CHILDREN'S HEALTH Ear/Nose/Throat • Earwax blockage • Acute sinusitis • Hearing loss • Chronic sinusitis • Tonsillitis • Ear infection, middle ear • Tinnitus • Laryngitis • Airplane ear • Swimmer's ear • Nasal polyps • Ruptured eardrum • Sore throat • Epiglottitis • Benign paroxysmal positional vertigo (BPPV) • Meniere's disease • Nonallergic rhinitis

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You've just settled in for a long, relaxing flight. But then you start to feel pressure and discomfort in your ears. Then there's some pain. And sounds are somewhat muffled. You may be experiencing a condition known as airplane ear.

Also called barotrauma or barotitis media, airplane ear is a condition of discomfort associated with your middle ear. The cause is rapid changes in altitude and air pressure. Often airplane ear occurs when you fly while you have a cold, congested nose, nasal allergy, or throat or sinus infection (sinusitis). It can also occur when you drive in the mountains or go scuba diving. Although the condition is usually just a minor annoyance, airplane ear may result in temporary ear pain and hearing loss.

Ear pain associated with flying is due to unequal pressure between your middle ear and the cabin of the airplane.

Usually, self-care steps can relieve the symptoms of airplane ear in a short time. However, a severe case of barotrauma may require you to see your doctor.

Airplane ear can occur in one or both ears. Signs and symptoms may include:

• Moderate discomfort or pain in your ear
• Feeling of fullness or stuffiness in your ear
• Slight hearing loss
• Ringing in your ear (tinnitus)
• Dizziness

If airplane ear is severe or prolonged, you may experience:

• Severe middle ear pain
• A pressure feeling in your ear similar to being underwater
• Moderate to severe hearing loss
• Bleeding from your ear

Airplane ear occurs when your eardrum bulges outward or retracts inward as a result of a difference in air pressure. The air pressure in your middle ear usually is the same as that in your outer ear, because of the eustachian tube, which connects your middle ear to the back of your nose. When you swallow or yawn, the eustachian tube opens and allows air to flow into or out of your middle ear, equalizing the pressure.

If your eustachian tube is blocked, differences in pressure can occur between the two sides of your eardrum. When the pressure in your middle ear can't be equalized, your ear feels plugged. When this happens, your eardrum can't vibrate normally, so sounds are muffled or blocked. You may also have ear pain resulting from your eardrum being stretched.

The common cold is a frequent cause of a blocked eustachian tube that can result in airplane ear. Other factors that can lead to airplane ear include a sinus infection or a nasal allergy, such as hay fever. A stuffy nose often involves stuffy ears because your swollen membranes block the opening of the eustachian tube.

Children are especially vulnerable because the eustachian tube in a child's ear is narrower than that in an adult's, making blockage more common. Scuba divers and mountain climbers often experience barotrauma. Water-skiers, too, are vulnerable. Being slapped or hit on the ear — as when falling and hitting water at high speed — can cause a rapid change in pressure within the ear.

If your symptoms don't disappear within a few hours or if pain persists, see your doctor. He or she can examine your ear and, if indicated, refer you to a doctor who specializes in the care of ear disorders (otolaryngologist). See your doctor if you develop new signs and symptoms, especially fever, severe ear pain or drainage from your ear.

Your doctor will examine your ear to determine if you've experienced barotrauma, using a lighted instrument to look inside your ear. A slight outward or inward bulging of your eardrum indicates barotrauma. If your condition is severe, small capillaries in your middle ear may have burst, pooling blood behind your eardrum. Signs and symptoms of severe barotrauma may mimic those of an ear infection.

Possible complications of airplane ear include:

• Ruptured or perforated eardrum
• Ear infection
• Hearing loss

Airplane ear usually isn't serious and responds to self-care. Hearing loss is almost always temporary.

Treatment of airplane ear focuses on relieving your symptoms. If self-care attempts don't relieve your discomfort within a few hours or if the condition is severe, you may need to see a doctor. Your doctor may suggest these treatments:

• Medications. Decongestant nasal sprays, oral decongestants or oral antihistamines may relieve nasal congestion and allow your eustachian tube to open. Antibiotics may prevent ear infection, if barotrauma is severe.
• Surgery. Surgical treatment of airplane ear is rarely necessary. If your eustachian tube won't open with other treatments, however, your doctor may make an incision in your eardrum to allow pressure to equalize and fluid to drain (myringotomy). If you're prone to airplane ear and must fly often, your doctor may surgically place tubes in your eardrums to aid fluid drainage, ventilate your middle ear and equalize the pressure between your outer ear and middle ear.

Follow these tips to avoid airplane ear:

• Reconsider travel plans. Don't fly with a cold or upper respiratory congestion or infection unless necessary.
• Use an over-the-counter decongestant nasal spray. When you're asked to buckle your seat belt before takeoff, spray about four vigorous puffs in each side of your nose while holding shut the opposite side. Be sure to have chewing gum or peppermint in your mouth so that you are swallowing at the same time. This will mask the medication's bitter taste and place the spray closer to the opening of your eustachian tube.
• Cautious use of oral decongestant pills. Oral decongestants may be helpful if taken 30 minutes to an hour before an airplane flight. However, if you have a heart disease, heart rhythm disorders or high blood pressure or you've experienced possible medication interactions, avoid taking an oral decongestant unless your doctor approves. Men age 50 and older may experience serious side effects after taking decongestants containing pseudoephedrine (Actifed, Sudafed), including a sudden enlargement of their prostates requiring an immediate visit to the local emergency room and placement of a urinary catheter.
• Time your medication. If you have allergies, take your medication before your flight.
• Suck candy or chew gum during flight. This encourages swallowing. Yawning also activates the muscles that open your eustachian tube.
• Clear your ears regularly upon takeoff and landing. Do this by gently blowing while pinching your nostrils with your mouth closed (Valsalva maneuver). Repeat several times during descent to equalize the pressure between your ears and your environment.
• Avoid sleeping during descent. This allows you to make sure you're swallowing enough to keep your ears clear.
• Have infants and young children drink fluids during ascent and descent. This encourages swallowing. A pacifier may also help. Give acetaminophen (Tylenol, others) 30 minutes before takeoff to help control any discomfort that may occur. Decongestants in young children generally aren't recommended.
• Talk to your doctor. If you've recently had ear surgery, consult your doctor before you fly.
• Try filtered earplugs. These slowly equalize the pressure against your eardrum during takeoff and landing. You can purchase these at drugstores, airport gift shops or your local hearing clinic.

• Drink plenty of water to avoid dehydration. Avoid alcohol and caffeine, because they constrict your blood vessels and may increase the risk of ruptured capillaries.

If your ears become plugged during flight, try clearing them by inhaling and then gently exhaling while holding your nostrils closed and keeping your mouth shut. Repeat as necessary to relieve discomfort. If your ears are still blocked a few hours after landing, see your doctor.