The air pressure in the cabin of a commercial aircraft can fall to the equivalent of around 2 500 metres above sea level. This can cause earache for some passengers. The pain is especially likely to be felt if the pressure cannot be fully equalised between the middle ear and the ambient air. And this particularly occurs in people who are suffering from a cold, whose symptoms include a swelling of the nasal mucous membrane and of the passage between the back of the throat and the middle ear, which is known as the Eustachian tube.

The takeoff and climb to cruising altitude are usually less of a problem in earache terms. This is because here the cabin pressure will be gradually decreasing to less than that of the middle ear, and the “overpressure” in the middle ear can be equalised fairly easily via the Eustachian tube.

Landing often presents more of a problem. During an aircraft’s descent, the cabin air pressure will steadily increase; and, as it does, anyone with a cold (and the associated swelling of the mucous membranes) may be unable to adequately equalise the pressure difference between the middle ear and the ambient air via the Eustachian tube. This can result in the pressure in the middle ear being lower than that of the cabin, and this can put painful pressure on the eardrums.

The best way to balance out the pressure in the cabin and in the middle ear is the “Valsalva Method”. Take a breath, pinch your nose, close your mouth and force the air trapped inside you into the back of your throat. This will open your Eustachian tubes, and any differences in pressure should thus be equalled out.

You can also try to prevent the problem occurring in the first place by applying an anti-swelling nasal spray to both nostrils about half an hour before the aircraft leaves cruising altitude to begin its descent. Chewing will also help balance out any pressure difference, as will deliberate yawning.

If you are suffering from an acute or severe inflammatory ailment of the paranasal sinuses or the middle ear, we advise you to contact the doctor treating your condition before you travel and ask them whether they consider you fit to fly.