DEAR DOCTOR K: I get pain in my ears every time I fly and the plane descends for landing. A friend says that chewing gum works for him, but it doesn't work for me. What can I do?
DEAR READER: The ear pain you experience -- barotrauma of the ear -- is the most common medical problem reported by air travellers. "Barotrauma" refers to injuries caused by increased air pressure.
Here's why it happens. Your ear has three parts: the outer ear (including the ear canal), the middle ear and the inner ear. The eardrum comes between the outer ear and the middle ear. The middle ear is connected to the uppermost part of your throat (called the nasopharynx) by a thin canal called the Eustachian tube. Air is constantly moving through the Eustachian tube and into the middle ear. This balances the pressure in your middle and inner ears.
Air pressure changes as the altitude changes. Therefore, the biggest changes occur when a plane is taking off or landing. While the plane has systems to reduce the sudden changes that occur during take-off and landing, some still occur.
When a plane's air pressure changes suddenly and the Eustachian tube is blocked, it can create a vacuum in the middle ear that pulls the eardrum inward. This can cause pain. It also can muffle sounds. In more severe cases, the middle ear can fill with clear fluid. In the most severe cases, the eardrum can rupture. Fortunately, this is rare.
Barotrauma is much more likely if you're flying with a cold, infection or allergies. That's because these conditions can block the Eustachian tube.
So that's what causes the problem you asked about. Now, what can you do about it?
First, take a decongestant one hour before your flight or use a decongestant nasal spray, or both. Since your ear problems come when the plane is landing, use the spray about 30 minutes before the plane is scheduled to land. Antihistamines may also help if you have allergies.
If you experience the symptoms of barotrauma during a flight, try the following before the symptoms worsen. For most people, landing is worse than take-off. The easiest tricks to try are:
-- Suck on hard candy.
-- Yawn and swallow frequently. Open your mouth very wide, as if you were yawning. Swallow, even though there's nothing in your throat to swallow. When you do this, you tighten the muscles in the back of your throat. That tugs on the opening of the Eustachian tube and opens it. You often can feel and hear the tube pop open.
If these methods don't work, pinch your nose closed, inhale through your mouth, and then try to push the air out through your nose while keeping it pinched shut. Don't push hard, and stop as soon as one ear pops. If you blow too hard, you can tear your eardrums, so do it carefully.
One of these tricks should work for most people who have ear problems while flying -- and I'll bet one will work for you.
Dr Anthony L. Komaroff is a physician and professor at Harvard Medical School.
