Ears, altitude and airplane travel

Have you ever wondered why your ears pop when you fly on an airplane? Or why, when they
fail to pop, you get an earache? Have you ever wondered why the babies on an airplane fuss
and cry so much during descent?

Ear problems are the most common medical complaint of airplane travelers, and while
they are usually simple, minor annoyances, they occasionally result in temporary pain and
hearing loss.

The ear is divided into three parts:

The outer ear meaning the part of the ear you can see on the
side of the head plus the ear canal leading down to the ear drum.

The middle ear: the ear drum and ear bones (ossicles), plus
the air spaces behind the ear drum and in the mastoid cavities (vulnerable to air
pressure).

The inner ear: the area that contains the nerve endings for
the organs of hearing and balance (equilibrium).

The ear and air pressure

It is the middle ear that causes discomfort during air travel,
because it is an air pocket inside the head that is vulnerable to changes in air pressure.

Normally, each time (or each 2nd or 3rd time) you swallow, your ears
make a little click or popping sound. This occurs because a small bubble of air has
entered your middle ear, up from the back of your nose. It passes through the Eustachian
tube, a membrane-lined tube about the size of a pencil lead that connects the back of the
nose with the middle ear. The air in the middle ear is constantly being absorbed by its
membranous lining, and resupplied through the Eustachian tube. In this manner, air
pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is
not equal, the ear feels blocked.

Blocked ears and Eustachian tubes

The Eustachian tube can be blocked, or obstructed, for a variety of
reasons. When that occurs, the middle ear pressure cannot be equalized. The air already
there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such
an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching
can be painful. If the tube remains blocked, fluid (like blood serum) will seep into
the air from the membranes in an attempt to overcome the vacuum. This is called
"fluid in the ear," serous otitis or aero-otitis.

The most common cause for a blocked Eustachian tube is the common
"cold." Sinus infections and nasal allergies (hayfever, etc.) are also causes.
A stuffy nose leads to stuffy ears because the swollen membranes block the opening
of the Eustachian tube.

Children are especially vulnerable to blockages because their
Eustachian tubes are narrower than in adults.

How can air travel cause problems?

Air travel is sometimes associated with rapid changes in air pressure.
To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize
the changes in pressure. This is especially true when the airplane is landing, going from
low atmospheric pressure down closer to earth where the air pressure is higher.

Actually, any situation in which rapid altitude or pressure changes
occur creates the problem. You may have experienced it when riding in elevators or when
diving to the bottom of a swimming pool. Deep sea divers are taught how to equalize their
ear pressures; so are pilots. You can learn the tricks too.

How to unblock your ears

Swallowing activates the muscle that opens the Eustachian tube. You
swallow more often when you chew gum or let mints melt in your mouth. These are good air
travel practices, especially just before take-off and during descent. Yawning is even
better. Avoid sleeping during descent, because you may not be swallowing often
enough to keep up with the pressure changes. (The flight attendant will be happy to awaken
you just before descent.)

If yawning and swallowing are not effective, unblock your ears is as
follows:

Step 1: Pinch your nostrils shut.

Step 2: Take a mouthful of air.

Step 3: Using your cheek and throat muscles, force the
air into the back of your nose as if you were trying to blow your thumb and fingers off
your nostrils.

When you hear a loud pop in your ears, you have succeeded. You may have
to repeat this several times during descent.

Babies' ears

Babies cannot intentionally pop their ears, but popping may occur if
they are sucking on a bottle or pacifier. Feed your baby during the flight, and do not
allow him or her to sleep during descent.

Precautions

When inflating your ears, you should not use force. The
proper technique involves only pressure created by your cheek and throat muscles.

If you have a cold, a sinus infection or an allergy attack, it is
best to postpone an airplane trip.

If you recently have undergone ear surgery, consult with your surgeon
on how soon you may safely fly.

What about decongestants and nose sprays?

Many experienced air travelers use a decongestant pill or nasal spray
an hour or so before descent This will shrink the membranes and help the ears pop more
easily. Travelers with allergy problems should take their medication at the beginning of
the flight for the same reason.

Decongestant tablets and sprays can be purchased without a prescription
However, they should be avoided by persons with heart disease, high blood pressure,
irregular heart rhythms, thyroid disease or excessive nervousness. Such people should
consult their physicians before using these medicines. Pregnant women should likewise
consult their physicians first.

If your ears will not unblock

Even after landing you can continue the pressure equalizing techniques,
and you may find the decongestants and nose sprays to be helpful. (However, avoid making a
habit of nose sprays. After a few days they may cause more congestion than they relieve.)
If your ears fail to open, or if pain persists, you will need to seek the help of a
physician who has experience in the care of ear disorders. He/she may need to release the
pressure or fluid with a small incision in the eardrum.

What is Otolaryngology-Head and Neck Surgery?

(Ear, Nose, and Throat Specialist)

An otolaryngologist is a physician concerned with the medical and surgical treatment of
the ears, nose, throat and related structures of the head and neck.

The American Academy of Otolaryngology-Head and Neck Surgery, Inc. represents more than
7,500 ear, nose, and throat specialists. For more information or a list of
otolaryngologists practicing in your area, please contact the Academy.