You often hear the little ones on flights crying, especially on descent because of ear pain associated with an inability to equalise air pressure. Problems with regulating ear pressure is common and can be as high as 25% in children and 5% in adults. People with upper respiratory infection, allergies causing congestion or middle ear problems are more likely to have trouble equalising their ears when flying because their pressure equalisation tubes (Eustachian tubes) are typically not functioning at their optimum. Every few minutes when we swallow, talk, chew or yawn, this closed tube opens and allows air in and out of the middle ear space. In a normal functioning ear, the pressure of the air behind the ear drum is equal to atmospheric pressure. For most people these tubes do a good job of keeping the pressure in the middle ear spaces equal to the atmospheric pressure inside the plane and they have little if any discomfort or prolonged hearing issues.Chewing, yawning or performing the Valsalva manoeuvre (blocking the nose and blowing into a closed mouth) can help to equalise the pressure and often a “popping” sensation is described when the Eustachian tube opens and the pressure is equalised. For others flying can be a painful experience. Their Eustachian tubes can be blocked and when the plane takes off the atmospheric pressure becomes lower than the pressure of the air behind the eardrum causing the eardrum to bulge outwards. On landing, the eardrum bulges inwards and often the Eustachian tube is “locked” up to the extent that even the Valsalva manoeuvre is ineffective. In extreme cases this pressure build up can result in a burst eardrum. In children, the Eustachian tubes often cannot regulate themselves as well as adults resulting in ear pain.Here are some suggestions that may assist in providing ear relief for travellers:1. Where possible never fly with an upper respiratory infection.2. Perform the Valsalva manoeuvre at ground level before take-off to check if your ears “pop”.3. If you consistently have ear issues when flying, consult your GP or audiologist to check if your eardrum appears normal and that your canals are clear of wax and debris. A tympanometer is used to assess the functioning of the middle ear system including the Eustachian tube.4. Your GP may recommend or prescribe nasal sprays for use prior, during or after a flight.5. During descent when the pressure change is greatest the Modern Medicine of Australia Journal recommends:- staying awake (Eustachian tubes do not open well during sleep)- yawn or make chewing movements (with or without food)- swallow fluids or suck a lolly (menthol or eucalyptus) and allow babies to suck on a breast/bottle- do the Valsalva manoeuvre6. Use special EarPlanes* earplugs during flight.7. In severe cases of middle ear problems or pain, grommets (tympanostomy tubes inserted in the ear drum) may be required.* EarPlanes are a type of earplug developed specifically for flying by the prestigious research centre the House Ear Institute. They are available for adults and children to help slow down the rate of pressure change. 

I was pleasantly surprised how effective they are when I used them recently. Typically I need to constantly chew, swallow and perform the Valsalva manoeuvre to reduce my ear discomfort and blocked hearing on flights but with the EarPlanes I experienced little pressure change. They are inserted into the ear canals when the seat belt sign goes on at take-off and removed at maximum altitude. The Ear Planes manufacturer recommends re-inserting their plugs an hour before landing rather than waiting for the seat belt sign to turn on and they can be removed again when the seat belt sign goes off.

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