Middle Ear and Sinus Discomfort

The middle ear is similar to a box: closed at one end by a flexible cover (the ear drum) and drained at the other end by a thin, straight tube (the Eustachian tube). As the aircraft climbs, air in the body cavities expands as the barometric pressure decreases. Normally, air will escape from the middle ear and the sinuses and pilots will only notice their ears “popping”. The outlet of the Eustachian tubes, however, is narrow and, if the pilot has a head cold or a throat infection, local swelling may narrow it. On ascent, air may still be able to escape, but on descent—particularly at high rates—the outlet may close like a flap, preventing air from re-entering the middle-ear cavity. The increasing ambient air pressure will then force the eardrum inward. This can lead to severe pain and decreased hearing.

Pressure in the ears can be equalized by opening and closing the mouth, swallowing, yawning, chewing gum or by holding the nostrils shut while gently blowing the nose. If the pressure in the ears (or sinuses) cannot be relieved by these manoeuvres, it is best to climb back to the original altitude or to a higher level (if this is necessary, ATC should of course be kept informed). The ears should then be cleared and a gradual descent made, clearing the ears frequently on the way down. Sometimes, the pressure in the middle ear on descent is so low relative to the external pressure that the eardrum can bleed and even rupture. This is known as barotrauma. If barotrauma occurs, a physician familiar with aeromedical conditions should be seen for treatment as soon as possible after landing.

The best advice to pilots or passengers who are suffering from head colds, sore throats or allergies is to wait until the inflammation has subsided before flying. Nasal sprays can help provide relief, but this is only temporary. A cold lasts only a few days, but a blown eardrum may take weeks to recover!