The pain felt in the ears during an airplane’s descent is a common medical issue known as ear barotrauma, or aerotitis media. This discomfort results from a pressure imbalance between the air outside the body and the small air-filled space in your middle ear. While the feeling is often temporary, the pain is a sign that your body’s natural pressure regulation system is overwhelmed. This phenomenon is a mechanical injury to the ear structure caused by rapid changes in atmospheric pressure, a situation most often experienced during the landing phase of a flight.
Understanding Ear Barotrauma
The middle ear is a small, sealed cavity located behind the eardrum, and it must maintain air pressure equal to the outside environment for comfortable hearing. A narrow passage called the Eustachian tube connects this middle ear space to the back of the throat and nose. The tube opens periodically, allowing air to move in or out to equalize the pressure on both sides of the eardrum.
During an airplane’s descent, cabin air pressure steadily increases as the plane moves toward lower altitudes. The pressure pushing on the outside of the eardrum quickly becomes greater than the pressure inside the middle ear. This difference creates a relative vacuum inside the middle ear space, causing the eardrum to be stretched and pulled inward.
This stretching registers as a feeling of fullness, blockage, or pain. The Eustachian tube is designed to open during swallowing or yawning to release this pressure. However, the speed of an aircraft’s descent often exceeds the tube’s ability to react quickly enough. If the pressure difference becomes too large, the tube can become locked shut by surrounding tissue, intensifying the discomfort.
Factors That Increase Pain Severity
The difference in barotrauma severity among individuals relates to the function of the Eustachian tube during the flight. Any condition causing swelling or congestion in the nasal passages impairs the tube’s ability to open effectively. Common illnesses like a cold, influenza, or a sinus infection cause inflammation that can physically block the tube opening.
Seasonal allergies, such as hay fever, also contribute by thickening mucus and swelling mucous membranes. When the tube’s opening is compromised, the pressure difference during descent causes the tube to seal more easily. This failure to equalize traps lower-pressure air inside the middle ear, resulting in greater force pulling on the eardrum. Children are particularly susceptible because their Eustachian tubes are naturally narrower and more horizontally angled than those of adults.
Techniques for Pressure Equalization
Defense against barotrauma during descent involves actively forcing the Eustachian tube to open. A simple method is to swallow repeatedly, which is why chewing gum or sucking on hard candy is often recommended. Yawning widely can also help flex the necessary muscles and prompt the tube to open, allowing air to enter the middle ear.
The Valsalva maneuver is a more direct method of equalization. To perform it, pinch your nostrils shut, close your mouth, and gently blow air as if trying to exhale through your nose. It is important to perform this action gently, as blowing too forcefully can cause damage or push infected material into the middle ear.
Alternatively, the Toynbee maneuver involves pinching the nose shut while simultaneously swallowing. This action creates a negative pressure in the back of the nose to pull the tube open.
Pre-Flight Planning and Prevention
For those who frequently experience ear pain, preventative measures taken before and during the flight can reduce the risk of barotrauma. Over-the-counter oral decongestants containing pseudoephedrine can be taken about an hour before descent begins. This helps reduce swelling in the nasal passages and around the Eustachian tube opening.
Topical decongestant nasal sprays can also shrink tissue in the nose. However, these should only be used for a few days to avoid rebound congestion.
Specialized filtered earplugs are designed to slow the rate at which air pressure changes reach the eardrum. These earplugs incorporate a ceramic filter that regulates air flow into the ear canal, giving the Eustachian tubes more time to adjust. Insert these earplugs before the plane begins its descent and keep them in until the cabin door opens. Staying awake during descent is also helpful for proactive swallowing and equalization maneuvers.
Recognizing Serious Complications
Most cases of ear barotrauma resolve on their own, but the pain can occasionally signal a more serious complication that requires medical attention. Sudden, sharp pain followed immediately by relief, potentially accompanied by a watery or bloody discharge, can indicate a perforation or tear in the eardrum. This injury results directly from the intense pressure differential.
Other concerning signs include the onset of vertigo, a persistent spinning sensation, or hearing loss that does not resolve within a few hours of landing.
If the feeling of fullness or pain continues for more than 24 to 48 hours after the flight, or if a fever develops, consult a healthcare provider. An ear, nose, and throat specialist, known as an otolaryngologist, can examine the middle ear and recommend appropriate treatment, which may include medication or, in rare cases, a minor procedure.