Why airplanes bother your ears (and why flyers with Eustachian tube dysfunction struggle more)
When an aircraft descends, cabin pressure rises. A healthy Eustachian tube opens automatically with each swallow to equalize the middle ear, but if the tube is inflamed or fails to open (obstructive Eustachian tube dysfunction), the eardrum bows inward and hurts. This is middle-ear barotrauma, the most common pressure injury during air travel. Travelers are most vulnerable during landing, when pressure changes fastest. [1]
Eustachian tube dysfunction presents with ear fullness, popping, muffled hearing, and pain. Flyers often report that one ear “never clears,” or that they disembark with a blocked ear that improves only hours later. In true obstructive dysfunction, the tube does not open when it should. In patulous dysfunction, the opposite problem occurs—the tube is stuck open, producing autophony (hearing one’s own breathing and voice loudly), and the management is very different. Distinguishing these matters because certain maneuvers or procedures help one and worsen the other. [2]
Safe pressure-equalizing maneuvers (and when to use them)
Swallowing and yawning are first-line. Each swallow briefly opens the Eustachian tube, which is why chewing gum, sipping water, or using a lozenge can help on descent. If that is not enough, gentle auto-insufflation methods can add a bit of air to the middle ear:
- Valsalva: (pinch the nose, mouth closed, blow gently).
- Toynbee: (pinch the nose and swallow).
- Frenzel: (pinch the nose and contract the tongue and throat muscles to move air).
Major centers advise these during ascent and especially descent; light, repeated attempts are safer and more effective than forceful blowing. [3]
Never “blast” a Valsalva: Aggressive, repeated force against a blocked tube can shift pressure into the inner ear and, in extreme cases, contribute to inner-ear barotrauma or even perilymphatic fistula—injuries described in otology and diving medicine literature. Flyers are not divers, but the same anatomy applies. The rule is gentle, frequent, never forceful. [4]
Should you use decongestants or “ear-plugs for planes”?
If you are congested from a cold or allergies, many travel-medicine and clinical sources allow a long-acting oral or topical nasal decongestant before takeoff and again before descent to reduce swelling around the Eustachian tube opening. Swallowing and yawning remain essential. Pressure-regulating earplugs can slow pressure change at the eardrum; some travelers find them helpful as an adjunct. Use decongestants cautiously if you have hypertension or heart disease, and avoid chronic daily use. [3]
What does the evidence say about sprays, pills, and devices?
Despite their popularity, intranasal steroid sprays do not have strong evidence for chronic Eustachian tube dysfunction in adults. Randomized and controlled studies and systematic reviews have repeatedly failed to show meaningful benefit for typical chronic symptoms, although they may help if nasal allergy is driving swelling upstream. Manage rhinitis for comfort, but do not expect the spray alone to fix a stubborn flying problem. [5]
Autoinflation devices (like nasal balloons) have evidence in children with otitis media with effusion, where they can improve middle-ear ventilation and hearing during watchful waiting. That is a different condition than adult flying-related dysfunction; still, the principle—gentle positive pressure through the nose—explains why light, repeated equalization during descent is reasonable. For frequent flyers, devices are less studied, so focus on technique and timing rather than gadgets. [6]
Balloon dilation: when the office procedure helps—and when it does not
Balloon Eustachian tuboplasty (often called balloon dilation) is an office or operating-room procedure that gently dilates the cartilaginous part of the Eustachian tube with a small catheter balloon. It is not for everyone with airplane ear, but for selected adults with obstructive Eustachian tube dysfunction lasting at least three months and affecting function, expert panels and randomized trials show improvement in symptoms, tympanometry, ability to perform Valsalva, and hearing measures. [7]
The American Academy of Otolaryngology–Head and Neck Surgery’s 2019 Clinical Consensus Statement provides practical criteria: adults with obstructive dysfunction that impairs quality of life despite appropriate medical therapy can be candidates; evaluation should document objective or reproducible signs of poor ventilation. Crucially, patulous Eustachian tube dysfunction is a contraindication—balloon dilation can make those symptoms worse. Your clinician’s first job is to clarify the diagnosis and rule out patulous features before considering dilation. [7]
What about outcomes? Randomized and controlled studies in adults report clinically meaningful improvements that persist through 6–12 months (and longer in some series), with low complication rates when performed by trained clinicians. Dilation is a step after optimizing allergy control, rhinitis management, and correct auto-insufflation. It is not a quick fix for every “plugged” ear on planes, but it can be transformative for the right obstructive cases. [8]
A flyer’s step-by-step plan to prevent airplane ear (evidence-informed)
- Before the trip: If you have allergic rhinitis, optimize treatment (saline, antihistamines as needed). If you are acutely ill with a heavy cold or sinusitis, consider postponing travel if possible—barotrauma risk is higher when the tube is blocked. [1]
- One hour before descent: If you safely can, use a long-acting decongestant (oral or topical) and start sipping water. Put in pressure-regulating earplugs if they help you. [3]
- During descent: Swallow every 30–60 seconds—sip, chew, or use a lozenge. Add gentle Valsalva or Toynbee every couple of minutes if you feel pressure build. If one ear is stubborn, try a few gentle equalizations with the head turned toward the blocked ear to angle the tube. [3]
- After landing: If your ear remains blocked, continue periodic gentle equalization and yawns for an hour or two. Most cases resolve spontaneously. If you develop severe pain, vertigo, or hearing loss, seek care—these can signal more serious barotrauma. [9]
DIY mistakes that make flying ear pain worse (and what to do instead)
Mistake 1: Forceful, repeated Valsalva against a completely blocked ear.
