Diseases & Conditions

Airplane ear

Airplane ear is the stress exerted on your eardrum (tympanic membrane) and other middle ear tissues when the air pressure in your middle ear and the air pressure in the environment are out of balance. You may experience airplane ear at the beginning of a flight when the airplane is climbing or at the end of a flight when the airplane is descending. These fast changes in altitude cause air pressure changes and can trigger airplane ear.

Airplane ear is also called ear barotrauma, barotitis media or aerotitis media.

Usually self-care steps — such as yawning, swallowing or chewing gum — can prevent or correct the differences in air pressure and improve airplane ear symptoms. However, a severe case of airplane ear may need to be treated by a doctor.

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

• Moderate discomfort or pain in your ear
• Feeling of fullness or stuffiness in your ear
• Muffled hearing or slight hearing loss

If airplane ear is severe or lasts more than a few hours, you may experience:

• Severe pain
• Pressure in your ear similar to being underwater
• Moderate to severe hearing loss
• Ringing in your ear (tinnitus)
• Spinning sensation (vertigo)
• Vomiting resulting from vertigo
• Bleeding from your ear

When to see a doctor
Usually you can do things on your own to treat airplane ear. If discomfort, fullness or muffled hearing lasts more than a few hours or if you experience any severe signs or symptoms, call your doctor.

In order for your eardrum to vibrate as it should, the air pressure in the middle ear has to be the same as the air pressure of the environment. Air pressure regulation is the work of a narrow passage called the eustachian tube. One end is connected to the middle ear. The other end has a tiny opening where the back of the nasal cavity and the top of the throat meet (nasopharynx).

Normally, tissues in your middle ear slowly absorb air. This results in less air pressure on the inside of your eardrum than on the outside. When you swallow or yawn, you activate muscles that open the eustachian tube and allow the middle ear to replenish its air supply. This is why swallowing or yawning can often eliminate airplane ear symptoms.

Air pressure changes in flight
When an airplane climbs or descends, the air pressure in the environment changes rapidly, and normal function of the eustachian tube doesn't occur quickly enough.

Even though the cabins of airplanes are pressurized, the air pressure at a cruising altitude is still less than the air pressure on the ground. Therefore, when your airplane is climbing, pressure in your middle ear is greater than the pressure in the cabin. In order for the pressure to be balanced, air has to escape out the eustachian tube. This escape of air is relatively easy.

During your flight the air pressure on both sides of the eardrum usually becomes equalized again. During an airplane's descent, the air pressure is greater in the environment than in your middle ear. In order for this air pressure difference to equalize again, air has to enter the middle ear through the eustachian tube. Rapidly getting air into the middle ear doesn't happen so easily. Because of this, you're more likely to experience airplane ear during a descent.

Air pressure effects on your ear
When air pressure on one side of your eardrum is out of balance with that on the other side, a number of things can happen in the middle ear, depending on the severity and duration of the pressure difference.

• The eardrum stretches and doesn't vibrate correctly, resulting in muffled or impaired hearing.
• The stretching of the eardrum causes a feeling of pressure or pain.
• If the air pressure imbalance persists, fluids from the middle ear tissues may fill the space in an attempt to equalize the pressure.
• If the pressure is severe or prolonged, the eardrum may rupture.
• Small blood vessels (capillaries) in the middle ear may rupture and cause mild bleeding behind the eardrum.
• Either of the small membrane-covered openings of the inner ear (oval window and round window) may rupture.

Problems similar to airplane ear
Ear barotrauma is also a common problem with scuba diving, because the water pressure on the outside of the ear is greater than the air pressure of the middle ear.

You may also experience a minor case of barotrauma while riding an elevator in a tall building or driving in the mountains.

Being slapped or hit on the ear also can cause a rapid change in pressure within the ear. This type of barotrauma can, for example, affect a water skier hitting the surface of water at high speed.

Your doctor will likely be able to make a diagnosis based on questions he or she asks and an examination of your ear with a lighted instrument (otoscope). Signs of airplane ear might include a slight outward or inward bulging of your eardrum. If your condition is more severe, your doctor may see a tear in the eardrum or a pooling of blood or other fluids behind the eardrum.

If you're experiencing a spinning sensation (vertigo), there may be damage to structures of your inner ear. Your ENT may suggest a hearing test (audiometry) to determine how well you detect sounds and whether the source of hearing problems is in the inner ear.

For most people airplane ear is easily corrected with self-care strategies. When the symptoms persist, you may need treatments to equalize pressure and relieve symptoms.

Medications
Your doctor may prescribe medications or direct you to take over-the-counter medications to control conditions that may prevent the eustachian tubes from functioning well. These drugs may include:

• Decongestant nasal sprays
• Oral decongestants
• Oral antihistamines

Self-care therapies
Along with your drug treatment, your doctor will instruct you to use a self-care method called the Valsalva maneuver. To do this, you pinch your nostrils shut, close your mouth and gently force air into the back of your nose, as if you were blowing your nose. Once the medications have improved the function of the eustachian tubes, use of the Valsalva maneuver may force the tubes open.

Surgery
Surgical treatment of airplane ear is rarely necessary. However, your doctor may make an incision in your eardrum (myringotomy) to equalize air pressure and drain fluids.

Severe injuries, such as a ruptured eardrum or ruptured membranes of the inner ear, usually will heal on their own in time. Surgery may be needed in rare cases to repair them.