rather than your ears getting worse at the job.
A Pre-Flight Checklist
Putting all of this together into a practical sequence:
- Days before: If you have a cold or bad congestion, consider whether rescheduling the flight is possible. If not, start treating the congestion with whatever you normally use.
- 30-60 minutes before departure: Take 120 milligrams of pseudoephedrine if you’re prone to ear trouble and have no contraindications. Have gum, candy, or a water bottle in your carry-on.
- During ascent: Swallow frequently. If you feel fullness, try a Toynbee maneuver (pinch nose and swallow). Ascent is usually manageable without much effort.
- Mid-flight: Set an alarm so you don’t sleep through the descent. Stay hydrated, since dry cabin air can thicken mucus.
- During descent: Begin gentle Valsalva maneuvers as soon as the plane starts descending and repeat every 15 to 30 seconds. Alternate with swallowing. If one ear clears but the other doesn’t, tilt the stubborn side upward and try again.
- For children: Offer a bottle, pacifier, or snack during descent. Older kids can chew gum or try blowing through a pinched nose if they’re old enough to understand.
Nasal sprays like oxymetazoline are not harmful to add to this routine, but the evidence suggests they contribute relatively little beyond what oral pseudoephedrine and active equalization already achieve. If you rely on them alone, you’re likely to be disappointed.
The Role of Cabin Pressure Itself
Some newer aircraft, like the Boeing 787 Dreamliner, pressurize the cabin to the equivalent of a lower altitude, roughly 6,000 feet compared with the 8,000-foot equivalent on older planes. That difference translates into a smaller pressure swing your ears need to handle. Passengers on these planes sometimes report fewer ear problems, though no controlled studies have compared barotrauma rates between aircraft types. The trend in aircraft design is toward lower effective cabin altitudes, which should gradually make airplane ear less common over time. Still, even at 6,000 feet equivalent altitude, the pressure change is more than enough to cause pain if you’re congested or not actively equalizing.
Smaller regional jets and turboprops sometimes descend more steeply than large long-haul aircraft, meaning the pressure change happens faster. If you’ve noticed your ears hurt more on short regional hops than on transatlantic flights, the steeper descent rate is a likely explanation. The same techniques apply, but you may need to be more aggressive about starting them early.