Flying and the ear (factsheet)

The effects of flying on your ears and hearing
Many people, whether they are hearing or deaf, or they have tinnitus, find that flying can cause pain or discomfort in their ears, and temporary hearing loss. These side effects usually last only while you are flying and should get back to what is normal for you after a short time.
What causes pain and discomfort?
Pain or discomfort in your ears and temporary hearing loss during flying results from a difference between the air pressure in the part of your ear called the 'middle ear' and the atmospheric pressure of the plane. The middle ear is behind your eardrum, or tympanic membrane, and it contains the ossicles that conduct sound to the inner ear and nerve of hearing.
The space in the middle ear is normally filled with air at the same pressure as the surrounding air. Air reaches the middle ear through the eustachian tube, which connects the middle ear to the back of the nose and throat. The eustachian tube is closed for 95% of the time and only opens when you swallow or yawn: when this happens the air pressure on either side of the eardrum evens out.
After an aeroplane takes off, the pressure inside slowly drops. Usually this does not cause a problem as the air in the middle ear is at a relatively high pressure and gets blown down the eustachian tube.
You are most likely to get pain or discomfort, or hearing loss, when the plane comes down to land. During landing, the air in the middle ear is at a lower pressure than that in the plane. The eustachian tube may become blocked and the small muscles in the throat may not be able to open it. The resulting low pressure in the middle ear causes the eardrum to press inward, causing discomfort or pain, and temporary hearing loss. This small temporary reduction in your hearing may make a huge difference in your ability to understand speech if you already have a hearing loss. However, the blockage usually clears up by itself after a short time.
The inner ear and flying
Very occasionally, sudden decompression - a drop in air pressure - occurs in the plane. This can affect the inner ear and cause a sudden disturbance in your balance and hearing. Though this is extremely rare, if it happens to you, you should go to the accident and emergency department of the nearest hospital as quickly as possible to check for any damage and to get treatment.
If you develop any ear problems or conditions during or following a flight which do not clear up after a few hours, you should see your GP.
Reducing the effects of flying on your ear
You can do a number of things to reduce the effects of flying on your ear. Most of these help to help keep your eustachian tube open.
The eustachian tube does not open effectively when you are sleeping. Make sure you are awake before the plane begins its descent, which may start up to an hour before it lands.
Yawn, chew gum or suck on a hard sweet to encourage your eustachian tube to open.
Keep swallowing, using a glass of water or another drink, but not alcohol. Do this regularly; every 15 to 30 seconds if you need to. If this does not clear your ears, carry out the 'Valsalva manoeuvre': pinch your nose between your finger and thumb, and gently blow air down it with your mouth closed, without releasing the air. If you hear or feel air going into your ears then your eustachian tube is working well.
Make sure you are not dehydrated and that you have had plenty to drink. Do not drink alcohol.
Flying may be uncomfortable if you have a cold. When you get a cold or other infection around the nose and throat, the lining of the eustachian tube is swollen and gets blocked more easily. If you have to travel, ask your GP (family doctor) or local pharmacist for advice and ask about decongestants you can use. Decongestants reduce inflammation and relieve the blocked sensation. Many GPs recommend you use a decongestant spray about 20 minutes before you land. It is important not to use the spray for more than five days in a row.
Some people have reported that earplugs called EarPlanes® have helped them to fly comfortably. EarPlanes® are earplugs designed for flying. They have a small ventilation tube down the middle, which slows down the pressure change in the eardrum when the plane is pressurised and depressurised. However, so far, there has been no medical study to prove that EarPlanes® help people who normally get severe ear pain when flying. The use of ordinary soft earplugs is not recommended. You can buy EarPlanes® from RNID Sound Advantage (see "Buying equipment from RNID" for contact details) or try your high street pharmacy.
Tinnitus and flying
If you have tinnitus, you may find that flying is the one time when you are usually completely free of tinnitus because of the noise made by the engines and airflow around the plane. However, if your eustachian tubes are blocked, your tinnitus may seem temporarily louder. It should return to its previous level when your eustachian tubes become unblocked.
If you have tinnitus and hearing loss, you will find that it is often the 'straining to hear' that makes your tinnitus louder when on a plane. If you normally wear hearing aids, you should keep them on during your flight as removing them may make your tinnitus louder and more noticeable. Being anxious about flying may make your tinnitus worse: basic relaxation exercises during the flight may help you. For further information about relaxation exercises, see our factsheet "Tinnitus and relaxation".
Very rarely, the sound of plane engines can make your tinnitus worse.
If you are worried about the noise of the plane engines, book ahead and try and get a seat near the front of the plane, away from the engines. Sound generators that you wear can help to reduce any discomfort due to loud sounds such as engine noise. For more information about sound generators, see our factsheet "Equipment, sound therapy and tinnitus".
Grommets and flying
Flying is less likely to cause discomfort in a child or adult with a grommet in their ear. The grommet allows air in and out of the ear and reduces the stress on the eardrum that is caused by changes in air pressure in the plane. However, children who have a history of frequent ear infections or have had grommets in the past (but no longer have them) are occasionally at risk of perforation of the eardrum when flying. If you are worried about this, ask your GP.
If you have perforated eardrums as a result of infection or injury, flying is also less likely to cause discomfort. This is because any change in pressure can even out across the eardrum and does not depend on the eustachian tube working normally.
Flying after ear surgery
If you have any kind of ear surgery, always check first with your ear, nose and throat (ENT) consultant when it would be safe for you to fly.
Flying and anxiety
If you are anxious about the effects of flying on your ears and worried about flying generally, discuss your fears with your GP. Very rarely they may prescribe tranquillisers. Relaxation and breathing exercises can also be helpful for anxiety in general.
If your only worry is that flying may be harmful to your ears, in almost all cases you can go ahead and enjoy your flight. If your reason for flying is to take a holiday, you have something enjoyable and relaxing to look forward to!