What happens in the ear when there is a pressure difference
The middle ear is a closed cavity connected to the nasopharynx by a narrow auditory (Eustachian) tube. As you gain altitude, the pressure outside drops, and excess air easily leaves the ear on its own. And when the plane descends, the external pressure increases, and the air must enter the ear through the pipe, which is more difficult. If the tube is blocked by edema, the eardrum bends inward, stretches and hurts. The faster the drop and the stronger the swelling of the mucous membrane, the more severe the damage.
- Mild degree - membrane retraction, congestion and slight pain
- Moderate - redness and bleeding into the membrane
- Severe - fluid or blood in the tympanic cavity
- Complicated - rupture of the eardrum
- Barotrauma of the inner ear - dizziness and sudden loss of hearing
Causes and who is at risk
The main reason is impaired patency of the auditory tube at the time of pressure drop. This is why flying with a runny nose is much worse tolerated than in a healthy state. In children, the auditory tube is shorter and located more horizontally, and the adenoids additionally block its mouth, so children complain of ear pain on an airplane more often than adults. For divers, the risk is higher when diving quickly and when trying to dive with a cold.
- ARVI, runny nose, sinusitis on the day of flight
- Allergic rhinitis and swelling of the nasal mucosa
- Adenoids and chronic tonsillitis in children
- Severe curvature of the nasal septum
- Scuba diving, working in a pressure chamber
- Sleeping while the plane is descending - swallowing is less likely
Symptoms
Complaints appear directly during descent or dive and persist after. Typically there is a bursting pain in the depths of the ear, a feeling of a plug and a muffled sound, as if the ear was covered with a palm. Your own voice may sound unusually loud in your head. When fluid accumulates in the middle ear, hearing decreases more noticeably, and when you change the position of the head, a feeling of transfusion appears. A rupture of the membrane usually results in sharp pain, after which it becomes easier, and scanty discharge.
- Fullness and pressure in the ear
- Pain of varying strength, increasing with decrease
- Hearing loss and muffled sounds
- Noise or ringing in the ear
- Sometimes slight dizziness
- Sensation of fluid transfusion when tilting the head
Diagnostics
The diagnosis is made by an ENT doctor during otoscopy: he sees a retracted, reddened membrane, hemorrhages or the level of fluid behind it. An endoscopic examination of the nose and nasopharynx helps to understand why the auditory tube does not work: edema, polyps, adenoids in a child. Hearing is assessed using tuning forks or hearing aids to distinguish between a sound conduction problem and damage to the inner ear. In case of dizziness and severe deafness, the doctor excludes barotrauma of the inner ear, which requires different tactics.
- Otoscopy or otomicroscopy
- Endoscopy of the nasal cavity and nasopharynx
- Checking the patency of the auditory tube
- Hearing assessment and, if indicated, tympanometry
- Examination by a neurologist for persistent dizziness
Treatment and prevention
Mild aerootitis goes away on its own; treatment is aimed at restoring the patency of the auditory tube. The doctor may prescribe vasoconstrictor nasal drops in a short course, rinsing the nose with saline solution, local hormonal sprays for allergies, and if the course is prolonged, blowing or catheterization of the auditory tubes. Antibiotics are needed only when an infection occurs. A ruptured eardrum often heals on its own under medical supervision, but the ear should not be wet. Medicines are prescribed by a doctor; you should not put anything in your ear without examining it.
- Swallow, yawn and drink water more often as the plane descends
- Use gentle blowing with a closed nose without excessive force
- Apply a vasoconstrictor spray 30–40 minutes before a runny nose goes down.
- Give children something to drink or suck on during the descent
- Do not fly or dive if you have a severe runny nose.
- Do not wet the ear or drip drops if you suspect a ruptured membrane
