Are you one of those people who love travelling but the most dreaded part of the trip is to take the flight? Does your work entail you to fly to different destinations quite frequently, but you have to ignore that earpain and earblock that accompanies the trip? Well, here’s what you need to know about this phenomenon commonly known as ‘Airplane Ear’ or Ear Barotrauma. Airplane ear or Barotitis media or Ear Barotrauma is a condition wherein you suffer from extreme ear pain and /or ear blockage in one or both ears often while ascent or descent of the flight. It is known to cause due to sudden or quick changes in altitude or changes in air pressure. Its not often addressed as it tends to resolve by itself in a few hours but more often than not , it may trouble the person for more than just a few days and the symptoms might be more severe than just earache or earblock. Hence it is the most commonly encountered , yet the most neglected problem for frequent fliers. And when you are going through that intense agonizing pain and coming to terms with that deafness in your ear with the person next to you on the same flight enjoying his last piece of dessert or calmly watching the latest movie in front of him; you wonder what curse was cast on you to make you go through this suffering every single time you take that flight! Well, the answer lies in your Eustachian tube! The Eustachian tube is a tube connecting your nose to the middle ear. The primary function of this tube is to equalize the pressure between your middle ear and the external canal i.e. ventilation. When your Eustachian Tube is unable to do that you get Airplane ear or Ear Barotrauma. In normal circumstances, the air pressure in the middle ear cavity is almost equal to the external canal which is physiologically maintained and hence we have a normal auditory function and balance. Whenever there are sudden changes in air pressure, as often occurs during descent or ascent of flight, the Eustachian tube has to quickly equalize the pressure and when it is unable to do so, you suffer from air barotrauma. This often happens if you have the following Risk Factors: 1. A small eustachian tube, as is the case with infants and toddlers 2. A sinus infection 3. Allergic rhinitis 4. Deviated nasal septum 5. Middle ear infection 6. Sleeping ( when you cant yawn or swallow to equalize the air pressure) 7. Obesity ( fat accumulates near the opening of the eustachian tube to block it) In 5% of the population, the ET does not open normally. Most of these people have no symptoms or problems except when exposed to rapid changes in air pressure for eg. A plane ride. Even without a functioning Eustrachian tube, the pressure can eventually stabilize through natural gas exchange between the lining of the middle ear and the middle ear air. A similar proportion of the population can have abnormally open ET known as Patulous ET. If changes in pressure causes failure of ventilation through the middle ear, there is outward bulging of the ear drum causing earache which may be moderate to severe in intensity. Conversely, when the air pressure in the middle ear reduces rapidly , due to vacuum effect, the eardrum may be pulled inside . The Eustachian tube becomes flattened during the pressure changes and it necessitates bringing air into the middle ear. During flying, the sudden ascend and descend , causes the pressure in the middle ear cavity to drop compared to the outside increase in cabin pressure. This causes unusual stretching of the ear drum and lead to severe earpain, decreased hearing or muffled sounds as the ear drum is unable to vibrate normally. This same pathophysiology applies to scuba divers and in hyperbaric oxygen chambers, and during explosions happening in the nearby vicinity. Symptoms: can occur in one or both ears, Discomfort, pain and fullness in the ear Mild to moderate hearing loss Tinnitus or ringing sound in the ear Vertigo (giddiness) Sometimes Hemotympanum ( collection of blood behind the eardrum) Generally, permanent damage does not occur , unless there is any structural damage in the middle ear. Very rarely, it may lead to permanent hearing loss or chronic tinnitus. How to prevent airplane ear? 1. Manouvers like yawning, swallowing, chewing gum during take off and landing of the airplane help by activating the muscles that make ET patent 2. Avoid sleeping during ascent or descent of the flight 3. Use earplugs – these help in slowly equalizing the pressure against our ear drum 4. Decongestants – both oral decongestants as well as local decongestant nasal drops taken 30 mins before landing or take off can help 5. If you are suffering from sinusitis or common cold or ear infection, it is always better to reschedule your travel. 6. Valsalva manouvre ( forced expiration against a closed glottis) can help unblock your ear. A permanent solution for frequent fliers. If you are a person who has to travel by air quite frequently and all the above mentioned preventive measures are of little or no help to your problem, then you have to consult you ENT doctor for the following solutions: 1. Treat the cause – if you are suffering from long standing nasal allergies or a deviated nasal septum or sinusitis etc. visit the ENT specialist near you to resolve your chronic problems. 2. Grommet ( ventilation tube) insertion in the eardrums – this helps in draining middle ear fluid and equalizing the pressure between the outer and the middle ear 3. Eustachian Tube dilatation – A novel way to help a dysfunctional ET improve its function is by balloon dilatation of the Eustachian tube opening . This is a minimally invasive method which is proven to be very much effective in chronic Eustachian tube dysfunction. The mechanism of action possibly is that ballon dilatation of the Eustachian tube causes micro ruptures in the region of the tubal cartilage which leads to a permanent widening of the cartilaginous part of the Eustachian tube. Another explaination is that Balloon dilatation of the Eustachian tube stimulates the proprioceptors which may influence the muscles which open and close the Eustachian tube system (viz. the Tensor Veli Palatini muscle and the Levator Veli Palatini muscle). Yet another hypothesis is that Balloon dilatation of the Eustachian tube can prevent inflammation by separating scars or adhesions of the folded mucosa of the Eustachian Tube . In short, the good news is that you do not have to go through the suffering of ear pain and ear blockage every time you travel by the plane. The preventive measures explained above can help you in avoiding this phenomenon of airplane ear most of the times . If simple preventive measures are of no help to you, please consult your Ear Nose Throat doctor or the ENT specialist near you to resolve this issue before it leads to any permanent or irreversible damage.