Why Your Ears Hurt on Airplanes — and How to Fix It

Airplane ear — barotrauma, formally — is one of the most common travel complaints, and one of the most preventable once you understand the mechanism.

The mechanism

Your middle ear is an air-filled space behind the eardrum. It connects to the back of your nose through the eustachian tube, a narrow passage that opens briefly when you swallow, yawn, or chew, equalizing middle ear pressure with the outside world.

During descent, cabin pressure rises faster than your eustachian tube can equalize. Relative negative pressure develops in the middle ear, and the eardrum gets pulled inward. That's the fullness, the muffled hearing, and — as the difference grows — the pain.

Descent is worse than ascent for a structural reason: the eustachian tube vents outward more easily than it lets air in. Ascending, excess middle ear pressure tends to escape passively. Descending, you have to actively open the tube.

Preventing it

Swallow, yawn, and chew frequently during descent. Gum, hard candy, or sips of water all work by triggering the muscles that open the eustachian tube.

Stay awake for descent. You don't swallow often enough while asleep. Ask to be woken.

Try the Valsalva maneuver — gently. Pinch your nostrils closed, keep your mouth shut, and blow softly as if blowing your nose. You should feel a gentle pop. Gently is the operative word: forceful blowing can injure the ear. Repeat every few minutes during descent rather than waiting for pain.

The Toynbee maneuver — pinch your nose and swallow — works well for many people and is lower risk than Valsalva.

Consider filtered ear plugs. Pressure-regulating plugs slow the rate of pressure change and help some travelers meaningfully.

Treat congestion before you fly. This is the big one. Flying with a cold, active allergies, or a sinus infection dramatically raises your risk, because an inflamed eustachian tube doesn't open well. A decongestant or nasal steroid before flying may help — check with your provider or pharmacist about what's appropriate for you, particularly if you have hypertension or heart conditions.

Nasal saline during the flight can help keep tissues from drying in the low-humidity cabin, which makes equalization easier.

For children

Infants and young children have shorter, more horizontal eustachian tubes that equalize less efficiently — which is why they're often the ones crying on descent. Feeding during descent (bottle, breast, or pacifier) prompts swallowing. For older children, a drink through a straw or chewing works.

When it doesn't resolve

Most airplane ear settles within hours. See a clinician if you have persistent hearing loss beyond a day or two, ongoing significant pain, drainage or bleeding from the ear, severe vertigo, or ringing that doesn't settle. Occasionally the eardrum perforates or fluid accumulates behind it, and both benefit from examination.

Also worth knowing: if you have a recent ear surgery, a known perforation, or an active ear infection, ask your physician before flying.

Does ear wax matter here?

Indirectly. Wax sits in the outer canal, on the wrong side of the eardrum to affect middle ear equalization directly. But a fully occluding impaction can trap air in the canal and contribute to discomfort with pressure change, and it makes examination harder if you do develop a problem. Travelling with clear canals is simply more comfortable — keeping wax soft with oil drops in the weeks before a trip is a reasonable habit, not an urgent necessity.

FAQ

Why does only one ear hurt?

Eustachian tube function often differs between sides. One tube may be narrower or more inflamed.

Should I use decongestant spray before landing?

Some travelers do, and it can help. Nasal decongestant sprays shouldn't be used more than a few days consecutively due to rebound congestion, and oral decongestants aren't right for everyone. Ask your provider.

Can flying with a cold damage my ears?

It raises the risk of barotrauma and, less commonly, perforation. If you're significantly congested and the trip is flexible, it's worth reconsidering.