Barotrauma of the Ear When Flying

Definition

Barotrauma is the pain or damage done to the eardrum, the middle ear, or the sinuses, or any combination due to the inability of the Eustachian tube to open properly and equalize pressures between the middle ear and the external environment.

How the middle ear works

The middle ear is very sensitive to changes in atmospheric pressure. Nerves in he middle ear chamber where the ossicles (the bones that transmit sound from the ear drum to the inner ear) are located, continually send messages to the Eustachian tube (located at the back of the throat) to open and close to keep the chamber pressure the same as outside the body. (For more details on how the ear works, please click here). The Eustachian tube connects the middle ear space to the nasopharynx at the back of the nose.  It normally opens with swallowing or yawning and allows equalization of pressure in the middle ear.

 

Eustachian tube

Taking off and Ascending

During ascent in an airplane, there is a decrease in cabin air pressure, leading to a relative increase in the pressure of the middle ear.  If the Eustachian tube is able to open normally, air will leave the middle ear until the pressure is equalized.  If the tube is unable to open due to a cold or other reason and the Eustachian tube does not open, the excess pressure can lead to pain, often in the sinuses or the teeth. 

Descending and coming in for a landing

How to Alleviate Problems of Air Pressure Inequality with medication
(If you have heart or prostate problems, you should consult with your physician before using over-the-counter decongestants.)

Begin taking the daytime "4 hour" over-the-counter decongestant pseudoephedrine (Sudafed®)  4 hours prior to the flight according to the directions on the package.  If your sinuses feel plugged up while flying and it is 8 hours before you normally sleep, continue taking the daytime version. However if you are within 4 hours of your normal sleep cycle, take the "night-time" version (no pseudoephedrine). Depending on your sleep/wake schedule alternate between the daytime versions (pseudoephedrine) and the night-time versions (no pseudoephedrine) 24 hours after the flight.

When all else fails

If you experience discomfort on ascent, plug your nose and swallow or hold your breath and "push" out gently with your breath.  This will help equalize air pressure from the middle ear through the Eustachian tube so the pressure is the same as the outside air.  During descent, the opposite will be true: air pressure will be less in the middle ear than outside.  However, use the same maneuver as before: Force air from the middle ear cavity through to open the Eustachian tub.  Once opened, the air pressures will be equalized.

Individuals who have chronic Eustachian tube swelling (and continual air pressure differential problems) may get middle ear and tympanic membrane hemorrhages.  If this occurs repeatedly with flying, an ENT (Ear, Nose and Throat) specialist may recommend an in-office placement of a pressure equalizing tube (PE tube), or grommet.  The grommet will remain in the ear drum for a few months then slowly get pushed out naturally by the body. because the grommet has a hole in it, the air in the middle ear is equalized through this device rather than through a problematic Eustachian tube.