Ear pain on a plane is a pressure problem. The middle ear has to match the cabin, and the eustachian tube is the only vent.
What changes in the air
The eardrum separates the canal from the middle ear. The eustachian tube runs from the middle ear to the back of the nose. It opens when you swallow, yawn, or chew, and lets a little air in or out so pressure stays even.
On the way up, air in the middle ear expands and usually slips out through the tube. On the way down, cabin pressure rises and the drum is pushed inward unless the tube opens and lets air back in. That is when ears hurt, feel blocked, or fail to pop. A cold, sinus infection, or allergy flare makes the tube lining swell, so the same pressure change is harder to clear.
How to equalize
Swallow, yawn, and chew during descent. If that is not enough, use cheek and throat pressure only:
- Pinch the nostrils shut
- Take a mouthful of air
- Use the cheek and throat muscles to push that air toward the back of the nose, as if you were trying to blow your fingers off the nostrils
A pop means the tube opened. You may need to repeat this several times on the way down. Do not push with the chest or the abdomen. That pressure is too high.
Babies cannot pop their ears on purpose. Sucking does it for them. Offer a bottle or pacifier during descent, and try not to let them sleep through the landing.
Before you fly
If you have a cold, a sinus infection, or an allergy attack, postpone the trip when you can. If you recently had ear surgery, ask the surgeon when flying is safe.
Many travelers take a decongestant pill or nasal spray about an hour before descent so the membranes shrink and the ears pop more easily. People with allergy symptoms should take their usual medicine at the start of the flight for the same reason. Decongestants are a poor fit if you have heart disease, high blood pressure, an irregular heartbeat, thyroid disease, or marked nervousness. Pregnant patients should ask before using them.
After you land, keep swallowing and equalizing. A short course of a decongestant can still help. Do not turn a nasal spray into a daily habit. After a few days of continuous use, many sprays cause more congestion than they relieve.
If the ear stays blocked or the pain continues, you need an exam. Sometimes pressure or fluid has to be released with a small opening in the drum. Ears that stay blocked after a flight are part of our ear, nose, and throat care. Repeated fluid behind the drum is covered in earache and middle ear infections.
