Aerotitis Media (Plane Ear Pain, Flying Ear Pressure Problems)

Ear problems are one of the common complications of flying. It is not always a problem for every person. Some may feel a slight discomfort, other a slight popping sensation when landing or even with takeoff. However, many people experience a more severe form of this ear problem. It is painful, affects hearing, may trigger vomiting, dizziness and even cause bleeding from the ears.

What is aerotitis media?

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Aerotitis media is the medical term for unequal air pressure on either side of the eardrum. This mainly arises with air travel but can also occur when working in a pressurized environment or traveling over different altitudes in a short period of time. In very rare cases, mild aerotitis media can occur with rapidly descending a high hill. Slow descent and gradual changes in ear pressure are usually not a problem.

Aerotitis vs Barotitis

Aerotitis media is the same condition as barotitis media. The term aerotitis refers specifically to air pressure while barotitis refers to any form of pressure, including pressure from water as is seen with scuba diving.  Aerotitis media and barotitis media are ear problems arising from rapid pressure changes but other air spaces like sinuses and even gas in the blood can also be affected. Pressure-related conditions are collectively known as dysbarism.

Flight Ear Pressure Problems

The problem that develops in flight ear or airplane ear is due to the pressure difference between the outer and middle ear. The outer ear is in contact with with the environment. Air pressure within the ear canal and on the outside of the eardrum (tympanic membrane) is the same as the environment. The air pressure on the inner side of the eardrum should also be the same. Air travels from the back of the throat up the narrow canal known as the Eustachian tube into the middle ear.

However, the Eustachian tube is narrow and many problems can develop which affects the pressure. With flight, the pressure in the outer ear is greater than the pressure in the middle ear. The eardrum buckles inwards and when it persists it can cause severe damage within days. Only in rare cases like when there is a sudden increase in outer ear pressure will the damage occur almost instantly. This is seen with trauma like a slap or punch to the ear and even with an explosion. Here the air is suddenly compressed in the outer ear. It can even cause the eardrum to tear.

Plane Ear Causes

Although the problem in plane ear is caused by pressure difference on either side of the eardrum, the underlying problem is usually with the Eustachian tube. These conditions are jointly known as Eustachian tube dysfunction (ETD). Sometimes it is within the middle ear itself.

Structure

Sometimes there is a problem with the structure of the Eustachian tube. In children the main structural factor that can lead to plane ear is that the Eustachian tube is shorter than normal and easily blocked by nasal mucus or becomes infected quicker. Adults who smoke omay also experience some dysfunction as the tiny hairs that clear the mucus out of the ear are damaged.

Infections

Infections of the ear, nose and throat are very common in all age groups. Since the Eustachian tube is connected to the area at the back of the throat and nose on one end and the middle ear on the other end, infections in these areas can also affect the tube. Once the tube walls swell, the opening of the tube may close. Mucus can also block the Eustachian tube. Infections where this may occur includes :

  • Common cold
  • Sinusitis
  • Middle ear infection (otitis media)

Allergies

Allergies can affect the Eustachian tube in the same way as infections inflame the wall and cause mucus obstruction. Allergic rhinitis, commonly known as hay fever, is the main allergic condition that can contribute to plane ear. It is a chronic condition but if well managed it may not pose a problem during flights.

Sleeping

Sleeping during landings is another factor that may contribute to plane ear. By keeping the mouth closed and not swallowing air in an attempt to clear out any imbalance, the pressure difference is more likely to occur. When awake, a traveler can chewing gum, talking or just swallowing helps the muscles of the Eustachian tube open. This encourages the air to enter the middle ear an equalize with the air pressure in the outer ear.

Plane Ear Symptoms

Blocked Ear

There is a sensation of fullness or congestion in the ear. It is commonly referred to as a blocked ear because the sensation of stuffiness coupled with the diminished hearing. The sensation is similar to being underwater where the ears feel full and sound is muffled.

Pain in Ear

Although the congestion in the ear causes discomfort, in most cases it is not painful. It quickly eases once the ear “pops” and the pressure equalizes. In severe cases though there may be pain that can vary from a dull ache to sharp pain.

Hearing

The hearing is muffled in plane ear and there may be some temporary hearing loss. A person may also complain of ringing in the ears which is known as tinnitus. When the condition persists for hours or days then the hearing loss becomes more severe yet its still reversible to a large extent. Sometimes however, hearing loss and tinnitus can be permanent and this is one of the more serious complications of plane ear.

Other Symptoms

  • Vertigo (room spinning)
  • Lightheadedness
  • Nausea and vomiting due to the vertigo
  • Bleeding from ear
  • Children may cry excessively during and after descent

Aerotitis Media Diagnosis

An otoscope, a small device with a light at the end, will be used to examine the ear canal and the ear drum. Usually with aerotitis media, there is an inward or even an outward bulging of the ear drum. It depends on whether the pressure is greater within the outer ear or middle ear. However other tests may also be necessary to exclude damage to the hearing apparatus and to see any areas of damage. In some cases there could have been other ear problems that were undetected until plane ear starts up.

Flight Ear Pressure Treatment

No medical treatment is needed in most cases of plane ear. The pressure will imbalance that builds up during the flight will equalize on its own over time, usually within minutes or hours but sometimes within days.

If the symptoms are severe and persistent, then the treatment will aim at opening up the Eustachian tube. This can sometimes be done with the Valsalva maneuver. Simply closing the nostrils with the fingers, closing the mouth and gently forcing air or swallowing will allow the pressure to equalize. It should not be forced.

Medication that may help includes :

  • Anti-inflammatory drugs like ibuprofen and acetaminophen to relieve pain and help reduce any swelling in the Eustachian tube.
  • Antihistamines to reduce any excessive mucus discharge which may be obstructing the tube.
  • Decongestants to reduce inflammation and mucus in the Eustachian tube.

Surgery is very rarely needed. Sometimes a small crescent shaped incision is made in the eardrum to allow for the ear pressure to equalize. A small plastic tube may be inserted to allow fluid in the middle ear to drain over time. Even when the eardrum is ruptured, surgery may not be necessary. The tear can heal on its own with time.

Plane Ear Prevention

The focus is usually on preventing plane ear.

  • Decongestant nasal sprays and antihistamines can be used as a preventative shortly before the flight.
  • Pressure regulating ear plugs prevents a rapid change in ear pressure on the eardrum.
  • Chewing gum, sucking sweets and the Valsalva maneuver may be helpful during ascent and descent.
  • Avoid sleeping during descent and landing.
  • Talking during landing can be helpful to some degree.

References :

  1. http://www.patient.co.uk/health/Ears-and-Flying.htm
  2. http://www.cumc.columbia.edu/student/health/pdf/B/Barotitis.pdf
  3. http://www.mayoclinic.com/health/airplane-ear/DS00472