Ear Pain During Flight: Why It Happens and How to Prevent It

Ear pain during flight is common — especially during descent. That uncomfortable feeling of pressure, fullness, blocked ears or even sharp pain usually happens because the pressure inside the middle ear is not equalizing quickly enough with the changing cabin pressure.

In most people, this is temporary and settles once the pressure is equalized. But severe or persistent symptoms can sometimes lead to barotrauma, fluid behind the eardrum, temporary hearing loss or, rarely, injury to the eardrum.

The good news is that there are simple ways to reduce the risk.

Why do my ears hurt during a flight?

Behind the eardrum is a small air-filled space called the middle ear.

The middle ear is connected to the back of the nose by a narrow passage called the Eustachian tube. Its main job is to allow air to move into and out of the middle ear so that the pressure on both sides of the eardrum remains balanced.

Under normal circumstances, the Eustachian tube opens when we:

• Swallow
• Yawn
• Chew
• Move the muscles involved in opening the tube

During a flight, however, the surrounding air pressure can change relatively quickly.

If the Eustachian tube does not open adequately, the pressure inside the middle ear cannot adjust fast enough.

This pressure difference can cause:

Ear fullness → blocked sensation → discomfort → pain → temporary hearing changes

Why is ear pain often worse during landing?

Many people notice that their ears hurt more during descent and landing.

As the aircraft descends, the atmospheric pressure outside the ear increases. The middle-ear pressure needs to increase as well, and the Eustachian tube must open to allow air to enter the middle ear.

If the tube does not open sufficiently, the pressure difference can pull the eardrum inward and cause pain or a blocked sensation.

This is why actively swallowing and equalizing pressure during descent is particularly important.

Why doesn’t my Eustachian tube open properly?

Several factors can interfere with normal Eustachian tube function.

These include:

• A common cold
• Nasal congestion
• Sinus infection
• Allergic rhinitis
• Nasal inflammation
• Enlarged adenoids in children
• Eustachian tube dysfunction

Children are particularly prone to ear pressure problems because their Eustachian tubes are shorter and more horizontally positioned than in adults.

If you frequently experience severe ear pain or blocked ears whenever you fly, it is worth having the ears, nose and Eustachian tube function assessed by an ENT specialist.

How can I prevent ear pain during a flight?

The simplest approach is to help the Eustachian tube open frequently, particularly during descent.

1. Swallow frequently

Swallowing activates muscles that help open the Eustachian tube.

You can encourage swallowing by:

• Drinking water
• Chewing gum
• Sucking on a hard candy

Start before the pressure becomes uncomfortable rather than waiting until your ears are already painful.

2. Yawn

Yawning can also help open the Eustachian tubes and equalize pressure.

If you feel your ears beginning to block, try yawning several times.

3. Try gentle pressure-equalizing techniques

A gentle Valsalva manoeuvre can help some people equalize pressure.

Close your mouth, pinch your nose and gently try to breathe out against the closed nose.

Do not blow forcefully.

The aim is gentle pressure equalization, not forceful blowing.

4. Stay awake during descent

If your ears are prone to pressure problems, it is preferable not to sleep through the descent.

Being awake allows you to swallow, yawn, drink and actively equalize pressure as the aircraft descends.

What can I do if I have a cold or blocked nose?

Flying with significant nasal congestion can make pressure equalization more difficult.

If possible, consider postponing non-essential air travel when you have:

• A significant cold
• Severe nasal congestion
• An acute sinus infection
• A severe allergy flare

If you must travel, speak with a doctor about whether any treatment is appropriate for you.

A topical nasal decongestant spray may sometimes be recommended for selected adults with nasal congestion, often shortly before descent. However, these sprays are not suitable for everyone and should not be used repeatedly for several days because prolonged use can cause rebound nasal congestion.

People with certain medical conditions, and young children, may need different advice.

Do not routinely use a decongestant spray just because you are flying without first considering whether it is appropriate for you.

What about babies and young children?

Babies cannot deliberately perform pressure-equalizing manoeuvres such as the Valsalva manoeuvre.

However, sucking and swallowing can help the Eustachian tube open.

During take-off and especially during descent, you can offer a:

• Breastfeed
• Bottle
• Pacifier

The important principle is to encourage swallowing while the cabin pressure is changing.

Young children may be more susceptible to ear pressure problems because their Eustachian tubes are smaller and function differently from those of adults.

Do not give young children decongestant medicines or nasal sprays unless specifically advised by their doctor.

What if my ears remain blocked after landing?

Usually, the pressure sensation improves as the Eustachian tube begins functioning normally again.

You can continue gentle swallowing, yawning and pressure-equalizing techniques.

However, you should seek medical attention if you develop:

• Severe or worsening ear pain
• Significant hearing loss
• Persistent blocked sensation
• Fluid or blood coming from the ear
• Dizziness or vertigo
• Symptoms that do not settle

These symptoms can sometimes indicate ear barotrauma or another middle-ear problem.

Can ear pain during a flight cause hearing loss?

It can cause temporary conductive hearing loss when pressure changes result in fluid or other changes behind the eardrum.

In most uncomplicated cases, hearing returns to normal as the pressure problem resolves.

However, sudden or significant hearing loss should not simply be attributed to the flight.

If you experience sudden hearing loss, particularly in one ear, seek urgent medical evaluation rather than waiting for it to resolve on its own.

A simple checklist for your next flight

Before the flight

• Avoid flying with a significant cold or severe nasal congestion if the trip can safely be postponed.
• If you frequently experience severe ear pain while flying, consider an ENT evaluation before your next trip.
• Ask your doctor whether a nasal treatment is appropriate if you have significant nasal congestion.

During take-off and descent

• Stay awake during descent if you are prone to ear blockage.
• Swallow frequently.
• Drink water.
• Chew gum or suck on a hard candy.
• Yawn regularly.
• Use gentle pressure-equalizing techniques if needed.

For babies and young children

• Encourage sucking and swallowing during descent.
• Breastfeed, bottle-feed or offer a pacifier when appropriate.
• Do not give decongestant medication unless advised by a doctor.

The bottom line

Ear pain during flight is usually caused by a temporary difference in pressure between the middle ear and the surrounding air.

The Eustachian tube normally equalizes this pressure, but congestion, allergies, infections or Eustachian tube dysfunction can make the process more difficult.

For most travellers, frequent swallowing, yawning and gentle pressure equalization — particularly during descent — can make flying much more comfortable.

If your ears repeatedly become severely painful or remain blocked after flying, don’t simply put up with it. An ENT evaluation can help determine whether Eustachian tube dysfunction, nasal obstruction, allergy, adenoid enlargement or another underlying problem is contributing to your symptoms.

Comfortable flying begins with understanding how your ears respond to pressure changes.