What Happens To Your Ears During A Flight

Pressure and pain in your ears during a flight can be extremely annoying, even painful. And almost as unpleasant is having to wait another 12 hours, or longer, before being able to hear normally again. I’d like to give you some background information on this phenomenon, as well as some tips and tricks on how to prevent it, or minimise its effects. How do our ears work?

Our ears enable us to hear sounds, which are actually vibrations in the air. These vibrations travel through the ear canal to a thin membrane called the eardrum, which also hermetically seals the ear canal from within. On the other side of the eardrum is a tube called the Eustachian tube, which runs from the inner ear to the back of our nose/throat, where it can vent to the air outside. This tube allows air to flow to or from the inner ear, depending on whether the pressure in the inner ear is higher or lower than ambient air pressure.

An obvious precondition is that the Eustachian tube cannot be blocked! This can happen, for example, if it is obstructed by mucus or inflammation due to a cold, hay fever or perhaps a respiratory infection.

As the aircraft climbs the air pressure inside the cabin gradually decreases until it reaches the level at which it will remain for the rest of the flight (at cruising altitude). Because this air pressure will be lower than it was at ground level it means that some of the trapped air must be allowed to escape from the inner ear. If it doesn’t, the slightly higher pressure will cause the eardrum to bulge outwards. If all goes well, the overpressure air in the inner ear simply escapes via the Eustachian tube. It’s easier for this tube to exhaust air than to suck it in, which is why hardly anyone has problems with their ears when an aircraft is climbing. What happens in our ears when an aircraft descends?

As the aircraft descends the air pressure inside the cabin will gradually increase, so the rising air pressure will push the eardrums inwards. To counter this, the air pressure on the other side of the eardrums, in the inner ear, must also increase. To enable this to happen air must be sucked in through the Eustachian tube. What is happening when you have problems with your ears during a flight?

If you are suffering from a cold or hay fever, the mucous membrane in the Eustachian tube can become swollen and impede the flow of air through it. Consequently, when the aircraft is descending the air pressure behind the eardrum, in the inner ear, will remain too low and will not be able to counteract the increasing cabin air pressure that is pushing the eardrums inwards. Initially you will feel this as pressure and later as pain. Furthermore, because the eardrum will be under constant pressure, it will no longer be able to vibrate freely. So you won’t be able to hear properly either.

• There are a few other methods, such as blowing your nose, chewing gum, or drinking while pinching your nose closed. Whichever of these methods you find works best for you should be repeated a few times during the complete descent. We refer to all these methods as “coping”. Air is more likely to flow up the Eustachian tube if you swallow, yawn or chew.

• Try this: breathe in, then gently breathe out with your mouth closed while pinching your nose (it’s known as the Valsalva manoeuvre). In this way, no air will be exhaled but you will be gently pushing air into the Eustachian tube. While doing this you may feel your ears go “pop” as air is pushed into the inner ear. This often solves the problem. Repeat the procedure every few minutes while landing – or whenever you feel any discomfort in your ears.

• Sometimes you might hear other “never fail” remedies. Well, at the risk of disappointing anyone, the truth is that there is no medical evidence to support putting wet cloths over your ears, for example, or covering them with cups. It may comfort you, so it won’t do any harm. But at the end of the day it will not solve the problem either. The same can be said for using eardrops or cleaning your ears. They may have a soothing effect, but they will do nothing for the pain.

After scuba diving you should wait for about 12-24 hours before flying. This time frame depends on the depth to which you dived and the number of dives you made. In this case it has to do with having to clear the nitrogen from your body after diving, to avoid decompression sickness or Caisson disease. This is not directly related to the pressure issues of the ear. Although flying after diving can also make your ears malfunction (not work properly) due to the same mechanism. In a short period of time you extensively pressurize the eardrum.

If you have a severe cold, an earache, a high temperature or a combination of these, you might wonder whether it’s indeed wise to fly. The Eustachian tube could be blocked (due to mucus), for example, which could cause you more serious ear problems during the flight. In such a case, and if you really want to make your journey, my advice would be to have your ears checked by a medical doctor before departure. You may risk a barotrauma, damage to the eardrum due to pressure changes, or even a rupture of the eardrum (although rare). You might experience pain, hearing loss, dizziness or tinnitus (buzzing in the ears). Airport Medical Services at Schiphol has equipment that can measure the pressure-movements of the eardrum. They can also advise you on whether or not to fly. Barotrauma will heal quicker than a ruptured eardrum, which can take between a couple of weeks to several months. Still having ear problems after your flight?

• If the measures above fail to prevent ear pain, don’t despair. The pain may be quite acute, but it usually subsides fairly quickly. Take painkillers such as paracetamol until it goes. Fluid or mucus can sometimes accumulate in the inner ear for a few days after a flight, which may dull or dampen your hearing. This will happen if the Eustachian tube is still blocked, and it is more likely to occur if you had a cold before flying. To clear it, try one of the measures outlined above.

• If your complaints persist, seek medical advice: If you are at home contact your family doctor. At Schiphol we are available 24/7 at Airport Medical Services, where you can obtain advice at our first aid post. Extensive medical care at Schiphol Airport is available at the KLM Health Services Travel Clinic, which is located next to the first aid post.