Take control of ear pressure and pain when traveling
Afraid of getting on the plane with your head cold?
This summer I’ve been traveling quite a bit, some of it for fun, some for work and volunteering. All the air travel and sleep loss likely weakened my immune system and I ended up with a terrible cold. I hardly ever get sick, so I was annoyed. However, even more than an annoyance, I had a bad head cold, with a lot of congestion. I had to travel from NY to Peru for a medical mission. Air travel with a head cold is terrible! The headache and ear pain from the pressure changes is horrible and can result in a perforated ear drum if severe. If I didn’t have to be there for this medical mission I would’ve tried to postpone it, but that was not an option. What was I to do to achieve ear pain relief when traveling?
This is the medical term for the traumatic process that may result from the unrelieved pressure between the middle ear and the external environment (see image below). Best case scenario you just experience some ear pain, worse case you end up with a perforated ear drum.
According the WHO, a plane’s cabin is pressurized to about 0.75 ATA (absolute atmosphere units), so it is lower than the pressure at sea level. During flight:
“Passengers often experience a “popping” sensation in the ears caused by air escaping from the middle ear and the sinuses during the aircraft’s climb. This is not usually considered a problem. As the aircraft descends in altitude prior to landing, air must flow back into the middle ear and sinuses in order to equalize pressure. If this does not happen, the ears or sinuses may feel as if they are blocked and pain can result. Swallowing, chewing or yawning (“clearing the ears”) will usually relieve any discomfort. As soon as it is recognized that the problem will not resolve itself using these methods, a short forceful expiration against a pinched nose and closed mouth (Valsalva maneuver) should be tried and will usually help. For infants, feeding or giving a pacifier (dummy) to stimulate swallowing may reduce the symptoms.”
So, what is a person to do if these don’t work or you are very congested during flight?
I personally didn’t want to take over the counter cold medicine because they make me restless and agitated. I wanted to find solutions that were a bit more “local” and had fewer systemic side effects, while providing ear pain relief. So, I started investigating, looking at current research and spoke with my trustworthy neighborhood ears, nose and throat (ENT) expert. Finally, I chose to do four things to help my ears and head stay pain free and healthy. Read on to find out what those were and what the data behind them are 😄.
Days before take off
About 5 days before my trip, I started using a steroid nose spray to help with inflammation. Steroids usually take a little bit to start having its anti-inflammatory effect, so it is a good idea to start well ahead of your travel date. There are many brands out there, I used fluticasone nose drops, which is known as Nasacort™ in the US. However, any nasal steroid will work against inflammation and maybe help provide ear pain relief. I did my research in terms of nasal steroids helping relieve flight related otalgia (fancy name for ear pain), but found nothing.
Regardless, I decided to give them a try. These drops are usually used for the control of seasonal allergies, but they can also help with the nasal inflammation that occurs from having a cold, so it made sense to me that they could help.
1 hour before take off
My ENT expert recommends and loves oxymetazoline HCl nasal solution for a host of ENT issues. Here in the US, these little nose drops are known as Afrin™ nose spray. They are a nasal decongestant and vasoconstrictor, which means it will minimize the swelling inside your nose that happens when you get a cold and also helps minimize mucous production. I was hoping these could help with ear pain relief. You should use it one hour before take-off so that it is working when you take off and it lasts 12 hours. You can use it for up to three days, but you don’t want to use it longer than that. Why? There is a phenomenon called “rhinitis medicamentosa” which occurs when you use this product long term. You end up having a paradoxical reaction and you actually get the opposite effect, that is, you get worsening congestion!
It can cause drying and burning of the tissue inside your nose, but the steroid nose drops you take before hand can help keep that in check.
Now, is there data to support the use of these topical decongestants for ear pain relief? Yes! BUT, there is only 1 study. The study showed a slight, but not significant improvement in ear pain as compared to placebo. It should be noted that the study was NOT evaluating people who had colds or congestion. They were evaluating patients with prior history of ear pain in flights, so it’s hard to interpret for people with colds.
Although it is administered locally to the nose, make sure you speak to your doctor before taking this medication if you have high blood pressure because the tissue inside the nose can absorb some of it. This may cause your blood pressure to rise.
Right before take off
After looking and reading a bit, I ended up buying these special ear plugs called earPlanes™. They are used by navy pilots to help relieve in-flight air pressure ear discomfort and apparently it can help prevent vertigo symptoms as well. They come in two sizes, kids and adults. If you are on the petite side, like moi 🙋🏻♀️, get the kid ones. I don’t think my ears would have tolerated the adults sized ones. They fit pretty snuggly and after a while your ears can start bothering you. I know mine did, I wore them for two hours straight though, because our take off time kept getting delayed while already on the tarmac. They also minimize noise by 20 decibels, so you can use them as regular ear plugs.
I followed the instructions exactly as it says on the box: insert the EarPlanes™ right before take-off, wait till you reach the maximum altitude and then take them off. Then, 1 hour before landing, put them back in and leave them until you have landed.
Any data on these pressure regulating earplugs and ear pain relief? Yes, but again, studies were not done on people with colds or congestion. In addition, the number of patients evaluated was very small. One study showed a significant reduction in ear pain with the use of pressure regulating earplugs. While another study showed a higher rate of barotrauma with the earplugs than without! So, the evidence is inconclusive, although many people swear by them.
As soon as I saw that there was one hour left to land, I placed my ear plugs back in as explained above. I also had a piece of sugar-free gum that I started chewing to help equalize the pressure between my middle ear and the plane cabin.
As mentioned, activities such as chewing, drinking and yawning are all great to help open up your canal and bring ear pain relief, so you may want to try and do these as the plane descends.
And there you have it!
I did those four things on the three flights that I took in a span of three days. Now, of course, you are probably wondering if it worked 🤔? Well, although there is not sufficient scientific evidence at present, for me it did! I don’t think I would bother writing about it if I didn’t get ear pain relief 😬. Actually, I had no ear pain at all! I did feel a little pressure in one of the flights, but that dissipated when I started chewing gum.
I never had to take any oral medication, even though I brought it in case things got bad. The only thing that consistently works to diminish ear pain in adults, according to studies, was an oral decongestant, pseudoephedrine, taken 30 minutes before take-off. So, you can also try that if you tolerate these well.
Also, my 8 y/o had a cold too (surprise!). She followed the exact techniques I used and she had no discomfort at all. This is pretty impressive since she has been known to complain about ear pain when we are landing, regardless of having a cold or not.
So, I definitely recommend trying these techniques and I plan use them in the future if need be. What about the medical mission? It was incredible! I will leave all the amazing, sad and sometimes unbelievable details about it for my next post. Make sure you don’t miss it! Subscribe 👇🏼 so you can get it straight to your inbox.
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Here is to wishing decongested travel 😜,