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Byline: Jill O'Connor Staff Writer

It's the single biggest medical complaint of air travelers: ear pain during takeoff and landing. For babies, the discomfort can cause ear-piercing wails, making the flight painful for all on board.

And although the discomfort is unlikely to cause serious harm in most circumstances, it could result in lingering stuffiness or temporary fluid build-up in the ears if precautions aren't taken, particularly by chronic allergy sufferers or those with cold symptoms.

``It's actually a suction push-pull type sensation on the eardrum, which does cause some discomfort. For some people, it's really painful,'' said Dr. Carl Ermshar, an otolaryngologist and chief of the medical staff at Glendale Adventist Medical Center.

The problem occurs when changes in air pressure affect the middle ear. The discomfort can range from mild popping sensations - such as those felt driving in the mountains or riding in elevators - to a feeling of fullness, snapping sounds and even piercing pain during descent, when the air pressure inside the cabin increases from the airlines' standard 7,000- foot pressure to sea-level conditions.

When your ears start to hurt as you change altitudes, either during takeoff or landing, they are sending a signal that the eustachian tube - the canal that leads from the middle ear to the back of the throat behind the nose - has failed to help equalize the pressure quickly enough, a common problem when a flier is congested or experiencing inflammation from even mild allergies or a cold.

``Until that equalization happens, they're going to feel pressure because the eardrum is being pushed on by air,'' Ermshar said.

Sometimes the problem is that a person has a smaller eustachian tube, but again, congestion from colds or allergies is a major culprit in altitude-related ear pain.

``If they have a cold at the time they're flying, or they have an allergy, what could happen is that the eustachian tube tends to be a little swollen and it won't be open,'' explained Dr. Ali Namazie, an otolaryngologist at Providence St. Joseph Medical Center. ``It doesn't work normally - it doesn't allow the pressure to equalize.''

With kids and babies, tiny eustachian tubes can mean even bigger problems because child-size passageways often can't equalize pressure fast enough to keep up with the plane's descent.

``Children have smaller cavities, and it doesn't take much change for that pressure sensation to occur,''said Ermshar.

Another problem is that infants often fall asleep during air travel, so they aren't swallowing or yawning - two techniques that help in adjusting the ears. And although it's unpleasant for everyone in the cabin when a baby cries, the action does help clear his or her ears, alleviating the infant's pain.

For many adults, extreme discomfort can be caused by chronic nasal and sinus allergies or a eustachian tube that is smaller than normal.

``The lining between the sinuses and the nose and the eustachian tube and the middle-ear space are all connected through a membrane, and air can travel back and forth through all these channels,'' said Ermshar. ``And if these membranes are inflamed - for example, with a cold or flu or allergy - there's more likely to be more pain.''

While most travelers can release the pressure by chewing, swallowing or using another conventional method, said Namazie, ``There are some folks who just cannot - I mean, they're just miserable going up and down.''

He estimated from what he's seen at his practice that about 4 percent or 5 percent of the population has a chronic problem.

There are a few tricks that can help troubled fliers avoid agonizing sensations during the descent. Nasal decongestants, in spray or pill form, shrink the nasal membranes and can be extremely helpful to chronic sufferers. Others also find relief wearing earplugs such as EarPlanes, specialized silicone devices that contain a ceramic filter to help delay the rate at which pressure reaches the middle ear.

The old standby for less-intense pressure is to chew gum or suck on hard candy during takeoff and landing because it gets a person to swallow, which pulls open the eustachian tube and aids in the pressure equalization process. Sipping plenty of water can also help, according to Ermshar, because drinking will again open the tube; in addition, because the air inside airplane cabins is quite dry, being well-hydrated is a must to thin mucus and stave off congestion.

If the other techniques don't seem to be working, adult fliers can simply try to blow air into the middle ear space, which is known as the Valsalva maneuver.

``Patients can do that themselves by closing their mouth, and closing their nose with their fingers, and then blowing out through their nose,'' Ermshar said.

For babies, a bottle can be helpful during landing to make sure they're swallowing frequently. Pediatric acetaminophen formulations, such as Tylenol or drugstore brands, or decongestants for children, also may be helpful for youngsters who are very prone to pain, though the most helpful strategy may simply be to rouse them for the descent, said Ermshar.

Adults can greatly benefit, too, from remaining awake at the beginning and end of a flight so they can try to swallow more and partake of candy, gum or water to help equalize pressure.

The plane's descent is the hardest part of the flight on the eustachian tube, and sometimes travelers find that a few hours after disembarking, their ears remain stuffy. Decongestants should help right after the flight, though some fliers suffer from long-term ear congestion and may need a doctor's care.

Rarely, a vacuum may develop in the middle ear. Fluid may then collect and congest the space, potentially causing more-serious problems if left untreated.

In severe cases of congestion, doctors sometimes forcibly blow air through the eustachian tube to clear it out. For chronic sufferers of altitude-related ear pain, they occasionally insert small permanent tubes in the eardrum to help ventilate the space.

``There are some pilots and some (flight attendants) who have to put little tubes in their eardrums so that they can equalize the pressure,'' Ermshar pointed out.

For occasional fliers and those with only mild discomfort, though, such a procedure is rarely needed. A simple visit to the drugstore for water, candy, earplugs and nasal spray just may do the trick to keep the pressure away.

``It's very rare to have permanent damage,'' said Namazie.

Jillian O'Connor, (818) 713-3633


Tips for avoiding ear discomfort on planes

--Drink plenty of water (to facilitate swallowing and to thin mucus).

--Chew gum or suck on hard candy.

--Yawn frequently.

--Use a decongestant before takeoff and descent.

--Stay awake during takeoffs and landings to clear ears.

--Wear pressure-regulating earplugs.

--Close mouth, hold nostrils shut, blow out through nose.

--Avoid flying if you have a cold.

--Feed your baby during the flight and do not allow him/her to sleep during descent.

Source: Daily News research


3 photos, box


(1 -- cover -- color) OUTCH!

Learn to relieve ear pain during air travel

David Sprague/Staff Photographer

(2) no caption (ear)

Michael Owen Baker/Staff Photographer

(3) no caption (ear anatomy)

Courtesy American Academy of Otolaryngology - Head and Neck Surgery Foundation


How to avoid ear pain on planes (see text)
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Publication:Daily News (Los Angeles, CA)
Date:Jun 27, 2005
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