Air travel planning often collides with the reality of illness, presenting a difficult choice for travelers with a cold. A common cold is a viral infection primarily affecting the upper respiratory tract, causing inflammation and congestion. This swelling can significantly complicate the experience of flying, which involves rapid changes in atmospheric pressure. Making a decision requires balancing personal comfort and health risks with responsibility toward fellow passengers. This guidance addresses the physical dangers and practical steps for flying while sick, as well as the criteria for knowing when to stay home.
The Physical Risks of Flying While Congested
The primary danger of flying with a cold arises from the body’s inability to equalize air pressure in enclosed spaces like the middle ear and sinuses. Air travel requires the Eustachian tubes, which connect the middle ear to the back of the throat, to open and close to match the cabin pressure during ascent and descent. Congestion from a cold causes the tissues surrounding these tubes to swell, effectively blocking this pressure equalization process.
When the tubes are blocked, a condition known as barotrauma, or “airplane ear,” can develop as pressure builds up on one side of the eardrum. This imbalance can lead to intense discomfort, temporary hearing impairment, a feeling of fullness, and in some cases, vertigo. Severe pressure differences can cause more serious injury, including bleeding from the ear, fluid accumulation behind the eardrum, and, rarely, eardrum perforation. A similar, painful pressure imbalance, known as sinus barotrauma, can also occur in the air-filled cavities of the face, causing severe pain across the forehead, cheeks, and eyes.
Strategies to Minimize Discomfort During the Flight
For travelers who determine their cold is mild enough to manage, certain steps can mitigate the risks of barotrauma. Using over-the-counter decongestant medications can help reduce the inflammation in the nasal and Eustachian tube lining. Oral decongestants, such as pseudoephedrine, should be taken approximately 30 to 60 minutes before the aircraft begins its descent, which is the most challenging phase for pressure equalization.
Nasal spray decongestants, like oxymetazoline, may also be used shortly before takeoff and again about 30 minutes prior to landing to shrink nasal tissue swelling. It is helpful to perform physical maneuvers frequently, such as swallowing, chewing gum, or yawning, to encourage the Eustachian tubes to open. A gentle Valsalva maneuver—pinching the nostrils shut and gently blowing air through the nose while keeping the mouth closed—can force air into the middle ear to equalize pressure. This should be done with caution to avoid excessive force.
Using pressure-regulating earplugs can slow the rate of air pressure change reaching the eardrum. It is important to remain awake during the plane’s descent to actively perform these pressure equalization techniques. Remaining properly hydrated during the flight may also help keep mucus thin, which assists in drainage and tube function.
Contagion and When to Cancel the Trip
Traveling while sick also raises public health concerns, as the initial days of a cold represent the highest risk of transmission. The contagious period typically peaks during the first three or four days after symptoms appear. To protect other passengers and crew, simple hygiene practices are recommended, including frequent hand washing and covering coughs and sneezes with a tissue or the elbow. Wearing a high-quality face mask in the airport and on the aircraft can significantly reduce the spread of respiratory droplets.
However, there are specific illness markers that should prompt the cancellation of a trip. A more serious illness could worsen in the lower-oxygen cabin environment if the traveler has:
- A fever above 100.4°F (38°C)
- Severe chest congestion
- Difficulty breathing
- Evidence of a severe ear or sinus infection
Travel should also be postponed if recent ear or sinus surgery has been performed. Airlines retain the right to deny boarding to passengers who appear severely ill or require urgent medical attention during the flight. Consulting a healthcare provider is prudent if any of these severe symptoms are present to determine fitness for air travel.