Why do my ears hurt when I fly?

The middle ear is the part which causes discomfort in flight.

Normally, as you swallow, air enters the Eustachian tube and thereby moves into the middle ear space. This air is absorbed and is constantly being replaced via the Eustachian tube. This is how the ear maintains equal pressure either side of the eardrum, which allows it to vibrate when sounds enter the ear. When the air either side of the eardrum is not equal, your ears feel blocked.

The entrance to the Eustachian tube is situated in the space behind the nose, which is lined with similar wet mucus as in the mouth. It can easily become blocked with sticky mucus if you have a common cold. Air is unable to enter the tube when you swallow and so the middle ear space becomes a vacuum with no air in it. The eardrum is sucked inwards, which means it cannot vibrate so well, and the vacuum formed draws fluid from the middle ear lining which makes the ear feel more blocked.

The most common causes of blocked tubes are the common cold, hay fever and nasal allergies. Children up to the age of eight or nine who have small, undeveloped tubes are particularly prone to blocked tubes.

When the air pressure outside the ear changes (as in flight), it is necessary to swallow or yawn to open the tube and let air of the same pressure enter the middle ear space.

The greatest air pressure changes are noticed when the aircraft is descending to land. The pressure is lower while the aircraft is in flight and becomes higher as the plane descends. These changes in pressure cause a vacuum to form in the middle ear faster than normal and there is a need to swallow more frequently to allow the air pressure to equalise on both sides of the eardrum.

What can I do to make it better?

Clear the back of your nose so that when you swallow, air can pass more easily into the Eustachian tube. There are decongestant nasal sprays on the market which help clear the nose and can be used an hour or so before descent. Use these sprays sparingly because repeated use over many days may cause the nose to become more congested than before.

Children and babies are unable to equalise the air pressure as explained above. If a baby or child has a stuffy nose, there is a saline spray on the market which may help to decongest their nose. It may help if a bottle or dummy is offered during descent to encourage swallowing.

Keep swallowing during descent; this is helped by chewing mints or gum. Yawning is a stronger activator to open the tube.

It is best not to sleep during descent as you may not swallow enough to maintain the equal pressures. Ears will also unblock when you pinch your nostrils shut and then swallow until you feel air enter the middle ear.

Ear plugs protect the outer ear from sudden pressure changes, so that it is not so necessary to swallow frequently. These may be helpful for smaller children.

It is just as effective to press on the outer part of the ear at the front, which closes off the outer ear canal for a short while. However, be aware that if the ear canal is completely blocked (if the ear canal is full of wax or the ear plug fits too tightly) the difference in pressure between the ear canal and the middle ear space could cause pain or discomfort.

If these exercises and nasal drops do not help, and you are still experiencing pain or discomfort, seek medical advice.