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“Owww. My ears hurt…” It’s a common complaint from kids travelling by air.

It is usually infants and very young children who suffer from ear pain during air travel, but older kids and adults can experience it, too.
In fact, ear pain during flight – known as barotrauma or ‘aeroplane ear’ – happens to some degree to most passengers on take-off and landing as the pressure inside their air-filled middle ears suddenly becomes different to the air pressure in the aircraft cabin.
Aeroplane ear typically occurs when the Eustachian tube, which connects an air space in the middle ear with the nasopharynx (where the back of the nose meets the throat), is already partly blocked – usually by a build-up of mucus from a cold, or pus from an infection.

The twin causes of in-flight ear pain

Two things are in play to cause ear pain when we travel by air.
ON TAKE-OFF: After take-off, the air in the middle ear expands as the aircraft ascends. The trapped air exerts pressure on surrounding tissue, causing pain.
ON LANDING: The reverse happens during descent. The air contracts and the resulting vacuum in the middle ear sucks in surrounding tissue and causes pain.
The contraction that occurs in creating a vacuum is more forceful than during expansion, so a traveller is more likely to experience pain as the plane is coming in to land than when it’s climbing into the sky.
The reason young kids are more prone to ear pain in the air is because their Eustachian tubes are smaller and straight, making drainage more problematic. The tubes become bigger and more curved as we age, so less prone to blockages.

Permanent damage is rare

The good news is the pain is usually short-lived, with no permanent damage to the ear.
That said, complications such as a perforated tympanic membrane (ear drum), dizziness, permanent tinnitus, or hearing loss may result from barotrauma. Frequent or severe aeroplane ear may damage the tissues of the Eustachian tube, increasing the chances of experiencing the problem again.
If possible, it’s best not to fly with a cold or upper respiratory infection. Either could mean ear problems are more likely.
Ironically, for travellers of any age, an ear infection actually reduces the risk of ear pain. That’s because infection tends to fill the middle ear with pus or fluid, leaving no air to expand or contract, and therefore cause pain.

Ways to prevent aeroplane ear

So what can parents do to reduce a child’s potential for flight-related ear pain?
The answer is learn what works best in preventing or alleviating pain for each child (or adult) when it comes to keeping open the Eustachian tubes.
Here are some of the techniques to try during take-off and landing to prevent or alleviate ear pain.
1. Top of the list is pinching the nostrils and blowing the nose, while keeping the mouth closed. It’s called the Valsalva Manoeuvre. Repeat this several times during ascent and decent, taking care not to blow too hard and potentially damage the ear drums.
2. A variation is to swallow rather than blow. The easiest way is to encourage the child to mimic the action of swallowing by chewing gum, sucking on a hard sweet or lollypop, or consuming a drink as the plane gains altitude or descends. (Swallowing and yawning activate muscles that open the Eustachian tube and allow air back into the middle ear, often eliminating the pain of aeroplane ear.)
3. Keep infants awake during take-off and landings. Sleep reduces the frequency of swallowing, so it’s counter-productive.
4. To reduce persistent pain, children can take paracetamol (Panadol) or Ibuprofen (Nurofen). Indeed, if a child has a history of ear pain during flights, try giving the medication 30 minutes before descent. (To give yourself plenty of time, ask your flight attendant to let you know when your flight is about an hour from landing.)
5. For all travellers, staying hydrated by drinking non-alcoholic beverages (alcohol causes dehydration) helps avoid irritation of nasal passages and pharynx, and promotes better function of the Eustachian tubes. Staying hydrated also reduces the potential for jet lag and deep vein thrombosis, too.

See a doctor if…

Ear barotrauma also may be caused by scuba diving, hyperbaric oxygen chambers, and explosions occurring nearby. You can even experience mild barotrauma while riding an elevator in a tall building or driving a vehicle at higher altitudes.
Barotrauma may also affect other air-filled body cavities, such as the sinuses or abdomen. Travellers sensitive to abdominal bloating should avoid carbonated beverages and foods that can cause an increase in gas production.
While severe symptoms are rare, see a doctor if pain or muffled hearing last more than a few hours, or if you experience any severe signs or symptoms, including:
- Severe pain
- Pressure in your ear similar to being underwater
- Moderate to severe hearing loss
- Ringing in your ear (tinnitus)
- Spinning sensation (vertigo)
- Vomiting resulting from vertigo
- Bleeding from your ear
People who have had recent surgery, particularly intracranial, intrapulmonary, or intraocular procedures, should seek advice from their doctor before flying.

A plug, of sorts…

You may have heard of – or even tried – EarPlanes. They are pressure-regulating earplugs designed to be inserted in the ears during air travel. They consist of a silicone ear plug, which creates an airtight seal at the outer ear, and a ceramic pressure regulator, one end of which is exposed to the external cabin pressure. As the cabin air pressure changes, a pressure differential is created across the ceramic filter, causing air to flow through the filter, into and out of the ear canal. The makers claim… “Discomfort is reduced because the air pressure difference on the exterior and interior of the middle ear is lessened, allowing the Eustachian tubes to function more normally.” We haven’t field-tested EarPlanes, so can’t vouch for their effectiveness. But, you can read more about them and buy them online in child and adult sizes.

For more about aeroplane ear or other travel health risks, call our free travel health advisory service on 1300 360 164 (toll-free from landlines). You can also book a pre-travel medical consultation for recommended or required vaccinations at your nearest Travelvax Australia clinic.

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