With widespread vaccination reducing the impact of the COVID-19 pandemic, many people are flying again, especially during the summer months. While it’s great that we can all get away for vacations again, flying can sometimes spell trouble for our ears. Wherever we’re seated on the plane, we have the same likelihood as anyone else that changes in cabin pressure could damage our ears. Most people experience the “popping” or discomfort that comes with rapid pressure changes as a mild annoyance, but some may have greater difficulty reaching equilibrium. Sometimes if the cabin pressure drops very rapidly, it can perforate or tear eardrums throughout the plane.

What’s Going On with All this Pressure?

The eardrum—a non-porous skin membrane—separates our ear canal from our middle ear. Because, under normal circumstances, there is no way for air to pass through the eardrum, changes in pressure are accommodated by the Eustachian tube, or “auditory tube.” The auditory tube connects the middle ear to the throat, allowing air to move into or escape out of the middle ear in order to create equal air pressure on both sides of the eardrum. For the eardrum to work properly, pressure equilibrium is required. The thing is, our bodies weren’t built with rapid changes in air pressure in mind! Most of the time, we don’t experience wild swings in air pressure. Even if we hike up a mountain, the pressure changes so slowly that we don’t notice it happening. When pressure changes quickly, the normal process of equalization doesn’t happen quickly enough to avoid the unpleasant experience of “popping.” The technical term for this is “ear barotrauma.”

Ascent vs. Descent

When your plane takes off and begins to climb upward toward the jetstream, the pressure outside your body begins to drop. Since the amount of air inside your middle ear has stayed the same, it begins to push your eardrum outward. On descent, the exact opposite happens. The pressure around you increases, while your middle ear stays the same. The eardrum bows inward. On descent, the auditory tube may also be pinched shut, making it harder to reach equilibrium without some extra effort. In both situations, the eardrum is not able to function as normal, so you may experience muffled hearing or temporary hearing loss. Once equilibrium is reached, hearing should return to normal.

Preventing Ear Pain in the Air

Anyone who has flown in an airplane—or driven through the mountains, for that matter—has had the experience of ear barotrauma. A “fullness” in the ears and “popping” are both common. There are a few tricks you can use to help equalize the pressure and avoid the pain:

• Swallow - Swallowing helps air move into the auditory tube. It may produce a clicking or popping sound as it does so. We frequently swallow without even realizing we’re doing it, and this helps us maintain the pressure equilibrium between our middle ears and the outside world under normal circumstances. When pressure is changing more rapidly, it can help to intentionally and repeatedly swallow until the plane has reached altitude.

• Chew Gum or Eat Hard Candy - Gum and hard candy both stimulate our salivary glands, which means we’ll be swallowing more regularly. If you have trouble forcing yourself to swallow on command, some gum or hard candy can help you do it more naturally.

• Valsalva Maneuver - This trick helps open your auditory tubes. Take in a mouthful of air, keep your lips sealed and pinch your nostrils shut. Gently breathe out, forcing air out of your tightly-closed mouth, until your ears pop. If you have a cold or allergies, do not perform the Valsalva maneuver as it can cause infection. Instead, use the Toynbee maneuver.

• Toynbee Maneuver - Close your mouth and pinch your nose closed. Swallow several times until pressure equalizes.

You will likely have to perform any of these maneuvers multiple times during ascent and descent. The changes in pressure do not happen all at once, but over the course of a few minutes. As soon as pressure is equalized, it will likely be upset again as the plane continues to climb or descend. Take care as you travel by airplane this summer, and if you are having hearing issues, make an appointment for a hearing test today!