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Health condition

Airplane ear, Eustachian tube dysfunction and how to prevent it.

A middle ear that will not equalise on descent hurts, muffles hearing and can rupture the drum. A stepped plan, from earplugs to ENT surgery, keeps most people flying comfortably.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against ENT UK, NICE CKS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including balloon Eustachian tuboplasty and pressure-regulating earplugs.

Key facts

Airplane ear at a glance.

The essentials, in plain English - what it is, why the Eustachian tube matters and how it is treated in the UK today.

  • What it is

    Middle-ear barotrauma from a rapid pressure change the Eustachian tube fails to equalise, most often on aircraft descent.

  • Why it happens

    A negative pressure differential between the middle ear and the outside world causes retraction, effusion and sometimes eardrum rupture.

  • Grading

    Wallace and Reissner grades run from 0 (symptoms only) to 5 (perforation), which guides how urgently ENT gets involved.

  • Who is at risk

    Anyone with a cold, allergic rhinitis, sinusitis, deviated septum or adenoid hypertrophy, and infants and young children.

  • First response

    Decongestants, autoinsufflation (Valsalva, Toynbee), swallowing, yawning and chewing on descent prevent most cases.

  • When it persists

    Grommet tubes or balloon Eustachian tuboplasty help recurrent or chronic Eustachian tube dysfunction.

Why this guide matters

Preventable, treatable, worth planning for.

Barotrauma is common, mostly avoidable and rarely serious - but the exceptions matter, and the fixes for repeat sufferers are excellent.

  • Descent is the risky bit

    Cabin pressure rises as the aircraft descends and the middle ear needs an open Eustachian tube to keep up.

  • A cold changes everything

    Even a mild upper-respiratory infection makes the Eustachian tube swell and refuse to equalise.

  • Chronic dysfunction has answers

    Grommet tubes and balloon Eustachian tuboplasty transform life for frequent flyers with repeat episodes.

How the diagnosis is made

From ear pain on landing to a clear plan.

The steps a UK GP or ENT surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and triggers

    Recent flight, dive or mountain drive, plus any cold, allergy or sinus symptoms in the days before.

  2. 02

    Assessing

    Otoscopy

    Look for a retracted drum, a middle-ear effusion, haemotympanum or frank tympanic membrane rupture.

  3. 03

    Assessing

    Symptom pattern

    Ear pain, muffled hearing, tinnitus, vertigo and sometimes bloody discharge point to middle-ear barotrauma.

  4. 04

    Confirming

    Tympanometry

    A flat or negative-pressure trace confirms Eustachian tube dysfunction and middle-ear fluid.

  5. 05

    Confirming

    Pure-tone audiometry

    Hearing testing is arranged if symptoms persist beyond a week or two, to quantify any conductive loss.

  6. 06

    Confirming

    ENT referral

    Recurrent episodes, persistent effusion, perforation or complex anatomy earn a specialist opinion.

  7. 07

    Preventing

    Underlying nasal and sinus workup

    Allergic rhinitis, chronic sinusitis, septal deviation and adenoid hypertrophy are treated to prevent recurrence.

Typical timeline: most cases settle in days; persistent effusion earns audiometry within a few weeks.

Symptoms

What airplane ear actually feels like.

The classic pattern of pain, muffled hearing and pressure on descent - and the features that mean it is time to escalate.

  • Ear pain on descent

    A sharp, deep, pressing pain as cabin pressure rises around a middle ear that has not equalised.

  • Muffled or blocked hearing

    A stuffy, underwater sensation from a retracted drum and a middle ear filling with fluid.

  • Tinnitus

    Ringing, hissing or roaring that often settles as the pressure equalises over hours or days.

  • Vertigo

    Short spells of spinning or unsteadiness, especially with more forceful pressure changes.

  • Bloody discharge

    A few drops of blood from the ear canal after a rupture, usually with a sudden easing of the pain.

  • Persistent effusion

    A middle-ear effusion that lingers for weeks and keeps hearing muffled after the flight.

  • Recurrent episodes

    The same pattern with every flight or dive, especially if there is underlying Eustachian tube dysfunction.

  • Red flag - sudden severe vertigo

    Severe vertigo, sudden sensorineural hearing loss or facial weakness suggests inner-ear barotrauma or a perilymph fistula.

Prevention and treatment

How airplane ear is prevented and treated.

Simple pre-flight measures first, then symptomatic treatment - and for repeat sufferers, grommet tubes or balloon Eustachian tuboplasty.

  • Pre-flight prevention

    Oral pseudoephedrine 30 minutes before descent, avoided in pregnancy, hypertension and heart disease. Oxymetazoline nasal spray is a topical alternative.

  • Antihistamine cover

    Useful when allergic rhinitis is driving the Eustachian tube dysfunction, started a few days before travel.

  • Autoinsufflation on descent

    Gentle Valsalva or Toynbee manoeuvres, plus swallowing, yawning and chewing gum keep the tube opening as pressure rises.

  • Pressure-regulating earplugs

    EarPlanes or Alpine FlyFit slow the rate of pressure change and give the Eustachian tube more time to equalise.

  • Symptomatic treatment

    Simple analgesia, a short course of a decongestant and an antihistamine settle most cases within days.

