Ear barotrauma (airplane ear): what it is, symptoms and how to ease it

Barotrauma means damage to tissues caused by a difference in pressure between air spaces inside the body and the air outside. Patient.info says barotrauma to the ear is the most common type. The middle ear, the small space behind the eardrum, should normally be filled with air at the same pressure as the air outside. When the pressures are unequal the eardrum is pushed or pulled out of its usual position, which can be painful and stops it vibrating as well as it should, so hearing becomes dull or muffled for a while.

Everyday names include airplane ear, aeroplane ear and, for divers, divers' ear. They describe the same mechanism: a rapid change in surrounding pressure that the middle ear cannot match quickly enough.

Patient.info lists practical steps that work by getting air into the Eustachian tube as the plane descends, and says the measures usually work for most people.

The NHS says that for earache in general, most earaches get better on their own, and you can use painkillers such as paracetamol or ibuprofen (children under 16 should not take aspirin) and place a warm flannel on the ear. It says not to put anything inside your ear, such as cotton buds. Get medical help if symptoms do not improve within 2 to 3 days.

• Suck sweets, swallow, yawn or chew when the plane begins to descend, since air is more likely to flow up the Eustachian tube when you do.

• Take a deep breath in, then breathe out gently with your mouth closed and your nose pinched, so no air is blown out but air is gently pushed into the Eustachian tube. Your ears may go "pop". Repeat every few minutes if you feel discomfort.

• Do not sleep during descent. Ask the cabin crew to wake you when the plane starts to descend.

• For babies, feed them or give them a drink at the time of descent to encourage swallowing.

• If you are particularly prone to it, a decongestant nasal spray such as one containing xylometazoline from a pharmacy may help; Patient.info suggests spraying about an hour before the expected descent. Decongestants are not suitable for young children.

• Air pressure-regulating ear plugs may slow the rate of pressure change. Patient.info says it is not yet known how effective they are, but some people find them helpful.

Patient.info describes ear pain and dulled hearing as the key features. Other symptoms are those the NHS lists for a perforated eardrum, which can start suddenly after a sudden change in air pressure such as flying on a plane.

• Ear pain or earache, sometimes severe.

• A feeling of fullness or pressure and temporarily muffled hearing.

• A ringing or buzzing sound (tinnitus) and dizziness, which the NHS lists with a perforated eardrum.

• Clear fluid, blood or pus leaking from the ear, which suggests the eardrum may have torn.

Patient.info explains that in most people the normal swallowing and chewing movements allow air to move up or down the Eustachian tube quickly enough to keep the pressure balanced. Some people have a Eustachian tube that does not open as easily, for example because it is narrower than normal, and any condition that blocks the tube stops air travelling up or down.

The common cause of blockage is mucus and inflammation from colds, throat infections, hay fever and similar problems. This is why barotrauma tends to occur when flying with a cold. Patient.info advises that anyone with a cold, respiratory infection, ear infection or medical condition affecting the middle ear should ideally not fly, while acknowledging that few people will cancel a trip for this reason.

Babies and young children are often affected. Patient.info suggests feeding a baby or giving a drink during descent to encourage swallowing, and notes that decongestants are not suitable for young children.

Patient.info says the normal practice of divers is to descend and ascend slowly, which gives time to equalise the pressure on either side of the eardrum, and that divers can use the same breathe-out-against-a-pinched-nose manoeuvre (the Valsalva manoeuvre). It also says you should not dive if you have a condition that may cause a blocked Eustachian tube, because this may cause severe barotrauma and severe ear pain.

Patient.info says that in most cases no serious damage is done, but occasionally the eardrum tears. The NHS says a perforated (burst) eardrum usually gets better on its own within 2 months and your hearing returns to normal, though you may need antibiotics if you have an ear infection or to stop an infection while the eardrum heals. Sometimes surgery to repair the eardrum (myringoplasty) is needed if it is not healing by itself.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have sudden hearing loss in one or both ears, if your hearing has been getting worse over the last few days or weeks, or if you have hearing loss along with other symptoms such as earache or discharge from the ear. It also says to see a GP if symptoms of a perforated eardrum have not started to improve after a few weeks.

While an eardrum heals, the NHS advises not going swimming or getting the ear wet, not putting anything inside the ear (such as cotton buds or eardrops, unless a doctor recommends them), and trying not to blow your nose too hard. Painkillers such as paracetamol or ibuprofen can ease pain.

On flying, the NHS says it is safe to fly with a perforated eardrum, but if you have had surgery to repair it you should not fly until you are told it is safe.

Babies and young children are often affected. Patient.info suggests feeding a baby or giving a drink during descent to encourage swallowing, and notes that decongestants are not suitable for young children.

The NHS says a young child with earache might rub or pull their ear, not react to some sounds, have a temperature of 38C or above, be irritable or restless, be off their food, or keep losing their balance. It says to call 111 for advice for a child under 5, and to ask for an urgent GP appointment or NHS 111 help if a child under 2 has earache in both ears.

Most cases are managed with self-care, and a GP or pharmacist is the usual starting point. Persistent symptoms are assessed through NHS ear, nose and throat (ENT) or audiology services. Some people choose to pay privately for faster hearing tests or an ENT opinion; the clinical assessment is the same, and the main difference is speed of access.