What should I do to avoid ear pain when flying?

I’ve always had some issues with my right ear and also with a congested nose.
Recently, flying to a vacation with a stopover, I had really bad pain on both flights, including major sensations of movement within my ear (not a “pop”, there was no relief). This started within about 20-30 minutes of takeoff, lasted about 15 minutes then slowly subsided. The next day my ear started bleeding and I went to see an ear specialist doctor who confirmed a heavily ruptured eardrum. This was a guy who worked, among other things, with navy submariners.

The doctor’s recommendation was to always use nasal spray when you fly, if you have this kind of problems. Use it before takeoff and again before landing. You can supplement that with chewing gum, but your first line of defense is clearing your nasal cavities with a spray – those were his exact recommendations.

His recommendation was Afrin, but I don’t think it has much to do with the brand, but rather the active ingredient, oxymetazoline. For those concerned that this is an endorsement: I never use nasal spray – there is, among other things, the risk of becoming dependent on it given long term usage.

Flying back was fairly uneventful though my ear did register some pressure on the first flight out.

I researched “ruptured eardrums” to figure out my risks of long term hearing loss and flying is listed a major cause of ruptured eardrums. Luckily, most hearing loss is temporary and goes away within a few weeks or months, mine’s pretty much back to normal after 3 weeks.

(I also took this as a vindication of always traveling with health insurance, preferably zero-deductible. If something goes wrong, you want to be able to check it out right away and not second-guess whether you’re OK or not – this could easily have led to a major infection, esp being in the tropics).

And, BTW, pinching nose and blowing? certainly didn’t work in this case, though I know it and it usually does for me. On the plus side, doctor didn’t seem to think it made things worse either. And he did say too, that once blown, the eardrum leak equalizes pressure, so it’s a one-off mess – i.e. you need to fix it, but you don’t need to panic at flying right there and then.

There was a time when the Ear Popper required a prescription in the USA while in Canada AFAIK never did but now even in the US you can just buy it. It’s a lifesaver.

This is a common problem, especially if you have a flu and your nose is clogged. What usually does the trick for me is:

• yawning. luckily flights make me tired in some way
• gulping. chewing gum and a bottle of water will be helpful.

A quick google for “ear pressure relief” adds to the list:

• “Inhale, and then gently exhale while holding the nostrils closed and the mouth shut”
• “Suck on candy” [source]

Wikihow has a similar list on tricks that includes recommendations on medicine. Besides what has already been said they recommend:

• Taking antihistamines before the flight
• special filtered earplugs available in pharmacies and airport stores

Also stay awake during the flight so you don’t miss the initial part of the descent sleeping which is usually hardly noticed but makes for a good part of pressure difference to build up which then takes time to compensate (we’re talking days here in extreme cases).

In a discussion to a somewhat related question it was mentioned that there are business jets which offer sea-level altitude pressure if you are willing and able to splurge on that.

My method is not official, but it helps.

By using paper bags in flights, it gets better. I cover ears, mouth and nose, then deeply inhale and exhale. It’s not perfect, but at least it’s bearable

Hope it helps

Earpain in planes is typically caused by an obstructed eustachian tube (see picture below from Wikipedia)
The tympanic membrane is the membrane that catches the noise and by vibrating sounds get translated to signal in our nerve system. To work the air pressure on both sides of the Tympanic membrane needs to be the same. This is maintained by the earlier mentioned eustachian tube, which is connected with the Pharynx. If this tube is obstructed pressure pressure can’t get even. Over presure on one side of the membrane causes pain.
Being connected to the Pharynx means that the tube easily get obstructed with mucus when having a cold.

Getting rid of the pain is basically done by getting rid of the obstruction. There are multiple ways to do this. If you don’t care what people think, you could use a soother. This is typically advised when traveling with infants. You can’t explain to them yet how to clear their noses, so by either giving a soother or a bottle of baby milk during taking of and descent works. If you don’t want to use a soother you could resort to Chewing gum, bringing a bottle of water, or bring an vicks inhaler with you.

When I have a cold while traveling I try to drink as much water as possible before and during the flight. It seems to work a bit. The downside is that you will have more visits to the lavatory.

When descending, the pressure in the cabin rises, so it’s higher outside your nasal cavities than inside. There are various ear clearing techniques used by scuba divers who regularly experience much bigger pressure differentials. Different ones seem to work for different people, but for me the most effective one is the Valsalva maneuver: pinch your nose, close your mouth and blow against it (carefully).

Note that this will not work during ascent, since then the pressure inside your cavities is bigger than outside. But that case seems to normalize by itself much more easily.

A cold can block your Eustachian tubes and hinder these techniques, especially the more gentle ones like yawning and swallowing, but I’ve never had one so bad that the Valsalva maneuver didn’t work. There is one problem though: it may help the cold spread to previously unaffected nasal cavities, though in my experience they’re all affected sooner or later anyway.

Kids and some adults have a very similar problem as you’re describing. My wife is one of them. The only thing that helps her are pressure reducing earplugs. It doesn’t relieve it completely but makes it bareable enough during the flight and pressurization changes of the airplane.

Position inside the airplane also seems to play a role during pressure change phases with front being more bareable then the rear.