Flying soon? How to prevent ear barotrauma.
Ear barotrauma is a pressure injury that happens when outside air pressure changes faster than your middle ear can equalize. Simple habits before and during travel prevent most cases.
What is ear barotrauma?
When the Eustachian tube does not open, pressure pushes or pulls on the eardrum. This can cause pain, fullness, muffled hearing, fluid buildup, and rarely an eardrum tear. Inner-ear injury is uncommon but serious.
Common triggers
Airplane takeoff and descent
Scuba and freediving
Mountain driving, fast elevators, hyperbaric therapy
Symptoms
Sharp or pressure-like ear pain
Fullness, popping, muffled hearing
Ringing (tinnitus)
Severe signs: vertigo, ear bleeding, sudden hearing loss
Who is at higher risk
Colds, allergies, sinusitis, recent nasal congestion
Young children
Recent ear surgery or chronic ear problems
Tobacco use or reflux (tube inflammation)
Prevent it on flights
Start early and repeat during ascent and descent.
Swallow, sip water, yawn, or chew gum to open the tube.
Valsalva maneuver (gentle): pinch nose, close mouth, blow lightly for 1–2 seconds. Stop if pain. Repeat intermittently.
Toynbee maneuver: pinch nose and swallow.
Pressure-regulating earplugs from boarding through landing.
Nasal prep if congested: isotonic saline rinses; consider a short-term topical nasal decongestant spray 30 minutes before takeoff and before descent. Limit sprays to ≤3 consecutive days.
Allergy control: use your prescribed nasal steroid and antihistamines as directed in the 3–5 days before travel.
Avoid
Sleeping through descent if congested
Forceful or repeated hard Valsalva
Decongestants if you have uncontrolled hypertension, heart disease, glaucoma, thyroid disease, or pregnancy without clinician guidance
Tips for children
Offer feeding, bottle, or pacifier during ascent and descent to encourage swallowing.
Use child-size pressure-regulating earplugs if tolerated.
Avoid decongestants unless approved by pediatrics.
Divers: equalize early and often
Do not dive with congestion.
Descend slowly and equalize every few feet.
If you cannot equalize, ascend a bit and try again. Do not force.
If pain hits mid-flight:
Sit upright, sip water, swallow, yawn, or chew gum.
Try gentle Valsalva or Toynbee.
Use a warmed towel over the ear if available.
After landing, continue saline rinses and avoid forceful equalization.
When to see an ENT:
Severe pain, vertigo, ear bleeding, or symptoms >24–48 hours
Sudden hearing loss at any time
Recurrent barotrauma with travel or diving
FAQs
Can the eardrum rupture? Rarely. Most injuries are mild and heal.
Do special earplugs help? Yes. Filtered plugs slow pressure change and help many travelers.
Are decongestants safe for everyone? No. Some conditions and medications conflict. Talk to a specialist.
Will this affect hearing long term? Persistent symptoms are uncommon. Seek care if they do not resolve.