How do I stop my ears from hurting on airplanes?

The first thing to understand is that the middle ear has a cube-like structure with five rigid walls made of bone and one elastic wall, the tympanic membrane. The middle ear is filled with air, and its pressure needs to match that of the atmosphere for the tympanic membrane to vibrate properly when it receives sound waves. This vibration is transmitted to the ossicles, and from there to the cochlea and auditory nerve. To equalize the pressure between the inside and outside of the ear, we have the Eustachian tube, an osteocartilaginous passage that regulates this pressure.

When we board a plane, we experience a sudden change in atmospheric pressure. Nowadays, planes are depressurized and therefore sudden changes in pressure should not be so noticeable, but even so, pain or discomfort sometimes occurs. This can be due to various factors, including the type of plane, the takeoff or landing maneuvers, which can vary depending on the pilot, the type of runway, weather conditions, and, most importantly, the physiological condition of the middle ear, Eustachian tube, and nose. Other individual characteristics of the person can also play a role.

As I mentioned earlier, for the tympanic membrane to vibrate and transmit sound as effectively as possible, the pressure inside the middle ear must match the external pressure. Since it is living tissue, the oxygen inside is gradually consumed, leading to a decrease in pressure. To restore balance, the Eustachian tube comes into play. This tube connects the anterior wall of the middle ear to the nasopharynx, which is the posterior part of the nasal cavity. Additionally, the opening of the tube at this point is closely associated with the muscles that form the palate.

When the oxygen in the middle ear is depleted, the Eustachian tube opens, allowing air to flow in and equalize the pressure. If this equalization does not occur — such as during a rapid pressure change — the eardrum is pushed inward forcefully, causing pain. Along with the discomfort, there is often a sensation of hearing loss, as if the ear is full, or the head feels hollow. You may experience the sensation of hearing yourself speak from inside or an echo of your own voice. Tinnitus, or ringing in the ears, can also occur. These symptoms result from the imbalance between the pressures inside and outside the ear.

The Eustachian tube opens whenever we swallow saliva, as the muscles of the soft palate move, allowing air to enter the middle ear and equalize the pressure. You’ve probably seen someone pinch their nose and force the tube to open when ascending a mountain, which helps relieve the feeling of congestion. This works well in gradual pressure changes, like those encountered on a mountain, but not on an airplane. In an airplane, pressure changes can be very sudden. And that is why it can cause significant pain. In some cases, the pressure change can be so sudden and forceful that it may cause a hemorrhage or even a perforation of the eardrum. It can cause serious harm.

Certain factors can make pressure changes more painful for some people. For instance, individuals with nasal conditions such as polyps or a severely deviated septum often experience worse function of the Eustachian tube, making them more susceptible to pressure changes. People with allergies or inflammatory conditions affecting the nasal mucosa may also face similar issues. Or, even someone without these conditions could suffer if they have a cold during the flight. These varying circumstances are all linked to how well the Eustachian tube functions. Factors such as the airplane’s depressurization capacity and the abruptness of takeoff can also play a role. In other words, you may have these predisposing factors and not experience pain, or you may not have them and still feel discomfort.

But it can be prevented. Before boarding a plane, it’s important to keep your nasal passages as clear as possible. If you have a cold, make sure to blow your nose thoroughly and consider rinsing it with saline. Chewing gum vigorously, even aggressively, with your mouth wide open can help, as it engages the palate muscles to open the Eustachian tube. Sipping small amounts of water or sucking on a hard candy can also be effective. Another technique to equalize pressure is the Valsalva maneuver, which involves closing your mouth, pinching your nose, and gently exhaling. This maneuver can help open the Eustachian tube, allowing air to enter the ear and making pressure changes less uncomfortable.

For individuals with nasosinus conditions or those who frequently experience this issue, it’s a good idea to consult an otolaryngologist. A specialist can provide tailored advice and, in some cases, recommend appropriate medical treatments.

Elisa Gil-Carcedo is head of the Otorhinolaryngology section at the Río Hortega University Hospital and associate professor at the Faculty of Medicine of the University of Valladolid.

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