FLYING AND THE EAR Introduction This factsheet covers what is known about the effects of flying on your ears. It tells you how flying affects your ears and how to minimise these effects. The effects of flying Earache is an unpleasant side-effect of air travel for many people. People who are hard of hearing or who have tinnitus may worry that their ears could be further damaged, or the conditions aggravated, by flying. This is not true for most people, and you can take precautions whether you are deaf or hearing to help minimise any pain or discomfort in your ears when flying. How flying affects your ears Pain or discomfort in our ears during flying is caused by a difference between air pressure in the middle ear and the atmospheric pressure in the aircraft cabin. The middle ear is the part of the ear behind the eardrum (tympanic membrane) containing the small bones (ossicles) that conduct sound to the inner ear and nerve of hearing (see diagram on page 2). The middle ear cavity is normally filled with air at the same pressure as the surrounding air. This air is continuously absorbed by the body, but each time we swallow or yawn, the Eustachian tube, which connects the middle ear to your nose and RNID HelpLine, PO Box 16464, London EC1Y 8TT Website: www.rnid.org.uk Tel: 0870 60 50 123 Text: 0870 60 33 007 Fax: 0171 296 8199
throat, opens and allows air to pass into the middle ear cavity. This equalises the pressure on either side of the eardrum. Diagram: RNID/Gillian Lee The inside of the ear is divided into the outer, middle and inner ear. After take-off, the pressure in the aeroplane slowly drops. This does not usually cause a problem as the air in the middle ear is at a relatively high pressure and gets blown down the Eustachian tube. If there is going to be a problem with equalising pressure in the middle ear, it tends to happen when the aircraft comes down to land. At this time, the air in the middle ear is at a lower pressure than the air in the cabin. The Eustachian tube may become blocked and the small muscles in the throat, which open it, may not be able to do so. The resulting pressure in the middle ear is therefore low and the eardrum is pressed inward causing discomfort or pain, and temporary hearing 2
loss. This small temporary reduction in your hearing may make a huge difference in your ability to understand speech if you already have a hearing loss. The blockage of the Eustachian tube usually clears of its own accord after a short time. You may worry that your eardrum will be damaged by this pressure change. In fact, the eardrum is usually strong enough to withstand it. Children who have a history of frequent ear infections or have had grommets in the past (but no longer have them) are sometimes at risk of having a perforated eardrum. However, if a grommet is in place at the time of the flight, or you already have a perforated eardrum, you need not worry about flying (see Grommets and perforations, page 5). Checking your Eustachian tube function The Eustachian tube has an important role in keeping the air pressure equalised between the aircraft cabin and the middle ear. You can see how well your Eustachian tube is working with the aid of a test known as the Valsalva manoeuvre. Pinch your nose between your finger and thumb, and gently blow air down it with your mouth closed, without releasing the air. If you hear or feel air going into your ears then you know your Eustachian tube is working well. Minimising the effects of flying on your ear Eustachian tube function varies between different people and even in the same person over a period of time. You can do a number of things to reduce the effects of flying on your ear: Make sure you are awake before the plane begins its descent, which may start up to an hour before it lands. The Eustachian tube does not open effectively when you are sleeping. Yawn, chew gum or suck on a hard sweet to encourage the Eustachian tube to open. 3
Keep swallowing, using a glass of water or another drink, but not alcohol. Do this regularly, every 15 to 30 seconds if you need to. If this does not clear your ears, carry out the Valsalva manoeuvre (see page 3). Make sure you are not dehydrated and that you have had plenty to drink. Do not drink alcohol. Avoid flying if you have a cold. When you get a cold or other infection around the nose and throat, the lining of the Eustachian tube is swollen and gets blocked more easily. Many doctors recommend you use a decongestant spray about 20 minutes before you land. It is important not to use the spray for more than five days continuously. If you have to travel, ask your doctor or pharmacist about decongestants you can use. Some people have reported more comfortable flights with the aid of EarPlanes. EarPlanes are earplugs designed for flying. They have a small ventilation tube down the middle. The theory is that the tube slows down the pressure change at the eardrum when the cabin in the aircraft is pressurised and depressurised. However, to date, there has been no medical study to prove that EarPlanes help people who normally experience severe ear pain whilst flying. The use of ordinary soft earplugs is not recommended. Tinnitus and flying Some people worry that the noise of the aeroplane engines will damage their ears or cause their tinnitus to get louder. If you find the noise of the engines disturbing, either book ahead or try and get a seat near the front of the plane, away from the engines. You may find that being in an aircraft is the one time when you are usually completely free of your tinnitus because of the noise made by the engines and airflow around the aeroplane. 4
