Why does flying sometimes cause ear pain or discomfort? How can I reduce the effects of flying on my ears?... 3

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1 FACTSHEET Hearing health Ear care when flying Many people find that flying can cause pain or discomfort in their ears. This factsheet explains why these ear problems happen, and what you can do to help prevent them, for you and your family. Contents Why does flying sometimes cause ear pain or discomfort? What can help if I have a cold? How can I reduce the effects of flying on my ears? Can flying make tinnitus worse? Will flying affect my ears if I have grommets or a perforated eardrum? Can I fly after ear surgery? What can I do if I feel anxious about flying? Will my hearing aids cause any issues when I go through airport security? If you d like this factsheet in Braille, large print or audio, please contact our Information Line see last page for contact details.

2 2 Ear care when flying Why does flying sometimes cause ear pain or discomfort? Many people have ear pain, dulled hearing or an uncomfortable feeling of fullness in their ears when they fly. These ear problems are generally caused by quick changes in air pressure they are usually at their worst when the plane comes down to land and clear up a few hours later. How do changes in air pressure when flying affect the ears? Your ears have three parts: the outer, middle and inner ear (see diagram). The middle ear is filled with air that Outer ear is supplied by the Eustachian tube, which connects the middle ear to the back of the nose. The Eustachian tube is usually closed and only opens to let more air into the ear when you swallow, yawn or chew. It makes sure that the air pressure inside the ear is equalised with (the same as) air pressure outside the ear. If the air pressure isn t equal on either side of the eardrum, the ear will feel blocked. When a plane takes off and lands, there are quick changes in air pressure, and the Eustachian tube needs to open frequently to equalise the air pressure inside the ear with the air pressure in the cabin. This is especially the case when the plane is coming down to land, as the air pressure in the cabin increases. You will feel or hear your ears pop or click when the pressure is equalised. Middle ear Inner ear Vestibular nerve (balance) Vestibular system Incus Malleus Ear canal Auditory nerve (hearing) Cochlea Eardrum Stapes Eustachian tube

3 Ear care when flying 3 If the Eustachian tube doesn t open frequently, or if it is blocked for example, because you have a cold air can t reach the middle ear and so the air pressure can t be equalised. A vacuum is created, which sucks the eardrum inward and stretches it. This causes a throbbing pain, a dullness of hearing or a feeling of fullness in the ear, because it won t pop. If you have hearing loss, a small, temporary reduction in your hearing when flying may have a big effect on your ability to understand speech. How flying affects the inner ear Very occasionally, a sudden change in air pressure can affect the inner ear, which contains the cochlea (the organ of hearing) and the vestibular system (the organ of balance). The increased pressure in the inner ear may make you feel dizzy or give you hearing loss that doesn t clear up after a few hours. However, this is rare with modern aircraft it s more common to experience inner ear problems as a result of pressure changes when diving. If you develop any hearing or balance problems following a flight that don t clear up after a few hours, see a doctor. What can help if I have a cold? You may find flying uncomfortable if you have a cold, sinus infection or nasal allergy, because swollen blood vessels in the nose can block the opening of the Eustachian tube, leading to ear problems. A cold is the most common cause of a blocked Eustachian tube. Decongestants, a type of medicine that you can buy in pharmacies without a prescription, can provide short-term relief for a blocked nose. These medications can reduce the swelling of the blood vessels inside your nose and help your ears to pop more easily. You can buy decongestants that are nasal sprays, tablets, liquids or flavoured powders to dissolve in hot water. However, decongestants aren t usually recommended for children under 12, for women who are breastfeeding or for people with certain health conditions including high blood pressure. Speak to your GP or pharmacist to check whether decongestants could help you, and for advice on when to take them when flying. How can I reduce the effects of flying on my ears? You can do a number of things to reduce the effects of flying on your ears: Swallow frequently this encourages your Eustachian tubes to open. You swallow more frequently when you chew gum or suck on a boiled sweet, so try to do this just before take-off and when the plane starts to descend. Taking regular sips of water or another soft drink can also help.

