An active ear infection (otitis media) involves inflammation and fluid buildup in the middle ear space behind the eardrum. This condition presents a challenge for air travel because the rapid shifts in atmospheric pressure within the aircraft cabin complicate the infection. Understanding the risks and necessary precautions is important for protecting ear health during flight.
Understanding Pressure Changes
The discomfort experienced during air travel relates directly to changes in cabin pressure during ascent and descent. The middle ear is a closed space that must maintain pressure equal to the outside environment. This equalization is performed by the Eustachian tube, a narrow passage connecting the middle ear to the back of the throat. The tube opens briefly to allow air to move in or out, equalizing the pressure.
When an ear is infected, the surrounding tissue becomes swollen and inflamed, often blocking the Eustachian tube. As the plane climbs or descends, the pressure inside the middle ear cannot equalize rapidly enough with the changing cabin pressure. This creates a pressure differential across the eardrum, leading to feelings of fullness and intense pain.
Severe Consequences of Flying While Infected
When the Eustachian tube remains blocked, the resulting pressure imbalance can lead to barotrauma, or pressure injury. This stress places extreme mechanical force upon the tympanic membrane, the thin barrier separating the middle and outer ear. The pressure differential can become so severe that it causes the tympanic membrane to stretch inward or outward sharply.
If the pressure difference is substantial (ranging from 100 to 500 mmHg), the eardrum can sustain a perforation or rupture. A ruptured eardrum typically results in immediate, sharp pain followed by sudden relief, often accompanied by fluid drainage. Severe barotrauma may also cause temporary hearing loss, dizziness, or vertigo.
Actionable Steps for Necessary Travel
The recommendation for anyone with an active ear infection is to postpone air travel until the infection has cleared, typically five to seven days after starting treatment. If travel is unavoidable, consult a healthcare provider to assess the infection’s severity and receive tailored advice.
A doctor may prescribe a short course of oral decongestants, such as pseudoephedrine, to be taken before the flight to help reduce swelling around the Eustachian tube opening.
Using a decongestant nasal spray approximately one hour before takeoff and again 30 minutes before landing can help open the nasal passages, which indirectly aids the Eustachian tube function. During both ascent and descent, passengers must actively work to equalize the pressure by swallowing frequently or chewing gum. The act of swallowing stimulates the muscles that open the Eustachian tube, allowing air to pass.
The modified Valsalva maneuver can be used gently by pinching the nostrils shut, closing the mouth, and blowing air out very softly. Perform this with minimal force, as forceful attempts can increase pressure and worsen barotrauma if the tube is severely blocked. Travelers should remain awake during the descent, since swallowing occurs less frequently during sleep.
For infants or young children with ear infections, feeding them a bottle or breastfeeding during takeoff and landing encourages the necessary swallowing action. This helps equalize their smaller, narrower Eustachian tubes.