Consultant ENT, Head and Neck and Thyroid Surgeon


Individuals with a Eustachian tube problem may experience difficulty equalising middle ear pressure
when flying.
When an aircraft takes off, atmospheric pressure decreases, resulting in a relative increase in the middle
ear air pressure. When the aircraft lands, just the opposite occurs: atmospheric pressure increases and
there is a relative decrease in the middle ear pressure. Either situation may result in discomfort in the
ear due to abnormal middle ear pressure if the Eustachian tube is not functioning properly. Usually pain
is worst when landing.
To avoid middle ear problems associated with flying you should not fly if you have an acute upper
respiratory problem such as a common cold, allergy or sinus infection.
Should you have such a problem and must fly, or should you have a chronic eustachian tube
problem, try the following:

• Obtain from your chemist the following items: Sudafed tablets and oxymetalozine (Otrivine) nasal spray.

• Following the container directions, begin taking Sudafed tablets the day before your air flight.
Continue the medication for 24 hours after the flight if you have experienced any ear difficulty.

• Following the container directions for Otrivine, use the nasal spray shortly before boarding the
aircraft. Should your ears “plug up” when taking off, hold your nose and swallow. This will help
suck excess air pressure out of the middle ear.

• 45 minutes before the aircraft is due to land again use the nasal spray every five minutes for 15
minutes. Chew gum to stimulate swallowing and opening of the eustachian tube.

• Remember that it is unwise to fly if you have an acute upper respiratory infection. Should flying be
necessary under these circumstances do not try and forcefully pop your ears.

If flying is necessary and frequent, your surgeon may recommend a grommet (or middle ear
ventilation tube) to minimise ear discomfort and damage.

None of theses recommendations or precautions needed to be followed if you have a middle
ear ventilation tube (grommet) in place.