Pain, a fullness feeling in the ear and even a popping sound are some of the symptoms that air travellers may experience. This is not usually a long term problem despite the discomfort during the flight and often for hours or even days thereafter. However, for some people this ear problem that arises with air travel can cause some serious complications which may even need medical attention.
What is Aerotitis Media?
Airplane ear also known as barotrauma, barotitis media or aerotitis media is a medical condition where there is stress on the eardrum (tympanic membrane) due to air pressure changes. Most people experience this condition when travelling in a plane, therefore the term airplane ear. However, it can also occur when at high altitudes or even deep underwater.
Although airplane cabins are pressurized so that the passengers experience minimum change in air pressure, some people may still suffer from airplane ear especially when the plane is taking off or landing.Certain self care measures like chewing gum or yawning helps in preventing airplane ear. However, in severe cases medical attention is required.
Signs and Symptoms
Rapid change in altitude leads to rapid change in air pressure precipitating the symptoms of airplane ear. Common presenting symptoms include moderate to severe discomfort even pain in the ear along with partial loss of hearing and feeling of stuffiness or fullness in the ear. Usually the symptoms are relieved within 20 to 30 minutes after landing. However, in severe cases these symptoms persist for a longer duration.
In there severe cases there is excruciating pain the ear along with pressure felt in the ear similar to that felt underwater, severe degree of hearing loss, continuous ringing sound (tinnitus), spinning of head (vertigo), nausea and vomiting even bleeding from the affected ear. One or both the ears can be affected. If the symptoms persist for hours one should seek medical advice.
Usually airplane ear resolves with time without any complications. However, sometimes permanent hearing loss or chronic ringing in the ear (tinnitus) may occur. This is rare. Nevertheless, any person who has experienced previous incidents of severe airplane ear or who has a pre-existing ear condition should seek medical attention prior to air travel.
Causes of Airplane Ear
The ear is divided into three parts – the outer, middle and inner ear. The outer and middle ear are separated by the tympanic membrane (ear drum). Adequate vibration is necessary for sound waves to reach the inner ear and is thereby essential for sound perception. The air pressure in the middle ear is maintained by a narrow tube like structure, the Eustachian tube.
One end of the tube is leads to middle ear whereas the other end is leads to the upper part of the throat it meets the nose, which is known as the nasopharynx. Air that enters the mouth and nose thereby travel up the Eustachian tube to the middle ear. It ensures that the pressure within the middle ear is the same as the pressure in the outer ear, separated only by the ear drum.
However, with a change in altitude this balance of ear pressure on either side of the eardrum is disrupted. As the airplane ascends or descends there is a sudden change in environmental pressure. The muscles of the Eustacian tube may not react quickly enough to adjust to the changing air pressure.
Swallowing, yawning or chewing activity activates the muscles required for opening or closing of the Eustachian tube. With the opening of the Eustachian tube at the back of the throat opened, air can then enter into the middle ear cavity. It matches the middle ear pressure withe the environmental air pressure. This prevents airplane ear.
Symptoms similar to airplane ear may also occur during scuba diving, upon entering a hyperbaric oxygen chamber, being close to a site of an explosion, riding an elevator or driving in a hilly area. Some people are more likely to develop airplan ear than others. This is due to the presence of one or more risk factors. Common risk factors for airplane ear include:
- having a small, narrow Eustachian tube as is seen in children.
- suffering from common cold, sinusitis, hay fever, infection in the middle ear (otitis media).
- sleeping during ascent or descent of aircraft.
- repeated episodes of airplane ear increase the risk of suffering from airplane ear in the future.
Read more on otitis media.
Treatment of Airplane Ear
In most of the cases airplane ear usually resolves without any medical treatment. However, in cases where the symptoms persist, drugs may be necessary. This includes medication like:
- Nasal decongestants both nasal spray or oral drugs.
- Oral antihistamine agents
- Topical corticosteroids and sometimes oral steroids in severe cases.
- Painkillers are useful in treating associated pain and discomfort.
However, there are cases of airplane ear where drugs may not offer relieve Therefore surgery may be require in these severe cases. The surgical approach is to make an incision in the eardrum. This is known as myringotomy. It immediately restores the middle ear pressure to the environmental level and eases the symptoms of airplane ear. However, a myringotomy is rarely required.
Preventing Airplane Ear
There are several preventative measures that may be useful. However, it may not always be sufficient to prevent airplane ear entirely.
- Avoid sleeping when the aircraft is taking off or landing. Minimize the use of sleeping pills or alcohol which may make it difficult to stay awake.
- Suck on candy or chew gum during ascent and descent. Yawning and swallowing may also be helpful in this regard.
- Try the Valsalva maneuver when the aircraft is ascending or descending. This involves pressing the nostrils closed while gently blowing out through the nose.
- Use prescribed medication for ear and nasal problems as directed. Speak to a doctor about air travel and administer the medication accordingly.
- Filtered earplugs assist in gradually equalizing air pressure on the eardrum. It should not be used if a person has an outer ear problem unless a doctor approves its use.