Ear pain-how to help when flying or diving

Ear pain is common when descending in an airplane, or when diving.

The air in the middle ear shrinks on descent in air or water, creating a negative pressure in the cavity and an inward movement of the ear drum. It is then necessary to 'clear' the ear by swallowing, yawning, or by performing the Toynbee manoeuvre (pinch the nose and then swallow), or the Valsalva manoeuvre (blowing out through a pinched nose).

On ascent, the air in the middle ear expands causing the tympanic membrane to bulge outwards. In this case, the middle ear will usually clear passively via the Eustachian tube which connects the inner ear to the back of the throat, so most people do not experience problems during the ascent of a flight or a dive, unless the ascent is very fast.

For these manoeuvres to work, the Eustachian tube (which connects the middle ear to the back of the throat) must be clear and functioning properly. Some people are more prone to 'Eustachian dysfunction' than others and some conditions are more likely to create malfunctioning of the tube.

The commonest conditions to cause problems are:

  • Any acute cold/sinusitis
  • Allergic conditions affecting the nose, known as rhinitis
In divers, the pressure changes are relatively greatest during the early stages of the dive.
  • After only 1m of descent the diver will be aware of increased pressure on the eardrums
  • At 2m this will become painful.
  • If the ears have not been cleared at 3m, the Eustachian tubes become 'locked' and muscular action using the manoeuvres described above is unable to overcome the pressure differential and relieve the pressure.
  • At 4m the water pressure is enough to rupture the ear drum
What you can do
  • Anyone suffering from an acute cold or other upper respiratory infection should not dive and should ideally avoid flying, especially in unpressurised aircraft.
  • Treat with a systemic decongestant (such as sudafed) an hour or so before descent, combine with a topical nasal decongestant (sinex/otrivine).
  • Young children often have poor Eustachian tube function and should be encouraged to suck sweets or chew gum during the descent.
  • Infants can be given a feed, either breast or bottle, on commencing descent.
  • Adults should be advised to stay awake during descent as the Eustachian tube does not open when asleep.
  • Excess alcohol should be avoided as this causes upper respiratory congestion.
  • Clear the ears with a Toynbee manoeuvre (pinch the nose, then swallow) at the first sign of discomfort. Valsalva manoeuvre (pinch the nose then blow out through the nose) can also be performed but it can make some people feel faint. Do not do this if you have a history of heart disease.
  • Systemic decongestants such as sudafed should only be used with caution in divers, as the effects of drugs can be enhanced by increased pressure. Try the medication on a nondiving day to establish side effects first. Under no circumstances should decongestants be used to enable diving while suffering from a cold or other respiratory infection.
  • Divers who suffer frequent bouts of pain should see their doctor to exclude conditions affecting their ears. Referral to an ENT surgeon may be advised.
  • Divers should not use earplugs to prevent symptoms, this can make matters worse. Sometimes, tightly fitting neoprene hoods can act like earplugs, as can wax which is impacted on the eardrum.

Further information

This article published on
28 November 2005

Next review date 11/1/2013


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