If you have been fitted with white noise generators (these used to be called masking devices ), it is very helpful to use them on the aeroplane to reduce the discomfort of any loud sounds such as those described above. If you normally wear hearing aids, you should also wear these during your flight as removing them may make your tinnitus louder and more noticeable. People with hearing loss find that it is often straining to hear that makes their tinnitus louder when they are on an aeroplane. If your Eustachian tubes are blocked when you fly, your tinnitus may seem temporarily louder as it does when you put an earplug in your ear. Your tinnitus should return to its former level once the Eustachian tubes return to normal. Pressure changes and the inner ear Very occasionally, sudden decompression occurs in an aircraft. This can affect the inner ear (see diagram on page 2). This is an extremely rare occurrence, and is usually accompanied by disturbance of balance and hearing loss. If this happens, visit the accident and emergency department of the nearest hospital as quickly as possible to check for any damage and to get treatment. Most people with tinnitus find that it does not get worse as a result of pressure changes when they fly. When tinnitus is due to hearing nature sounds coming from the nerve of hearing or the inner ear, it is not affected by flying as air pressure changes in normal commercial aeroplanes do not, generally, affect this part of the ear. Where changes in pressure do have an effect on tinnitus, the pitch may be changed, and in some cases it may become louder. Fortunately, these changes are temporary. 5
Grommets and perforations Do not worry if you have grommets very small ventilation tubes that are inserted in the eardrum to treat conditions such as glue ear or perforated eardrums as a result of infection or injury. In either case, flying is actually less of a problem than if the eardrum is intact. This is because any change in pressure can be equalised across the eardrum and does not depend on the Eustachian tube functioning normally. Flying after ear surgery If you have recently had an operation on your middle ear, or are about to have one, it is important to ask the ENT consultant whether you can fly immediately afterwards. Some ear specialists recommend that you avoid flying for six weeks after ear surgery. If the operation involves the insertion of a grommet or ventilation tube, there should be no problem flying. Other operations which involve either the grafting or perforation of the ear drum, or more particularly the stapedectomy or stapedotomy operation for otosclerosis, usually mean that you cannot fly for a short time while the ear is healing. Consult your ENT consultant for advice before flying if you are concerned. Other factors and fear of flying If you are still anxious about the effect of flying on your ears and worried about flying generally, discuss your fears with your GP. Very rarely, a doctor may decide it is appropriate to prescribe a small dose of tranquillisers. Relaxation and breathing exercises can be extremely helpful for anxiety in general. If your only worry is that flying may be harmful to your ears, in almost all cases you can go ahead and enjoy your flight. If your reason for flying is to take a holiday, you have something enjoyable and relaxing to look forward to! 6
If you have a phobia about flying, you can attend a course to help you overcome this fear. Aviatours runs Fear of Flying courses every two or three months. Each course lasts for one day and involves taking a 45-minute flight from Heathrow or Manchester Airport. Friends and relatives may accompany you on the actual flight. There is a charge for the course and for the flight only. For further information, please contact Aviatours (Charter) Limited, Pinewoods, Eglington Road, Tilford GU10 2DH. Tel/Fax: 01252 793250. Further Information RNID Helpline PO Box 16464, London EC1Y 8TT. Tel: 0808 808 0123; Textphone: 0808 808 9000; Fax: 020 7296 8199; E-mail: helpline@rnid.org.uk Website: www.rnid.org.uk The helpline is open Monday to Friday, from 9am to 5pm. You can get advice and information about all aspects of hearing loss from the RNID Helpline. RNID Tinnitus Helpline Castle Cavendish Works, Norton Street, Nottingham NG7 5PN. Tel: 0808 808 6666; Textphone: 0808 808 0007; E-mail: tinnitushelpline@btinternet.com The helpline is open Monday to Friday from 10am to 3pm. The RNID Tinnitus Helpline gives advice and information about tinnitus the experience of noises in the ears or the head. RNID Information Services, October 2000 7