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The middle ear contains air. The air pressure needs to be the same as the pressure outside the body for you to hear well.

The Eustachian tube is a tube that runs from the back of the nose to the middle ear. The tube opens to allow air to pass into or out of the middle ear to equalise the middle ear pressure to the air pressure outside the body. Sometimes you will feel this happening, with a “pop” in the ear.

As the plane ascends, the air pressure reduces. The eustachian tube needs to work to allow movement of air from the middle ear, to reduce the middle ear pressure to match the pressure outside the body. As the plane descends, the reverse happens; air moves into the middle ear through the eustachian tube.

If the eustachian tube is not working well and pressure in the middle ear is suddenly much higher or much lower than the air pressure outside the body, you will have ear pain and a blocked ear feeling. This is called eustachian tube dysfunction with barotrauma (pressure trauma).

If the pressure is not relieved, you can develop:

  1. Bleeding into the middle ear with temporary hearing loss;
  2. A hole in the ear drum with bleeding from the ear and hearing loss. This may all improve as the ear drum heals itself over a month or so. Sometimes the hole in the ear drum and hearing loss are permanent;
  3. Rarely, a hole in the inner ear membranes causing sudden loss of hearing and balance with vertigo. Vertigo usually improves over a week or so but hearing loss is usually permanent.

Eustachian tube dysfunction can be permanent or temporary. The commonest cause of temporary dysfunction is having a cold or viral upper respiratory tract infection or hayfever. It’s best not to fly when you have a cold. Don’t fly for 3 months after major ear surgery. You can fly 24 hours after having middle ear ventilation tubes inserted

What helps the ears to equalise pressure during flights?

  1. Actively equalise the middle pressure every few minutes during ascent and descent by:
    1. Swallowing, chewing, yawning;
    2. Trying to breathe out with mouth closed and nose pinched with fingers, to increase pressure in the nose and throat;
    3. Using an Otovent device.
  2. Improve nasal and eustachian tube congestion with:
    1. One week of intranasal steroid spray before the flight;
    2. Nasal decongestant spray or decongestant tablet one hour before ascent and one hour before descent. Check with your doctor or pharmacist if these are safe for you or your child;
    3. Waiting til your cold or hayfever has improved before flying.
  3. Slow down the pressure changes using Ear Plane Ear plugs. You can purchase these from pharmacies;
  4. For severe and permanent eustachian tube dysfunction, have middle ear ventilation tubes inserted before the flight.

If you expect ear pain during a flight, it may be helpful to take paracetamol or ibuprofen one hour before take-off (and one hour before descent if flight is more than 6 hours).