Airplane Ear

Symptoms: Discomfort, a feeling of fullness in the ears, mild hearing loss, severe pain, pressure, moderate to severe hearing loss, tinnitus, vertigo, and even bleeding from the ear

Causes: The primary cause is the rapid change in air pressure that affects the eustachian tube’s ability to equalize pressure across the eardrum.

Risk factors: Small eustachian tubes (common in children), respiratory infections like the common cold or sinusitis, allergies, and sleeping during takeoff or landing.

Prevalence: According to a point prevalence study, 10% of adults and 22% of children had otoscopic evidence of eardrum damage, and 20% of adult and 40% of child passengers experienced negative pressure in the middle ear following their flight.

Severity: Mild to severe

Which doctor to consult: ENT specialist

Overview: 

Airplane ear, also known as ear barotrauma, is a condition that affects the middle ear due to rapid changes in air pressure, commonly experienced during airplane takeoffs and landings. Airplane ear occurs when there’s an imbalance in air pressure on either side of the eardrum, which can happen during flights, scuba diving, or exposure to explosive blasts.

Symptoms:

The symptoms of airplane ear, or ear barotrauma, can range from mild to severe and include:

Mild Symptoms:

• Discomfort in the ear

• Feeling of fullness or stuffiness in the ears

• Mild temporary hearing loss

Severe Symptoms:

Severe pain
A lot of pressure in the ear
Bleeding from the ear
Dizziness
Spinning sensation (vertigo)
Vomiting
These symptoms are caused by an imbalance in the pressure inside the middle ear, which can occur during rapid changes in air pressure, such as during airplane ascents and descents.

Causes: 

The causes of airplane ear, also known as ear barotrauma, are primarily related to the eustachian tube’s inability to equalize pressure between the middle ear and the environment. This condition typically occurs when there is a rapid change in air pressure, which can lead to an imbalance in the middle ear. Here are the common situations where this can occur:

Ascent/Descent of an Airplane is the most common scenario, in which rapid changes in altitude cause significant pressure differences.
Scuba Diving: Similar to flying, the pressure changes experienced while diving can affect the middle ear.
Hyperbaric Oxygen Chambers: The controlled pressure environments used for medical treatments can also lead to airplane ear.
Explosive Blasts: The pressure wave from an explosion can rapidly alter the pressure balance, affecting the ear.
The eustachian tube, which connects the middle ear to the back of the nose, usually maintains equal pressure on both sides of the eardrum. However, when these rapid pressure changes occur, the eustachian tube may not be able to react quickly enough, leading to the symptoms associated with airplane ear.

It’s important to note that certain conditions can increase the risk of experiencing airplane ear, such as having a small eustachian tube, middle ear infections, common colds, sinusitis, hay fever, or sleeping during takeoff and landing.

Risk Factors:

Common risk factors for airplane ear include:

A small eustachian tube, particularly in infants and toddlers
The common cold
Sinus infections
Hay fever (allergic rhinitis)
Middle ear infections (otitis media)
Sleeping on an airplane during ascent and descent can prevent the necessary pressure adjustments.
These conditions can block or limit the function of the eustachian tube, which is responsible for equalizing air pressure in the ear. To minimize the risk, it’s advisable to stay awake during takeoff and landing and to try yawning, swallowing, or chewing gum to help open the eustachian tube and equalize pressure.

Complications: 

Airplane ear, also known as ear barotrauma, is a condition that can occur when there is a rapid change in air pressure, leading to discomfort in the ear. While it’s usually not serious and often resolves with self-care, some potential complications can arise in rare cases:

Acute ear infection: This can occur if bacteria enter the middle ear during the pressure changes.
Rupture of the eardrum: If the pressure difference is significant, it can lead to a tear in the eardrum.
Vertigo: A severe imbalance in ear pressure can cause dizziness and a spinning sensation.
Hearing loss: In some instances, prolonged barotrauma can lead to temporary or even permanent hearing loss.
Ongoing (chronic) tinnitus: Due to the pressure changes, some people may experience persistent ringing in the ears.
Preventive measures like yawning, swallowing, or chewing during take-off and landing can help equalize the pressure and reduce the risk of complications. If you experience severe symptoms or they persist for more than a few days, it’s important to consult a healthcare provider. They may recommend treatments such as decongestants or, in rare cases, a myringotomy procedure to relieve pressure and drain fluids.

Prevention:

Preventing airplane ear involves equalising the pressure in your ears during ascent and descent. Here are some tips to help prevent discomfort:

Yawn and Swallow: These actions activate the muscles that open your eustachian tubes, helping to equalize pressure.
Chewing Gum or Sucking on Candy: This can stimulate swallowing and help maintain pressure balance.
Valsalva Maneuver: Gently blow as if blowing your nose while holding your nostrils closed and keeping your mouth shut during ascent and descent.
Toynbee Maneuver: Pinch your nostrils and swallow. This can be effective in opening the eustachian tubes and equalizing pressure.
Filtered Earplugs: Wearing earplugs designed for air travel can slow the rate of pressure change on the eardrum.
Stay Hydrated: Drink plenty of water before and during the flight to help keep the eustachian tubes functioning properly.
Avoid Sleeping During Ascent and Descent: If you’re awake, you can actively work on equalizing ear pressure.
When to See a Doctor: If symptoms persist for more than a few days or if you experience severe symptoms.

Diagnosis: 

The diagnosis of airplane ear, also known as ear barotrauma, typically involves a combination of patient history and a physical examination:

Patient History: The doctor will ask about recent activities and symptoms such as earache, spinning sensation, or hearing loss.
Physical Examination: The doctor will use a lighted instrument called an otoscope to look for signs like a bulging or ruptured eardrum.
In most cases, airplane ear symptoms resolve without treatment within a few hours or days. However, medical treatment may be necessary if symptoms are severe or persistent.

Treatment:

Mild cases often resolve without treatment.
Severe cases may require decongestants, anti-inflammatory drugs, or pain relievers like pseudoephedrine, ibuprofen, naproxen, or acetaminophen.
In rare cases, a procedure called myringotomy may be performed to relieve pressure and drain fluids.

For more detailed information, it’s best to consult with a healthcare provider, especially if you’re planning to travel and are concerned about airplane ear.

Additional information:

Frequent flyers may be at a higher risk of developing long-term complications from airplane ears if they repeatedly experience it. While occasional air travel is unlikely to cause long-term damage, continuous exposure to the unequal pressures can lead to chronic inflammation or damage to the delicate structures of the ear. This may manifest as recurrent ear infections or even hearing loss. In rare cases, long-term complications may include chronic ear pain, tinnitus, or even hearing loss. It’s important for frequent flyers to take preventive measures and consult healthcare providers if they experience symptoms regularly.