Do you get ear pain during airplane take-off or landing ? What is Airplane ear or Ear barotrauma ?

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Ear barotrauma or Airplane ear is the clogged up or sometimes painful feeling in ears when the air pressure changes suddenly. It is one of the common health problems for people who fly. It is especially painful for babies and kids as their ears are not fully developed.

This condition can also occur when we go in an elevator or drive in mountains. In water, it can happen while Scuba diving. They call it "Ear squeeze". As the diver goes deeper underwater, the middle ear is squeezed by the increasing pressure of the outside water.
Middle ear is an air filled space behind the ear drum. It is connected to nasopharynx (passage behind nose and just above roof of mouth) by the eustachian tube ( a tunnel like structure connecting middle ear to area behind the nose). A functional eustachian tube helps in maintaining the middle ear pressure equal to that of the surrounding atmospheric pressure. If due to any reason, if the eustachian tube is not functional or when we ascend or descend rapidly, the mechanism fails and there will be pressure difference across the eardrum.

Symptoms:
-Clogged up or fullness in ear feeling
-Ear pain
-Muffled hearing as the ear drum cannot vibrate in normal way because of pressure difference.
-Sometimes it gets corrected its own and we may be able hear a pop in ear when the eustachian tube opens. If it is not getting corrected, fluid start accumulating in the middle ear (middle ear effusion) inorder to equalise the pressure. Still if the eustachian tube is closed, the fluid cannot drain, then symptoms get worsened.
*There will be severe ear pain
*Dizziness/Vertigo
*Hearing loss
*Busted ear drum - indicated indirectly by blood or fluid in ear canal
In mild cases symptoms will go away after sometime. If the symptoms are persisting, then consultation with an ENT Doctor is required.

Risk factors:
All the persons who travel in flight do not get this problem, which means that certain individuals are more prone for this condition.
Those with pre existing eustachian tube disease.
*Stuffy sinuses
*Cold or other infection
*Allergies
*Shape and size of the ear canal
*Hormonal changes like pregnancy
*Tobacco, Smoke and other irritants
Higher risk if around loud explosions (eg: military area) or if scuba diving without proper gear.

Diagnosis:
With proper history and clinical examination most of the time your will be able to come to a diagnosis. Otoscopic(A small equipment used to check ear) examination helps to check damage to ear drum and also to look for fluid in middle ear. Hearing evaluation is also done.

Treatment
Mild symptoms of ear barotrauma will last a few minutes and will settle by itself. If not getting relieved you will need adequate treatment. 
In some severe cases like bursting ear drum or when there is severe hearing loss, surgery may be required.

*Initial treatment include oral decongestants and nasal sprays to open eustachian tube
*Antihistamines to relieve allergic changes
*Analgesics to relieve pain
*If middle ear effusion has occured then sometimes for relieving pain and also for drainage of fluid, grommet insertion and myringoplasty (these are minor surgical procedures done with insertion of a small tube in ear drum for drainage of fluid) may be considered if not much relief with medical treatment.
*Ruptured ear drum may need active treatment with antibiotics, and if there is severe damage, sometimes surgical repair may be required.
*Hearing tests are also done.
*If there facial palsy( weakness of facial muscles due to nerve damage), oral steroids may be required in tapering dose.

Is there anything you can do to prevent or minimise the problem? Yes, ofcourse!
*If you have cold or allergies, take decongestant tablets or nasal spray and antihistamine prior to the flight journey.
*Special ear plugs designed for air travel can slow pressure changes and allow ear to get time to adjust.
*Try to chew gum, candy or swallow sips of water while ascending and descending. Swallowing helps to open eustachian tube.
*Don't dive if there is any sinus or upper respiratory symptoms
*Get back to surface slowly if you experience pain while diving. Continuing diving can aggravate symptoms and cause more damage.
*Look up - extending your neck can open eustachian tubes.

- Dr.Yethin Yedukumar (MBBS, M.S.ENT)

Hi friends. In this blog, you will find some interesting articles related to Ear, nose and throat diseases. Do share if found useful. Thankyou.

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