4 Ear care when flying 4 Yawn this is a great way to open your Eustachian tubes, but yawning repeatedly can be difficult. Alternating between yawning and swallowing may be easier. Stay awake during descent this is when your ears will have a harder time adjusting to the pressure changes. It s important to stay awake as you don t swallow as frequently when you re asleep, so your Eustachian tubes may not open often enough to keep up with the pressure changes. Try the Valsalva manoeuvre this forces air along your Eustachian tubes, equalising the pressure. To do this, pinch your nose between your finger and thumb, close your mouth, and try to breathe out through your nose gently. Don t force the air out. You will feel or hear your ears pop when your ears are unblocked and the pressure is equalised. You may have to repeat this a few times. Use special earplugs some people find that earplugs designed for flying can help with ear discomfort they aim to slow down the pressure changes within your ear. Using ordinary soft earplugs is not recommended. How to reduce ear pain for children and babies when flying If you re travelling with a child or baby, try not to let them sleep during take-off or landing. Infants, like adults, swallow more frequently when they are awake, which helps to open their Eustachian tubes. Also, waking up with ear pain can be frightening for infants. If you re flying with a baby, feed them, or give them a dummy, during take-off and landing. Can flying make tinnitus worse? Most people with tinnitus find that flying doesn t make it worse. In fact, if you have tinnitus, you may find that the engine noise masks it, so you re not aware of it during the flight. If your Eustachian tubes are blocked, your tinnitus may seem slightly louder, but it should return to its previous level once your Eustachian tubes become unblocked after landing. If you normally use hearing aids, use them during the flight. Removing them may make your tinnitus more noticeable, because you ll hear fewer environmental sounds to mask it. You may find that your tinnitus seems worse when you feel anxious or stressed, and this may happen if you are worried about flying. See What can I do if I feel anxious about flying?, page 5, and our factsheet Stress and tinnitus for tips to help you manage both stress and tinnitus. If you find that your tinnitus makes you sensitive to the sound of the plane s engines, only use earplugs as a last resort using them may make your tinnitus appear louder, because you ve blocked out external noise. If you are worried about the noise of the engines, book ahead and try to get a seat near the front of the plane, away from the engines.

5 Ear care when flying 5 Will flying affect my ears if I have grommets or a perforated eardrum? Grommets are small ventilation tubes that are used to treat certain ear disorders. Perforations (holes) in the eardrum can happen as a result of infection or injury. Flying is less likely to cause discomfort if you have grommets or a hole in your eardrum, because air is able to pass through the grommet or hole. This means that the pressure in the ear can be equalised more easily, and it doesn t depend on the Eustachian tube functioning normally. Can I fly after ear surgery? If you have recently had any kind of ear surgery, always check with your ear specialist when it would be safe for you to fly. What can I do if I feel anxious about flying? You can find out more about mindfulness on the NHS Choices website: You can also make use of any in-flight entertainment systems to help you relax during the flight. Will my hearing aids cause any issues when I go through airport security? There are lots of myths about hearing aids being an issue during airport security checks and even that they won t work anymore after going through the X-ray machine or metal detector. This is not the case. But it is recommended that you tell airport security staff that you have hearing loss and use hearing aids. You re allowed to wear your hearing aids as you go through the metal detector, and it s the same for the external part of a cochlear implant. If you are anxious about the effects of flying on your ears or about flying in general, discuss your anxieties with your GP. They may suggest a small dose of a tranquilliser. You may find relaxation techniques, such as breathing exercises, and mindfulness a simple form of meditation very helpful, especially if you practise them beforehand.

6 Ear care when flying 6 Information you can trust The Information Standard certifies us as producers of high-quality, evidence-based information. Thank you to Dr Rudrapathy Palaniappan, Consultant Neuro-otologist in Audiovestibular Medicine, Royal National Throat, Nose and Ear Hospital, for reviewing this factsheet and making sure that our information is accurate and based on the most up-to-date evidence. For a list of references for this factsheet, please references@hearingloss.org.uk Did you find this factsheet helpful? We d love to know what you think of this factsheet please us at reviewpanel@hearingloss.org.uk If you d like to join our Readers Panel, to help us create new publications and improve existing ones, please let us know.

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