Why do my ears hurt so much when I fly?
I’m 59 and have been flying for more than 40 years, sometimes three or four times a year. On a recent flight back from Sweden with my wife, I experienced extreme pain in my left ear as we descended. It lasted only until a short time after landing. But on my next trip, I had excruciating pain in the same ear, again on the return flight. I am now extremely reluctant to fly - is there anything that can be done to cure this?
Mr R. F. Atkin, St Neots, Cambs.
You have described what we know in the trade as ear barotrauma - most frequently caused by flying. Other triggers include diving or treatment in a high pressure oxygen chamber.
It occurs as a result of changes in pressure in the middle ear. This is an air-filled space separated from the outside world by the eardrum.
It’s connected to the back of the nose just above the throat via the eustachian tube.
The tube’s job is to keep the air pressure in the middle ear the same as the atmospheric pressure outside, and it does this via a valve called the eustachian cushion - this opens every time you swallow and allows air to flow in or out so the pressure is balanced.
This mechanism can go wrong, usually when the membrane lining the nose or throat swells up (perhaps because of an upper respiratory infection or allergy).
When the tube does not function correctly the pressure differences force the eardrum to stretch, causing pain.
As you will know, the air in an aircraft is pressurised, but it’s at a lower pressure than in the ear. That’s why you get that feeling of slight blockage in your ears after take-off, as the pressure inside your ears hasn’t equalised with the cabin pressure.
The eustachian tube then opens, letting out air from the middle ear; some of this air is also absorbed into the bloodstream via the lining of the ear cavity. This process is usually not painful.
However on landing, the external pressure increases again rapidly and the pressure in the middle ear also has to catch up to balance the increase in atmospheric pressure.
This is where you have experienced problems, with the eardrum being pushed inwards, stretching painfully. If a doctor looks into your ear he may see the drum is bruised or even bleeding.
That has been your experience on more than one occasion, though it’s not clear why your eustachian tube should have failed to equalise pressure after so many years with no hint of trouble.
The most likely explanation is that either you had a minor degree of respiratory infection or a small allergic response to something - both common enough problems, although the result is you’ve now been put off future air travel. Of course, the best treatment for barotraumas is to avoid them.
But knowing pressure changes are the cause, you can take suitable medication. Decongestants such as pseudoephedrine tablets, taken an hour before the flight, are helpful, and can be taken in conjunction with a decongestant nasal spray.
A prescription is not needed for either - just ask at the chemist’s counter. The treatments work by reducing congestion around the eustachian tube and ensuring that pressure equalisation can occur.
It is going to need confidence, because once you are on that plane, there is no going back. The good news is that the above combination almost always works well. - Daily Mail