Dr Sarah Jarvis is the Clinical Director of the Patient Platform, an active medical writer, broadcaster, and the resident doctor for BBC Radio 2.
If you’ve ever flown on an aeroplane, chances are you’ll have felt pressure inside your ears. You may find your hearing becomes less clear, or you experience pain. For most people, you can take a few simple steps to avoid discomfort. But there are times when you need to take extra precautions.
How Do Your Ears Work?
There are several different parts to your ear, most of which you can’t see. The main part of the outer ear - the bit you can see – is also known as your pinna. Its main role is to funnel sound into the other part of the outer ear – the ear canal.
This ear canal leads down to your eardrum, which has two main roles. It vibrates when sound waves hit it, sending messages to your inner ear and onto your brain. It also protects your middle ear from germs, water etc.
Behind the eardrum is your middle ear. This is usually filled with air. This space is connected to the back of your nose by a tube called the eustachian tube. This normally lets air in, so the pressure in your ear canal and your middle ear is the same.
Buried even deeper inside your skull is your inner ear, which has two main functions. It’s an essential part of the hearing circuit that turns messages from your eardrum, via your middle ear, into nerve signals and sends them to your brain. It also monitors your movement and tells your brain what position you’re in, helping you to keep your balance.
How Can Flying Affect Your Ears?
As you gain or lose height in a plane, the air pressure changes. If your eustachian tube is blocked, or you have fluid in your middle ear, you may end up with different pressure levels on either side of your eardrum. This mismatch in pressure can result in stretching of the eardrum, leading to pain – the so-called ‘Aeroplane Ear.’
If you have a cold, your eustachian tube is more likely to get blocked, leading to increased pressure on your eardrum. If you have a middle ear infection, fluid or pus can build up behind your eardrum. This is painful even on the ground, but it can get worse with the change of pressure as the plane takes off and lands.
How Do You Avoid Aeroplane Ear?
Cold Comfort
If possible, don’t fly if you have a heavy cold. The mucus you produce can block your eustachian tube, making it more likely that you’ll get a build-up of pressure in your inner ear.
De-Congest
If you do have a cold, try a decongestant remedy from your pharmacist. Take it just before you get to the gate, so it’s at its peak when the flight takes off.
Suck - Chew – Repeat
If chewing, swallowing, or yawning, you often force air into your eustachian tubes. Start chewing gum or sucking a sweet just as you take off or when the seatbelt signs come on for your descent.
Trombone Time
The Valsalva manoeuvre is when you blow out against resistance as if you’re blowing a trumpet or trombone. You can do this easily, by pinching your nose between your thumb and forefinger and blowing out gently with your mouth closed. This pushes air into your eustachian tubes, helping to equalize the pressure inside and out. Keep doing this as you take off and descend.
Ease the Pain
If you do have a cold or are prone to Aeroplane Ear, you may want to take a simple painkiller such as paracetamol or ibuprofen ½-1 hour before you fly.
Blow a Balloon
Otovent® is a balloon designed to relieve pressure in your middle ear – you can buy it from pharmacies. Although it’s designed to relieve Glue Ear in children, it can also work in Aeroplane Ear. You block off one nostril at a time, put the balloon over the other nostril and blow out to blow it up. You may find it helpful to avoid getting pain or to unblock your ears from Aeroplane Ear.
How Do You Perforate Your Eardrum?
Your eardrum is very thin and delicate – it needs to be to vibrate when sound waves reach it. It can perforate because of sudden changes in pressure (mostly when diving or flying), because of infection in the middle ear, or because of very loud noise or injury.
If your eardrum perforates (bursts), you may notice a sharp pain in your ear. The pain usually settles quickly, but you may be left with a residual ache. If there’s fluid or pus in your middle ear (usually because of infection), this may leak out of your ear. You may also find your hearing is affected and you could feel dizzy or have a ringing/buzzing sound in your ear, known as tinnitus.
Can I Travel with a Perforated Eardrum?
The good news is that perforated eardrums usually mend by themselves within a couple of months. What’s more, it is almost always safe to fly if you have a perforated eardrum.
However, there are situations where you need extra precautions. In some situations, a perforated eardrum doesn’t heal on its own, and you may have hearing loss that doesn’t settle. In this situation, your specialist may advise a surgical repair of the eardrum, called a myringoplasty. This procedure is usually done under general anaesthetic. If you’ve had a myringoplasty, you’ll need to avoid flying until your surgeon says it’s safe to do so.
Holiday Precautions for Perforated Eardrum
If you have a burst or perforated eardrum, it will be easier for germs to get inside your middle ear through the hole. Ideally, you should avoid swimming (and certainly diving or scuba diving) until your eardrum heals.
It's also important to remember that if you have a perforated eardrum, you should also avoid putting anything in your ear (including cotton buds, which nobody should ever let anywhere near their ear!). You should also make sure you don’t blow your nose too hard – this increases the pressure in your middle ear (through the eustachian tube) and can further damage your eardrum.
What is an Ear Infection?
Outer ear infection, called otitis externa. This is an inflammation in your ear canal, usually due to bacterial, fungal, or sometimes viral infection. It can cause pain, itching and a blocked sensation.
Middle ear infection or otitis media. This is more common in children but can affect adults too. It can cause severe pain if the eardrum is stretched because of pus or fluid in the middle ear. Sometimes this will cause your eardrum to perforate – you’ll feel a sudden sharp pain, but the earache then improves very quickly as the pressure is released.
Inner ear infection. This can affect your balance and lead to vertigo – dizziness where you feel the room is spinning. It can affect your hearing temporarily but doesn’t usually lead to pain.
Can I Travel with an Ear Infection?
If you have an ear infection, seeing a doctor before you travel is important. If you can, you should avoid flying until treatment has kicked in and your symptoms have improved.
If you have an outer (and particularly a middle) ear infection, you’ll be more prone to Aeroplane Ear. If you do have to fly, use the tips above to try and avoid the pain getting worse.
Ear health is crucial for everyone, especially when travelling. Understanding the mechanisms and precautions related to flying can mitigate discomfort and prevent complications like Aeroplane Ear or perforated eardrums.
Remember to consult a healthcare professional if you experience persistent issues or infections before travel to ensure your ear health is properly managed, allowing you to enjoy your travels without the concern of ear-related issues.