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How To Fix The Splitting Pain Of In-Flight Ear Block

You've probably experienced ear block when climbing or descending when you've had a cold. It's an extremely painful experience and can lead to some nasty physical consequences. Here's what you need to know...

We spoke to Steve Martin, a professor of aerospace medicine and manager of the altitude chamber at the University of North Dakota to find out more.

Why Your Ears Won't Pop

If you've had a sinus infection, cold, or even allergies, you're at risk for a painful ear block. It's especially true when flying unpressurized airplanes.

Your sinuses are a series of connected hollow cavities in the skull surrounded by soft tissue. The largest is about an inch across. Experts don't really know why we have them, but a few theories suggest that sinuses help humidify and filter air. When you're sick and your sinuses become inflamed, it's difficult for air to pass in and out of the sinuses, leading to a buildup of pressure.

Wikipedia

In addition to your sinuses, your Eustachian tubes help equalize the pressure around your eardrums. They're about the size of a pencil, and run from your nose to your ear. When you have a sinus infection or cold, the membranes in your nose block off the Eustachian tube, and your ear subsequently loses much of it's ability to manage pressure changes. This is why sounds become muffled and you begin to feel pressure around your ears.

Wikipedia

As you climb in altitude, air pressure decreases, and the air within your sinuses and Eustachian tube also decreases. You typically won't notice pain during climbs, because it's easier for the Eustachian tube to push air out than to suck it in. Because of this, you and your passengers might go most of the flight without any pain.

But once you begin descending, the air around you increases in pressure. This increased pressure pushes on your ears and sinuses. Since they're inflamed, it's difficult for any air to pass back in. This high pressure air pushes in on your sinuses and ears, leading to a painful experience.

Left unchecked, a rapid descent can cause so much pressure buildup that an eardrum might become perforated. In rare cases, the tiny bones around an ear could go to the inner ear and cause a blowout of the "round window," leading to a loss of inner ear fluid and complete disorientation. This is the same fluid that surrounds the tiny hairs in your ears, and gives you a sense of motion.

How Long Should You Wait After Having A Cold?

After a bad cold, you may have to wait up to a week to fly comfortably again. Just because you feel better doesn't mean your sinuses have fully cleared. They could still be inflamed and unable to handle the pressure changes of flying.

You Fly Anyway, Now What?

If you get an ear block, there are a few steps you need to follow:

  • First, level off. When you or a passenger begin to experience pain, stop the pressure change. If necessary, initiate a climb back to higher altitude, which lowers the pressure on your sinuses and ears. Make sure to request your level off and climb with ATC, and keep them informed about your progress and timing requirements.
  • Second, attempt to equalize pressure in your sinuses and ears. Yawning, chewing gum, and swallowing are a few good ways to equalize pressure. (Keep reading below to learn how the valsalva maneuver and vasoconstrictors can help).
  • Third, begin descending at a slower rate. Once you're ready to try a descent again, don't exceed a 500 feet per minute on descent. Your ears will likely clear themselves slowly. As long as the pain doesn't become too severe, you won't hurt yourself.

If you need extra time and distance, extend your route, slow your speed, or both. This will give your ears and sinuses more time to adjust to changing pressure.

Don't Do The Valsalva Maneuver Wrong

Avoid simply squeezing your nose and attempting to blow out the pressure. If your right ear is blocked:

  • Tuck your chin into your left shoulder while tilting your head forward.
  • Pinch your nose.
  • Close your mouth.
  • Give one good burst of air pressure from your lungs.

The key to success is a quick, gentle pop of pressure that will help open up the Eustachian tubes and sinuses. Reverse these directions when your left ear is blocked. When the valsalva doesn't work after a few tries, don't blow harder. If you do it wrong, you could risk over-pressurizing yourself and making the situation even worse.

What About Babies And Children?

Just like the results of a cold or sinus infection, babies and young children experience ear block on descents from altitude. Their sinus passageways and Eustachian tubs aren't fully developed, and don't equalize pressure well.

When you fly with babies and young children, plan your descents the same way you would if you were sick. Avoid exceeding 500-600 FPM descents in unpressurized airplanes, lengthen your descent route if possible.

Fixes You Can Keep In Your Flight Bag

There are a few things you can keep at home or in your flight bag to help fix your sinus pressure and ear block:

  • Decongestants: Over the counter medications like non-drowsy mucinex will help clear inflammation and mucus from your sinuses, giving your body a better chance of handling pressure changes. Make sure to check that it's legal for you to take the medication before flying, that it's non-drowsy, and that a doctor approves.
  • Vasoconstrictor Sprays: A small bottle of a vasoconstrictor spray can be kept in your flight bag for moments when you need a little extra help clearing your sinuses. It increases blood pressure and reduces swelling to help open sinus and Eustachian passageways. To use them properly, make sure to hold the bottle about 90 degrees to your face to ensure the spray impacts the Eustachian tubes.

Wikipedia

Don't Let An Irritating Symptom Interrupt Your Flying

Having a bad ear block truly is debilitating. It consumes your thoughts, making it difficult to fly the plane.

If you're flying single pilot, do your best to clear your ears and avoid flying again for a few days. When you fly with another pilot, let them know what's going on, so you can plan your descents as best as you can.

The next time you have a bad cold, give yourself plenty of time to get better, avoid rapid descents, level off when you need to, use a decongestant, or just don't fly at all.

Have you had a bad ear block in flight? How did you fix it? Tell us in the comments below.

Swayne Martin

Swayne is an editor at Boldmethod, certified flight instructor, and an Embraer 145 First Officer for a regional airline. He graduated as an aviation major from the University of North Dakota in 2018, holds a PIC Type Rating for Cessna Citation Jets (CE-525), and is a former pilot for Mokulele Airlines. He's the author of articles, quizzes and lists on Boldmethod every week. You can reach Swayne at swayne@boldmethod.com, and follow his flying adventures on his YouTube Channel.

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