Holiday travel and flying with congestion: how to prevent ear pain and “airplane ear”

Holiday flights are stressful enough without sharp ear pain, pressure, or muffled hearing during takeoff and landing. Those symptoms are often caused by “airplane ear,” also called ear barotrauma, which happens when the air pressure around you changes faster than your middle ear can equalize.

When your nose is congested from a cold, allergies, or a sinus flare, the Eustachian tube (the small passage that connects the middle ear to the back of the nose) can have trouble opening. Pressure then pushes or pulls on the eardrum, leading to discomfort, fullness, popping, muffled hearing, fluid buildup, and rarely an eardrum tear.

Below is a practical, travel-friendly plan you can use before and during your flight, plus guidance on when to call ENT & Allergy, Inc. before you travel.

What ear barotrauma feels like

Common symptoms include:

• Pressure-like or sharp ear pain

• Fullness, popping, muffled hearing

• Ringing in the ear (tinnitus)

More serious warning signs include vertigo, ear bleeding, or sudden hearing loss. These need prompt medical attention.

Who is more likely to get ear pain when flying

You are at higher risk if you have:

• A cold, active allergies, sinusitis, or noticeable nasal congestion

• A history of chronic ear problems or recent ear surgery

• Young children in your party (their Eustachian tubes are narrower and can clog more easily)

The “before you fly” plan

3 to 5 days before travel (set yourself up for success)

If allergies are part of your congestion pattern, start controlling them early. Many prescribed allergy routines (like nasal steroid sprays) work best when used consistently for several days, not just a single dose right before boarding.

Practical steps:

• Use your prescribed allergy medications as directed

• Consider saline rinses or saline spray to reduce nasal swelling and clear mucus

Day of travel

Focus on keeping the nasal passages as open and calm as possible:

• Hydrate well

• Do a saline rinse or saline spray before heading to the airport

Some travelers consider decongestants, but they are not appropriate for everyone. If you have uncontrolled high blood pressure, heart disease, glaucoma, thyroid disease, or you are pregnant, get clinician guidance before using decongestants.

If a topical nasal decongestant spray is recommended for you, it is typically used short-term and timed before takeoff and again before descent. Limit decongestant nasal sprays to just a few days to reduce the risk of rebound congestion.

What to do on the plane (this is when it matters most)

Ear barotrauma is most common during ascent and especially descent.
Start early and repeat during takeoff and landing:

• Swallow, sip water, yawn, or chew gum to help open the Eustachian tube

• Try a gentle Valsalva maneuver: pinch your nose, keep your mouth closed, and blow very lightly for 1 to 2 seconds. Stop if it hurts, and do not force it.

• Try the Toynbee maneuver: pinch your nose and swallow

• Consider pressure-regulating earplugs (filtered earplugs) from boarding through landing, especially if you are prone to ear pain

Avoid these common mistakes

• Do not sleep through descent if you are congested, because you may miss the chance to actively equalize

• Avoid repeated hard, forceful Valsalva attempts. Aggressive pressure can irritate the ear and can worsen symptoms

Tips for kids (toddlers, children, and babies)

Kids often cannot describe pressure well, and they can struggle more with equalizing. Helpful strategies include:

• Offer feeding, a bottle, a pacifier, or a drink during ascent and descent to encourage swallowing

• Consider child-size pressure-regulating earplugs if they tolerate them

• Avoid giving decongestants unless your pediatric clinician approves. The FDA specifically warns against giving cough and cold products containing decongestants or antihistamines to children under 2.

If your child has frequent flight ear pain or recurrent ear infections, call ahead so you can discuss prevention strategies before travel.

If pain hits mid-flight

If you feel intense pressure or pain during descent:

• Sit upright

• Sip water and swallow repeatedly

• Chew gum or suck on candy

• Try gentle Valsalva or Toynbee maneuvers

• A warm towel over the ear can be soothing if available

After landing, continue gentle measures (saline, hydration) and avoid forceful equalization.

When you should call ENT & Allergy, Inc. before you fly

Call ahead if you have frequent ear pain with flights, especially if you have any of the following:

• Ear pain on most flights, even when you are not sick

• A history of ear barotrauma, ruptured eardrum, or ear surgery

• Planned travel while actively congested (cold, sinus infection symptoms, or uncontrolled allergies)

A quick pre-travel plan can make the difference between a manageable flight and a painful one.

When to seek urgent evaluation

Get medical care promptly if you experience:

• Severe ear pain with vertigo, ear bleeding, or sudden hearing loss

• Symptoms that do not improve within 24 to 48 hours after flying

Quick FAQ

Do yawning and chewing gum really work?
Often, yes. Swallowing, yawning, and chewing encourage the Eustachian tube to open and can relieve pressure for many travelers.

Do special earplugs help?
Filtered, pressure-regulating earplugs can help some people by slowing the rate of pressure change at the eardrum.

Are decongestants safe for everyone?
No. Some medical conditions and medications conflict with decongestants. For example, pseudoephedrine can worsen high blood pressure, heart and blood vessel disease, glaucoma risk, thyroid disease, and other conditions. Ask a clinician if you are unsure.