How does the ear balance pressure on either side of the eardrum?

There are three parts in your ear – external, middle and inner ear.

The external ear is open to pressure changes and the pressure in it is equal to the pressure in our surrounding atmosphere. Middle ear, on the other hand, is a sealed cavity and the pressure inside it is actively managed by a pipe opening into it called the Eustachian tube. The eardrum sits in between the external and middle ears.

The eustachian tube is a small pipe extending between the back of your nose and the middle ear. It is usually closed and opens up when you yawn, swallow or chew allowing for equalisation of pressure in the middle ear.

What happens to your ears on an aeroplane?

During your aeroplane ascent, the pressure in the outer atmosphere (& your external ear) starts dropping, and the higher pressure in the middle ear pushes the eardrum outside, stretching it. On the contrary, when your aeroplane descends, the pressure in the outer atmosphere (& your external ear) starts to rise becoming more than the pressure in your middle ear causing your eardrum to be sucked in or pushed inside. This stretch of the eardrum is what causes pain and discomfort. In this scenarios, the responsibility falls on the Eustachian tube which has to work overtime to balance the pressures.

What hinders the Eustachian tube function?

Eustachian tube is ready to work overtime except when specific risk factors hinder its function:

  1. Narrow Eustachian tube such as seen in infants and children
  2. Conditions causing the formation of mucus in the back of the nose such as common cold, sinusitis, allergic rhinitis
  3. Ear infections
  4. Sleeping during ascent and descent of the flight

What can you do to help?

  1. There is a saying “Avoidance is better than cure”. Avoid flight journeys while having cold or ear infections. But isn’t it difficult to replan when you are all packed up and ready for that holiday? In such cases, A visit to an ENT doctor can be helpful; He may prescribe some medicines which can make your journey at least a little comfortable.
  2. Take a candy and keep chewing on it as swallowing or chewing encourages the repeated opening of the Eustachian tube allowing for pressure equalization. Now you know why the Airhostesses are so nice in handing over candy to you right before take-off or landing. For infants/ children, giving something to sip/suck on before ascent and descent of the flight can be helpful.
  3. Valsalva is a manoeuvre where you breathe in deep, pinch your nose and gently blow out with your mouth closed, forcing air up the Eustachian tube until you hear a “pop” sound in your ear. This method should not be performed when you have cold, sinus or ear infections as you will be worsening the problem.

When should you visit an ENT specialist?

You should consult an ENT specialist if you are experiencing any of the following symptoms:

  1. Recurrent ear issues in aeroplane where the methods mentioned above are of little or no help
  2. When the block/ discomfort/ pain persists for more than two days after completion of journey
  3. Bleeding from the ear