Pain in the ear

  • Health
  • Sunday, 02 Mar 2003

If rising altitude causes discomfort, here are some simple tips for relieving the pressure, reports KATHLEEN DOHENY 


YOU’RE on a flight that’s about to land, and you begin to feel as though twin elephants are sitting on your eardrums. Or you’re driving to a ski resort, and your ears begin to snap, crackle and pop like breakfast cereal. Or you’re at the top of a mountain and you realise you can’t hear a thing.  

What’s behind the discomfort is excess pressure in the middle ear, the air-filled chamber behind the eardrum that includes your three “hearing” bones.  

The middle ear is connected with the upper part of the throat by the Eustachian tube. The tube’s job is to equalise air pressure in the middle ear. With every swallow or yawn, it opens.  

During airplane travel, the ears are subjected to large swings in barometric pressure. The discomfort can feel especially nasty on descent, when the Eustachian tube may be squeezed closed as a result of the vacuum-like pressure. The eardrum is stretched inward, impairing hearing and causing pain.  

If you’re congested from a cold or allergies, you may have even bigger problems. “If your Eustachian tube is blocked from congestion, allergy or whatever reason and air can’t get in or out, you get a pressure change, and that causes pain,” says Sig Soli, head of the department of human communication sciences and devices at House Ear Institute, a leading research and clinical centre in Los Angeles. Worst-case scenario? All that pressure could burst the eardrum, he says.  

Middle kingdom...the bones of the middle ear.

Dr John House, president of the ins-titute and a physician who treats ear, nose and throat disorders, offers this simple guideline: “If you can’t clear your ears on the ground, you should stay at sea level.”  

But Soli and House know many congested travellers won’t or can’t heed those words. If you must fly or you have a problem with your ears at altitude, take some simple precautions and pack some ear first-aid treatments.  

With a doctor’s approval, adults can take a decongestant. “If it’s a short flight, take the decongestant before leaving,” House says. If it’s a long flight, eight hours or so, you might take it an hour or so before the scheduled landing. “People usually have more trouble with the landing than the takeoff,” House says. You also can use nasal spray.  

Choose your decongestants according to whether you want to sleep, advises Harold Washington Jr, manager of Bevans Pharmacy in Los Angeles and past president of the California Pharmacists Association. Among the over-the-counter options he recommends are Actifed and Sudafed. “If you want to sleep on the flight, Actifed will make you more drowsy than Sudafed,” he says.  

Whichever decongestant you choose, take it an hour before boarding, Washington suggests. Don’t take a decongestant that will make you drowsy if you plan to drive.  

Soli says devices called Earplanes, which House Institute scientists helped develop, are worth trying. They’re available over the counter in adult and child sizes for about US$5.50 (RM20.90) a pair and can be used twice before they’re discarded. In the centre is a filter that allows air to flow through slowly, helping regulate air pressure naturally. The devices can be worn for the entire flight or inserted upon boarding and reinserted before descent.  

If you still feel pressure in your ears on descent, experts recommend the Valsalva maneuver: Hold your nose and blow out gently to equalize the pressure. If you hear your ears popping, “it means your ears are equalising the pressure,” and that’s a good thing, House says. (Be sure to blow gently and stop when you hear the popping sound.)  

If your ears stay clogged after a flight or other trip to a high altitude and won’t clear within a day, see a doctor to rule out barotrauma, caused by the changes in pressure. “We sometimes see blood in the middle ear,” House says of some of his patients with barotrauma. “They actually bleed into the middle ear from the pressure.”  

Treatment options for barotrauma include decongestants, corticosteroid medicines or making a tiny incision in the eardrum. The incision, called a myringotomy, is done in adults with the help of a topical anaesthetic, House says. It allows backed-up fluid to clear out of the middle ear. The incision usually closes within a few days.  

The Eustachian tube functions better in adults than in children, so if you’re taking young ones to a high altitude, pay special attention to them.  

For babies, that means keeping a pacifier or bottle handy for takeoffs and landings, or being prepared to breast-feed the child. “Sometimes sucking on a pacifier or having a bottle, anything that causes manipulation of the oral cavity, helps facilitate opening and closing of the Eustachian tube so air can get in and out,” Soli says.  

Older children won’t suffer quite as much as long as they don’t have a cold, House says. But if there’s congestion or a young traveller has a history of ear infections, ask your paediatrician about using over-the-counter paediatric nasal spray and decongestants, House says.  

For more information on ears and altitude, see altitude.cfm , produced by the American Academy of Otolaryngology-Head and Neck Surgery, a professional organisation of ear specialists. – LAT-WP 

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