How to Reduce Ear Pain When Flying (Addendum)

by Neil Bauman, Ph.D.

In my article, “Here’s How to Reduce Ear Pain When Flying“, I mentioned the Ear Ease. However, it needs to be filled with hot water.

One reader responded,

In today’s flight environment, obtaining hot water is not so easy. I have in the past used disposable hand warmers from an outdoor store. You just open the package and a chemical reaction makes them hot.” So that is another solution.

This reader then went on to suggest three other techniques:

1. Hold nose closed and swallow
2. Valsalva maneuver – hold nose and mouth closed and exhale – works only on descent, of course
3. Screaming—probably not a good solution for adults to use in commercial aircraft, but it is one solution babies use to open their Eustachian tubes.

The United States Federal Aviation Administration, in their book, “FAA Aeronautical Information Manual (AIM) 2012”, has this to say about what they call “ear block”. (The following is specifically addressed to pilots, but the principles apply to everyone on the plane. If you are hard of hearing and have problems flying, pay attention to these tips.)

Ear block.

1. As the aircraft cabin pressure decreases during ascent, the expanding air in the middle ear pushes the Eustachian tube open, and by escaping down to the nasal passages, it equalizes in pressure with the cabin pressure. But during descent, the pilot must periodically open the Eustachian tube to equalize pressure. This can be accomplished by swallowing yawning tensing muscles in the throat, or if these do not work, by a combination of closing the mouth, pinching the nose closed, and attempting to blow through the nostrils (Valsalva maneuver).

2. Either an upper respiratory infection, such as a cold or sore throat, or a nasal allergic condition can produce enough congestion around the Eustachian tube to make equalization difficult. Consequently, the difference in pressure between the middle ear and aircraft cabin can build up to a level that will hold the Eustachian tube closed, making equalization difficult if not impossible. The problem is commonly referred to as an ‘ear block’.

3. An ear block produces severe ear pain and loss of hearing that can last from several hours to several days. Rupture of the eardrum can occur in flight or after landing. Fluid can accumulate in the middle ear and become infected.

4. An ear block is prevented by not flying with an upper respiratory infection or nasal allergic condition. Adequate protection is usually not provided by decongestant sprays or drops to reduce congestion around the Eustachian tubes. Oral decongestants have side effects that can significantly impair pilot performance.

5. If an ear block does not clear shortly after landing, a physician should be consulted.

This same publication also has something to say about a closely related condition called “sinus block”. Sinus block can occur, and often does occur at the same time as your ears block, so you should know about it. The FAA manual explains:

Sinus Block

1. During ascent and descent, air pressure in the sinuses equalizes with the aircraft cabin pressure through small openings that connect the sinuses to the nasal passages. Either an upper respiratory infection, such as a cold or sinusitis, or a nasal allergic condition can produce enough congestion around an opening to slow equalization ,and as the difference in pressure between the sinus and cabin mounts, eventually plug the opening. This “sinus block” occurs most frequently during descent.

2. A sinus block can occur in the frontal sinuses, located above each eyebrow, or in the maxillary sinuses, located in each upper cheek. It will usually produce excruciating pain over the sinus area. A maxillary sinus block can also make the upper teeth ache. Bloody mucus may discharge from the nasal passages.

3. A sinus block is prevented by not flying with an upper respiratory infection or nasal allergic condition. Adequate protection is usually not provided by decongestant sprays or drops to reduce congestion around the sinus openings. Oral decongestants have side effects that can impair pilot performance.

4. If a sinus blocked does not clear shortly after landing, a physician should be consulted.

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Taken from the book, FAA Aeronautical Information Manual (AIM) 2014 by the United States Federal Aviation Administration. Chapter 8. Medical Facts for Pilots (Sections 8-1-2-b & 8-1-2-c).