Ear Pain and Pressure Changes During Flights

Ear problems

Hello Doctor: I frequently travel by plane, and I used to experience little discomfort.
However, during my flight back to Taiwan on December 20th last year, I experienced severe ear pain, akin to extreme ear pressure.
If I usually rate my ear pressure discomfort as a 3, that day it felt like a 10, with a deep sensation of blockage.
After disembarking, it took at least 30 to 60 minutes for the pressure to equalize.
Since then, up until today, January 22nd, I have been experiencing a peculiar situation where I can hear sounds from my left eardrum whenever I open and close my mouth or when I burp without opening my mouth.
When I am still and quiet, I do not notice any tinnitus.
I am unsure if there is any damage and whether I should see a doctor or if this will resolve on its own after some time.
Please advise, thank you.
(I have a history of nasal congestion due to allergies, but I have not sought medical treatment for it.)

marvin, 30~39 year old female. Ask Date: 2017/01/22

Dr. Ji Zhaoyun reply Otolaryngology

Hello Marvin,
The issue you mentioned may be due to 1) Eustachian tube dysfunction: this is the most common cause and can occur not only when flying, climbing, or diving, but also when forcefully blowing your nose or bending over.
2) Sudden sensorineural hearing loss.
3) Otitis media: a) Acute otitis media: often occurs alongside upper respiratory infections (such as colds) and sinusitis, and in severe cases, there may be ear discharge; changes in air pressure while flying can also lead to barotrauma of the ear.
b) Chronic otitis media with acute exacerbation: usually occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to unclean water or improper ear cleaning.

All of the above conditions can be appropriately treated with medication after consulting a healthcare provider.
If you have already undergone a pure tone audiometry test (which requires headphones in a soundproof room, where sounds prompt you to press a button, rather than just using a tuning fork), and it confirms that you do not have sudden sensorineural hearing loss, then medication may suffice.
However, if you have not had a pure tone audiometry test, it is advisable to visit a hospital for evaluation to rule out sudden hearing loss.
The golden treatment window for sudden sensorineural hearing loss is two weeks, and early treatment yields better results.

Based on your current condition as described, it is most likely due to Eustachian tube dysfunction, but other possibilities cannot be completely ruled out.
Therefore, if symptoms persist, it is best to seek medical evaluation and treatment.

Wishing you safety and good health,
Dr.
Chi Chao-Yun,
Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2017/01/22

More Info

Understanding ear pain and pressure changes during flights is crucial for frequent travelers, especially those who experience discomfort or unusual sensations in their ears. The symptoms described, such as intense ear pain during descent, a feeling of fullness, and subsequent auditory changes, are commonly associated with pressure imbalances in the middle ear, often exacerbated by flying.

When an airplane ascends or descends, the rapid changes in altitude lead to fluctuations in atmospheric pressure. The middle ear, which is connected to the back of the throat via the Eustachian tube, must equalize this pressure to maintain comfort and proper hearing. If the Eustachian tube does not function effectively, it can result in a condition known as barotrauma, which is characterized by pain, pressure, and sometimes hearing loss.

The pain experienced during descent is likely due to the inability of the Eustachian tube to equalize the pressure quickly enough. This can lead to a sensation of fullness or "plugged" ears, and in some cases, it can cause temporary hearing changes, such as muffled sounds or a feeling of "hearing through a barrier." The auditory phenomenon described, where sounds seem amplified or distorted, can also be attributed to pressure changes affecting the ear's ability to transmit sound effectively.

For individuals with pre-existing conditions, such as nasal congestion or allergies, the risk of experiencing these symptoms can be heightened. Allergies can lead to inflammation and blockage of the Eustachian tube, making it more difficult to equalize pressure. Therefore, managing nasal congestion through antihistamines or nasal decongestants before flying may help alleviate some of these symptoms.

To mitigate discomfort during flights, several strategies can be employed:
1. Yawning and Swallowing: These actions can help open the Eustachian tube, allowing for pressure equalization. Chewing gum or sucking on candy can also stimulate swallowing.

2. Valsalva Maneuver: This involves pinching the nose, closing the mouth, and gently blowing to force air into the Eustachian tubes. However, this should be done cautiously to avoid damaging the ear.

3. Stay Hydrated: Drinking water during the flight can promote swallowing and help keep the Eustachian tubes functioning properly.

4. Avoid Flying with a Cold: If possible, postpone flights if experiencing significant nasal congestion or sinus infections, as these conditions can severely impair Eustachian tube function.

5. Consult a Specialist: If symptoms persist or worsen, it is advisable to consult an ear, nose, and throat (ENT) specialist. They can assess for any underlying issues, such as Eustachian tube dysfunction or other ear-related conditions.

In your case, since you have experienced prolonged symptoms following a flight, it would be prudent to seek medical evaluation. An ENT specialist can perform tests to determine the functionality of your Eustachian tubes and assess for any potential damage or other underlying issues. Additionally, addressing your nasal congestion may also provide relief and improve your overall flying experience.

In summary, while experiencing ear pain and pressure changes during flights can be common, especially for those with nasal congestion, it is essential to take proactive measures to manage these symptoms. If discomfort persists, seeking medical advice is the best course of action to ensure your ear health and comfort during future travels.

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