What is it about ?
Atmospheric pressure (that is, the pressure of the air around us) is not the same everywhere. At sea level, for example, atmospheric pressure is higher than at high altitudes in the mountains.
The ear consists of an outer part and an inner part. The outer ear (pinna and external auditory canal) is in contact with the outside air. The pressure there is identical to atmospheric pressure. The middle ear is located behind the eardrum. It is a closed system, which is filled with air. The pressure there should be constant no matter where we are. It is for this reason that the middle ear is connected to the outside world via the Eustachian tube. This small tube connects the middle ear to the throat and allows the pressure in the middle ear to remain the same as in the environment.
The Eustachian tube works less well when the mucous membranes in the throat and / or nose are swollen, such as in the case of a cold or allergy. It can then become blocked and a pressure difference is created between the outside air and the air in the middle ear.
A difference in pressure can cause symptoms, such as ear pain during an airplane flight or while diving. When the plane takes off, the pressure in the plane drops creating a relative overpressure in the middle ear. The Eustachian tube (on the side of the ear) works like a valve and helps release too much pressure from the middle ear. During the descent, the reverse happens, as there is a relative depression in the middle ear. In this case, the Eustachian tube (on the throat side) serves as a valve. Unfortunately, it is more difficult for the air to return to the middle ear, which explains why complaints are more frequent on the descent.
If the Eustachian tube fails to compensate for the pressure difference, the mucous membranes and blood vessels in the ear are damaged: it is barotitis. When the pressure difference between the outer ear and the middle ear is so great that the eardrum tears, it is called barotrauma.
Where and how often?
Barotrauma is more common in children who fly than in adults. They affect 1 in 4 children and 1 in 6 to 20 adults. If there have already been complaints during a previous flight, the risk is even higher: there are 6 to 7 chances in 10 of doing so again. barotrauma during a subsequent flight.
How to recognize them?
In mild forms of barotite, you may feel your ears are plugged or hear ringing. The more serious forms are accompanied by intense pain in the ear.
In the case of a torn eardrum, the pain goes away quickly and a mixture of water and blood may flow through the ear. If there is a tear at the entrance to the cochlea, in the middle ear, usually suddenly you can’t hear anything (sudden deafness), you have dizziness and vomiting.
How is the diagnosis made?
The general practitioner examines the outer ear and eardrum with an otoscope, the device that allows him or her to see inside your ear. He can see the presence of fluid behind the eardrum and damage to the eardrum. A tuning fork test allows him to assess your hearing. For a more in-depth examination, such as a measurement of the pressure in the ear and hearing tests, he will refer you to the specialist (otolaryngologist or ENT).
What can you do ?
Avoid flying and diving as much as possible if you have an upper respiratory infection, otitis media, sinusitis, or allergic symptoms. If you absolutely must fly, it is important not to sleep while you land.
During landing, you can try to keep the pressure equal on both sides of the eardrum by repeating the following gestures every minute:
- open your mouth, move your mouth and lower jaw, swallow your saliva, yawn;
- exhale slowly, keeping your mouth closed and pinching your nose (Valsalva maneuver);
- swallow your saliva, keeping your mouth closed and pinching your nose;
- blow through your nose into a balloon (e.g. Otovent® for children from the age of 3 or Politzer ball for adults).
You can give young children drink while landing to balance the pressure in the middle ear.
If your ears hurt after a flight, a pain reliever with paracetamol can provide relief. So be sure to have this medicine in your travel pharmacy. Earplugs are not recommended.
After a barotrauma, it is absolutely not recommended to fly or dive for 10 days.
What can your pharmacist do?
You can use a nasal decongestant in drops or in a spray before take off, during the flight and on landing. This product deflates the mucous membrane around the Eustachian tube. Use this type of product for a maximum of 5 days in a row.
What can your doctor do?
Barotitis or barotrauma does not require treatment. Most often, the condition disappears spontaneously. If you are in great pain, the general practitioner will prescribe a painkiller. He may also prescribe a decongestant in drops, spray or tablet to deflate the mucous membranes of the nose and Eustachian tube.
If you still have symptoms after a week, the GP may refer you to the specialist (ENT), who will eventually pierce a small hole in your eardrum. This will allow the fluid to drain from the ear and your pain will be immediately relieved.
If you suffer from recurrent barotitis, a cortisone nasal spray may be needed.
If you have to fly often, you may want to consider having drains (diabolos) placed in the eardrums to compensate for pressure differences.
Want to know more?
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Nasal corticosteroids – CBIP – Belgian Pharmacotherapeutic Information Center
- Zelfzorgadvies in de apotheek, Praktijkgids 2. S. Cornwell, V. Foulon. Publisher Acco. 2018 edition.