The ear is divided into three parts:
1. The outer ear, meaning the part of the ear you can see on the side of the head plus the ear canal leading down to the ear drum
2. The middle ear, meaning the ear drum, ear bones (ossicles) and the air spaces behind the ear drum and the mastoid cavities
3. The inner ear, meaning where the nerve endings are for the organs of hearing and balance (equilibrium).
It is the middle ear that causes discomfort during air travel, and this is so because it is an air pocket inside the head that is vulnerable to changes in air pressure.
Normally, each time (or each 2nd or 3rd time) you swallow, your ears make a little click or popping sound. This is the moment that a small bubble of air enters your middle ear, up from the back of your nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead which connects the back of the nose with the middle ear.
The air in the middle ear is constantly being absorbed by its membranous lining, but it is frequently re-supplied through the Eustachian tube during the process of swallowing. In this manner, air pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is not equal, the ear feels blocked.
Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must function properly, that is, open frequently and widely enough to equalize the changes in pressure. This is especially true when the airplane is coming down for a landing, going from low atmospheric pressure down closer to earth where the air pressure is higher.
In the early days of flying with open cabins and cockpits, this was a major problem for flyers. Today's aircraft are pressurized so that air pressure changes are minimized. Even so, some changes in pressure are unavoidable, even in the best and most modern airplanes. Actually, any situation in which rapid altitude or pressure changes occur creates the problem. This happens when riding in elevators of tall buildings or when diving to the bottom of a swimming pool.
Is a middle ear problem the source of the discomfort during flying?
How do you do the Valsalva Maneuver?
What can the discomfort be minimized?
Would you advise using a decongestant or nasal spray?
When should this be used, and how often?
Would an antihistamine help?
What can be done if ear block is severe and unremitting?
The act of swallowing activates the muscle that opens the Eustachian tube. You swallow more often when you chew gum or let mints melt in your mouth. These are good practices, especially just before and during descent. Yawning is even better. It is a stronger activator of that muscle. Be sure to avoid sleeping during descent, because you may not be swallowing often enough to keep up with pressure changes.
If yawning and swallowing are not effective, the most forceful way to unblock the ears is to do the following: pinch the nostrils shut; take a mouthful of air; using your cheek and throat muscles, force the air into the back of your nose as if you were trying to blow your thumb and fingers off your nostrils. When you hear a loud pop in your ears, you have succeeded. You may have to repeat this several times during descent. This method is called the Valsalva Maneuver and is commonly used by military pilots to equalize middle ear pressure.
Other methods of coping with the problem include the use of the following:
Decongestants and nasal sprays. Many experienced travelers use a decongestant pill or nasal spray an hour or so before descent. That will shrink the membranes and make the ears pop more easily. Nasal spray decongestants are quick-acting agents such as oxymetazoline hydrochloride (Afrin). These are very effective and easy to use.
Oral decongestants include pseudoephedrine hydrochloride (Sudafed) and phenylpropanolamine hydrochloride. These agents effectively reduce mucosal swelling and edema by stimulating alpha-adrenergic receptors. Because they are taken systematically, oral decongestants affect areas that nasal sprays cannot reach. Use of these agents should be started 1 to 2 days before a flight.
Antihistamines. Passengers with allergies may benefit from use of an antihistamine. Newer agents that do not have a sedating side effect are a therapeutic aid for both crew and passengers.