Flying on a commercial airliner with an active ear infection is generally discouraged due to the inherent risks associated with cabin pressure changes. An ear infection involves inflammation and fluid buildup in the middle ear, which directly interferes with the body’s natural ability to equalize pressure during flight. The decision to fly must be made after consulting a healthcare provider, as the severity of the infection determines the potential for painful and possibly damaging complications. The physical effects of altitude on a compromised ear can result in severe pain or permanent injury.
The Physiological Impact of Altitude on the Middle Ear
The discomfort many travelers feel during a flight stems from ear barotrauma, which is amplified by an ear infection. Commercial aircraft cabins are pressurized to simulate an altitude of about 6,000 to 8,000 feet, causing air pressure to change rapidly during ascent and descent. The middle ear, an air-filled space behind the eardrum, must constantly match this external pressure to prevent the eardrum from bulging inward or outward.
Pressure equalization is normally regulated by the Eustachian tube, a narrow channel connecting the middle ear to the back of the throat. Swallowing or yawning typically causes this tube to open, allowing air to flow in or out and balance the pressure on both sides of the eardrum. An active ear infection causes the lining of the Eustachian tube to become inflamed, swollen, and often blocked with fluid or mucus.
This blockage prevents the tube from opening effectively, trapping air inside the middle ear. During ascent, trapped air expands and pushes the eardrum outward. During descent, the inability to draw air into the middle ear causes the eardrum to be sucked inward. This mechanical stress is the direct cause of pain and potential injury.
Potential Complications of Flying with an Active Ear Infection
The inability to equalize pressure due to an ear infection increases the risk of severe barotrauma. The most immediate and common complication is intense ear pain, or otalgia, which occurs as the eardrum stretches under the pressure differential. This discomfort can be excruciating, particularly during the plane’s descent when the pressure imbalance is often at its worst.
A sustained, severe pressure differential can lead to the collection of fluid behind the eardrum, known as serous otitis media, which may result in temporary muffled hearing and a feeling of fullness. The most serious potential outcome is a tympanic membrane rupture, also known as a perforated eardrum, which happens when the immense pressure difference tears the delicate tissue. While a ruptured eardrum often provides immediate pain relief, it exposes the middle ear to external contaminants and requires several weeks to heal.
Flying with an inner ear infection, distinct from a middle ear infection, presents the added risk of severe vertigo or balance disorders, as the infection impacts the vestibular system. A bacterial infection adds the complication of forcing infected fluid deeper into the ear structure. The temporary hearing impairment caused by the pressure imbalance can persist for hours or days after landing.
Pre-Flight and In-Flight Strategies for Minimizing Risk
If flying cannot be postponed, there are several actions that can be taken to mitigate the risk of severe barotrauma. Consulting a physician beforehand is advisable, as they may prescribe oral decongestants or nasal sprays to reduce swelling in the Eustachian tubes.
Oral decongestants should be taken 30 to 60 minutes before takeoff and again before descent to maximize their effect during the periods of greatest pressure change. The use of a decongestant nasal spray, such as one containing oxymetazoline, can also be beneficial, applied about 30 minutes before both ascent and descent to shrink the mucous membranes.
For pain management, over-the-counter analgesics like ibuprofen or acetaminophen can be taken prior to the flight to lessen the intensity of any developing ear pain. Pressure-regulating earplugs, which contain a filter to slow the rate of pressure change reaching the eardrum, can give the Eustachian tube more time to adjust.
During the flight, active maneuvers are necessary, especially during takeoff and landing. Chewing gum, sucking on candy, or frequent yawning encourages swallowing, which prompts the Eustachian tubes to open. For adults, the Valsalva maneuver is effective: gently blow air while pinching the nose shut and keeping the mouth closed, creating positive pressure to force the tube open. For infants and young children, feeding them a bottle, breastfeeding, or offering a pacifier during ascent and descent is recommended, as the act of swallowing helps to equalize the pressure.
Absolute Contraindications and When to Consult a Doctor
There are specific medical situations related to the ear that make flying risky without explicit medical clearance. Individuals who have recently undergone ear surgery, such as a myringotomy or mastoid surgery, should not fly until cleared by their surgeon. The presence of an existing eardrum perforation, whether from a prior infection or trauma, can also complicate flying, as it changes the pressure dynamics within the middle ear.
The presence of recently placed tympanostomy tubes, or ear tubes, usually allows for easy pressure equalization, which is a benefit, but a doctor should still be consulted to ensure the tubes are functioning correctly.
Any severe symptoms accompanying the ear infection, such as a high fever above 101°F, sudden onset of vertigo, or an inability to achieve pressure equalization, demand a consultation with a healthcare provider before boarding a flight. If an ear infection is acute and intensely painful, or if a doctor has diagnosed a severe inner ear infection, it is safest to delay travel until the infection has cleared, typically two weeks after treatment has finished.