Have you ever wondered why your ears pop when you fly on an airplane, and why it helps you feel much better? Or why, when they fail to pop, you get an earache? Have you ever wondered why the babies on an airplane fuss and cry so much during descent?Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss. Learn more below about ears and altitude.

The ear and air pressure

The middle ear is essentially an air pocket inside your head that is vulnerable to changes in air pressure Normally, each time (or each second or third time) you swallow, your ears make a little click or popping sound. This occurs because a small bubble of air that has traveled up the back of your nose, has entered your middle ear. The air bubble passes through the Eustachian tube — a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and resupplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If the air pressure is not equal, the ear feels blocked or full of pressure.

Blocked ears and Eustachian tubes

The Eustachian tube can become blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and causing it to stretch. A stretched eardrum can be painful and cannot vibrate naturally, so sounds are muffled or blocked. If the Eustachian tube remains blocked, fluid (like blood serum) will seep into the area from the membranes, in an attempt to correct the vacuum. This condition is referred to as “fluid in the ear,” serous otitis or aero-otitis.

Serous Otitis: (also referred to as otitis media with effusion(OME), middle ear effusion (MEE), or secretory otitis media) collection of serous — thin, clear — fluid in the middle ear.


Aero-otitis: (also called barotrauma) inflammation of the middle ear, resulting from differences between atmospheric pressure. This is common in air travelers, tunnel or underground workers, and deep-sea divers.

The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies are also common causes. A stuffy nose leads to blocked ears because the swollen membranes block the opening of the Eustachian tube. Blocked ears can also be caused by fluid in the ear from swimming, excessive buildup of earwax, or punctured ear drums caused by foreign objects.

Air travel causes rapid changes in air pressure, changing the equilibrium in the middle ear. To help correct the pressure differences, the Eustachian tube must open frequently and wide enough to equalize the pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.

Any situation in which rapid altitude or pressure changes occur creates the problem. You may have experienced it when riding in elevators, diving into a swimming pool, or driving through the mountains. Deep sea divers and pilots are taught how to equalize their ear pressure to prevent middle ear injury.

How to unblock your ears

Swallowing activates the muscles that open the Eustachian tube. You swallow more often when you chew gum or when mints melt in your mouth. These are good air travel practices, especially just before take-off and during descent.

Yawning helps even more. Avoid sleeping during descent because you may not be swallowing often enough to keep up with the pressure changes.

If yawning and swallowing are not effective, pinch your nostrils shut, take a mouthful of air, and force the air into the back of your nose as if you were trying to blow your nose. When you hear a pop, you’ll know you have succeeded. You may have to repeat this several times during descent.

Once you land, you can continue to use these pressure equalizing techniques for as long as you need to. You may also find decongestants and nasal sprays to be helpful. If your ears fail to open or if pain persists, you will need to seek the help of a physician who has experience in the care of ear disorders. The ear specialist may need to release the pressure or fluid with a small incision in the eardrum.

  • Chew gum.
  • Yawn – forced if it doesn’t happen naturally.
  • Swallow – preferably with water.
  • Valsalva maneuver – pinch nose and try to blow nose, gently.
  • Toynbee maneuver – pinch nose and swallow.
  • Frenzel maneuver – pinch nose and click tongue.
  • Take a nasal decongestant.

How can I help my baby unblock his ears?

Babies cannot intentionally pop their ears the way adults or older children can, but popping may occur if they are sucking on a bottle, pacifier, or breastfeeding. To help prevent pain or discomfort caused by the change in pressure, feed your baby during the flight, and do not allow him or her to sleep during descent. Babies and children are especially vulnerable to pressure changes because their Eustachian tubes are narrower than in adults.

For children who are able to follow instructions, you can easily teach them the Valsalva or Toynbee maneuver. Keep them awake for take-off and landing to help them swallow more during the times of biggest pressure changes.

Is the use of decongestants and nose sprays recommended?

Many experienced air travelers use a decongestant pill or nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop a little more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason. However, avoid making a habit of using nasal sprays — overuse can cause a “rebound effect” and cause more congestion than relief.

Decongestant tablets and sprays can be purchased over the counter. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or anxiety. People who suffer from these conditions should consult their physician before using these (or any) medications. Pregnant women should consult their physicians first.

As a diver descends into the water, the pressure increases on the external surface of the eardrum. At just one foot below the surface, pressure can already be felt as the eardrums flax inward. At four feet, the eardrums bulge and nerve endings are stretched, this is where many people begin to feel pain. At ten feet below the surface, if the descent was fast enough, your eardrums can burst. To avoid the pressure causing permanent damage, there are a few things you can do.

How to unblock your ears

When diving or going into a tunnel or underground cave, the precautions and treatments are similar to going into high altitude. However, you may not have the ability to continually chew gum or pinch your nose closed, so some modifications may be required. One thing to remember during the decent is to go slowly and pay attention to your ears. If you do feel ear pressure that you cannot relieve, position yourself head up and look up toward the surface. It requires 50% more force to relieve pressure when your feet are above your head and tipping your head upward helps to extend the Eustation tubes, forcing them to open when you have no other way to make them open. It is not recommended to use the Valsalva maneuver when diving.

  • Prepare early – begin equalizing your ears above surface a few hours prior to diving.
  • Descend feet-first.
  • Prevent water from entering the ear.
  • Look up toward the surface.
  • Use pressure-relief techniques often and before you feel the pressure.
  • Stop your decent if it hurts – it will NOT improve!
  • Voluntary tubal opening – closed mouth yawn.
  • Toynbee maneuver – pinch nose and swallow.
  • Frenzel maneuver – pinch nose and click tongue.
  • Edmonds maneuver – tense soft palate and throat muscles, push jaw forward to do a Valsalva maneuver.

When should I call a doctor?

Ear pressure problems — aero-otitis or barotrauma — are usually temporary when traveling or in situations we mentioned — hiking, traveling in high-altitude or underground, traveling in the mountains, or swimming. If you are unable to “pop” your ears or pain is intense or persists, consult your medical care provider. Don’t just assume that your ears haven’t popped yet, if the pressure or fluid conditions persist, symptoms could be a result of or cause:

  • Ear infection
  • Ruptured eardrum
  • Vertigo – chronic dizziness
  • Hearing loss

For all of your ear pain and ear needs contact us at Alpine ENT.

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