This can drive pressure into the inner ear and has been implicated—especially in diving—in inner-ear barotrauma and perilymphatic fistula. Flyers should copy the gentle and frequent pattern used in aviation medicine, not the “hard blow” sometimes seen in diving mishaps. If the ear will not clear after two or three gentle tries, pause, swallow, and retry.[4]
Mistake 2: Flying sick, then “power-equalizing” through pain.
Acute sinus or ear infections raise your risk of barotrauma; powering through with aggressive maneuvers can worsen injury. If you must fly, maximize conservative measures (humidified air, saline irrigations, approved decongestants) and accept that some pressure may linger until the illness resolves. [1]
Mistake 3: Confusing patulous and obstructive dysfunction.
If you hear your own breathing loudly (autophony), feel echoing voice, or symptoms improve when you lie down, you may have patulous Eustachian tube dysfunction. The approach is different—hydration, nasal moisturizing, and sometimes weight gain or targeted therapies—not more opening maneuvers or balloon dilation. Get properly evaluated; balloon dilation is contraindicated in patulous dysfunction. [2]
Mistake 4: Over-relying on steroid sprays for chronic flying problems.
Intranasal steroids are useful for allergic rhinitis, but trials do not show strong benefit for chronic adult Eustachian tube dysfunction. They will not replace technique, timing, or (for selected cases) balloon dilation. [5]
Mistake 5: Ignoring red-flag symptoms after a flight.
Severe ear pain with sudden hearing loss, roaring tinnitus, or spinning vertigo requires prompt evaluation. These can reflect significant barotrauma, including possible inner-ear involvement, and should not be treated with more forceful Valsalva. [9]
How a clinician evaluates a frequent flyer with Eustachian tube dysfunction
A good work-up begins with history (which phases of flight, how long symptoms last, any autophony), otoscopy (looking for retraction, fluid, or trauma), and tympanometry (to measure middle-ear pressure). When symptoms persist beyond travel days or impact hearing, clinicians may add endoscopy of the nasopharyngeal opening of the tube, audiometry, and, in selected patients with chronic obstructive dysfunction, consider balloon dilation after medical therapy. American Academy of Otolaryngology consensus recommendations and randomized trials guide this step. [7]
Special cases: kids, divers, and people who fly every week
- Children: Their tubes are smaller and more horizontal, which is why babies cry on descent. Sucking (nursing or bottle) helps. Autoinflation balloons help for otitis media with effusion during watchful waiting but are not a travel-only fix; ask your pediatric clinician for technique and timing around flights. [6]
- Divers who also fly: Diving evidence teaches us about barotrauma mechanics. The take-home for everyone, divers and flyers alike: never perform forceful Valsalva against a blocked ear. If equalization fails, stop and try again gently later. [4]
- High-frequency business flyers: If you fly weekly and still struggle despite perfect technique, an ENT evaluation is worthwhile. Selected adults with documented obstructive dysfunction often benefit from balloon dilation, with improvements in tympanograms, symptoms, and ability to equalize. [8]
Frequently asked questions
Is balloon dilation permanent?
Results often persist beyond 6–12 months in adult trials and case series; some patients need retreatment. Outcomes are best when obstructive dysfunction is well documented beforehand. [8]
Should I use a decongestant before every flight?
If you are prone to congestion or allergies, a dose before descent can help, but do not rely on it daily if you fly often. Always pair with swallowing, yawning, and gentle equalization. People with high blood pressure or heart disease should ask their clinician first. [3]
Do nasal balloons or gadgets help adults?
Evidence is strongest in children with ear fluid. Adults can focus on technique and timing; consider a trial if advised by your clinician, but do not expect a cure-all for flying. [6]
I hear my own breathing loudly—should I pop my ears more?
That sounds like patulous dysfunction, where the tube is too open. Popping can worsen symptoms. See an ENT; balloon dilation is not appropriate in this scenario.[2]
The bottom line for frequent flyers
- Equalize early and often with gentle swallows and light maneuvers during descent; never force a Valsalva. [3]
- Decongestants and pressure-regulating earplugs are adjuncts, not cures; use thoughtfully. [3]
- Chronic flying-related ear trouble deserves a proper diagnosis. In obstructive Eustachian tube dysfunction that resists medical care, balloon dilation has growing support from consensus statements and randomized trials. Patulous dysfunction follows different rules and should not be dilated. [7]