  • Grommet tubes

    A ventilation tube through the eardrum bypasses a failing Eustachian tube for recurrent or persistent cases, including frequent flyers.

  • Balloon Eustachian tuboplasty

    A day-case ENT procedure that dilates a scarred or dysfunctional Eustachian tube - useful for chronic dysfunction.

  • Treat underlying disease

    Intranasal steroids for rhinitis, sinus surgery for chronic sinusitis and adenoidectomy in children remove the driver behind repeat episodes.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT surgeon knows your ears and history and can tell you which parts apply to you. If in doubt, get seen.

  • ENT UK. Guidance on Eustachian tube dysfunction and middle-ear barotrauma.

  • NICE CKS. Otitis media with effusion and related Eustachian tube dysfunction topics.

  • Wallace and Reissner. Middle-ear barotrauma grading scale.

  • Aerospace Medical Association. Medical guidelines for airline travel - otologic considerations.

Red flags

When airplane ear needs urgent attention.

Most barotrauma settles at home. These are the situations that need a same-week or same-day medical opinion.

  • Sudden sensorineural hearing loss

    A sudden drop in hearing after a flight or dive needs urgent ENT review to exclude inner-ear barotrauma.

  • Severe, persistent vertigo

    Ongoing spinning or unsteadiness suggests a perilymph fistula and warrants same-week specialist assessment.

  • Facial weakness

    Any facial nerve weakness after barotrauma needs urgent medical review, not a wait-and-see approach.

  • Large or non-healing perforation

    Most small perforations heal within weeks. A persistent hole or ongoing discharge needs ENT input.

  • Signs of middle-ear infection

    Fever, worsening pain and purulent discharge point to a secondary otitis media that needs antibiotics.

  • Diving-related symptoms

    Barotrauma in a scuba diver, especially with neurological features, should be assessed for decompression illness.

  • Recurrent episodes in a child

    Repeated middle-ear barotrauma in a child suggests adenoid hypertrophy or chronic effusion needing paediatric ENT review.

  • Bloody discharge with vertigo

    Blood from the ear combined with vertigo raises the possibility of inner-ear injury and needs prompt review.

  • New tinnitus that does not settle

    Tinnitus persisting beyond a few weeks deserves audiometry and an ENT opinion.

Living with it

A preventable problem, with a clear ladder.

Four things that make the biggest difference in the departure lounge and on the way down - plan the descent, delay if unwell, treat the nose and escalate when it keeps happening.

A quiet reminder

Prevention beats treatment, every time.

A decongestant, earplugs and steady swallowing on descent do more than any tablet taken after the pain has started.

  1. 01 Prevent

    Plan for the descent

    A decongestant 30 minutes before landing, pressure-regulating earplugs and steady swallowing prevent most trouble.

  2. 02 Delay

    Do not fly with a heavy cold

    If the Eustachian tube is already swollen, defer non-essential travel or diving until the head clears.

  3. 03 Treat

    Address the underlying nose

    Well-controlled allergic rhinitis and treated sinusitis mean far fewer barotrauma episodes.

  4. 04 Escalate

    Do not accept repeat episodes

    Grommet tubes and balloon Eustachian tuboplasty exist for a reason - ask for an ENT opinion if it keeps happening.

Frequently asked

Everything we get asked about airplane ear.

Quick answers on prevention, decongestants, burst eardrums and when to see ENT.

  • What is airplane ear?

    Airplane ear, or ear barotrauma, is injury to the middle ear caused by a rapid pressure change the Eustachian tube cannot equalise. It happens most often on aircraft descent but also with diving and driving down mountains. Symptoms include ear pain, muffled hearing, tinnitus and sometimes vertigo or bloody discharge.

  • How do I prevent airplane ear on a flight?

    Take a decongestant such as pseudoephedrine about 30 minutes before descent if you have no contraindications, use an oxymetazoline nasal spray or antihistamine if you have allergic rhinitis, and swallow, yawn or chew gum during descent. Pressure-regulating earplugs like EarPlanes or Alpine FlyFit slow the pressure change and help too.

  • Who should avoid pseudoephedrine before flying?

    Pseudoephedrine is best avoided in pregnancy, uncontrolled hypertension and known heart disease. In those situations use a topical decongestant like oxymetazoline nasal spray, an antihistamine if allergy is driving the problem, or non-drug measures such as autoinsufflation and pressure-regulating earplugs.

  • How is a burst eardrum from flying treated?

    Most small perforations from barotrauma heal on their own within a few weeks. Keep the ear dry, avoid swimming and unprotected showers, and use analgesia for discomfort. ENT review is arranged if the hole is large, does not heal, or is accompanied by hearing loss, vertigo or discharge.

  • When should I see an ENT specialist?

    See ENT for recurrent episodes, a persistent middle-ear effusion, a perforation that is not healing, sudden hearing loss, severe vertigo or facial weakness. Chronic Eustachian tube dysfunction may benefit from grommet tubes or balloon Eustachian tuboplasty.

  • Can children have airplane ear?

    Yes - infants and young children are particularly prone because their Eustachian tubes are shorter and more horizontal, and adenoid hypertrophy is common. Feeding, a bottle or a dummy on descent encourages swallowing and helps equalise. Repeated episodes deserve a paediatric ENT review.

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