One unpleasant side effect of air travel is ear problems. In-flight clogged ears are caused by the difference in air pressurebetween the middle ear and the pressurized atmosphere on the plane. The problems can start as the plane climbs to its cruising altitude, but most commonly occur once the plane starts its descent. You may develop a ringing in your ears, experience ear fullness or difficulty hearing, and possibly become dizzy. The most severe cases result in excruciating pain and even rupture of the eardrum.
The medical name for this condition is barotrauma of the ear, also known as barotitis media or aerotitis media. According to a paper in the Journal of Applied Physiology, some 5 percent of adults and 25 percent of children who fly get clogged ears. But estimates vary greatly, with some sources reporting that as many as 20 percent of adults and 55 percent of children experience this pain. In fact, clogged ears are considered the most common medical condition among air travelers, according to a review article in the Journal of Laryngology & Otology.
Why do your ears clog on the plane?
The air-filled middle ear (which sits behind the eardrum and includes three tiny bones that are vital in hearing) is connected to the external environment by the Eustachian tube. This narrow channel runs from the middle ear to the back of the nose. See a diagram of the ear.
Normally, as you swallow, the Eustachian tube equalizes the pressure between these two areas. But with air travel, the environmental pressure of the plane’s cabin changes so rapidly both on ascent and descent that the Eustachian tube may not be able to keep up. The result: a pressure difference between the airplane cabin and the middle ear. Those most likely to have difficulties include infants and children, people with colds or allergies, or people whose Eustachian tubes don’t work efficiently.
There are a number of things you can do to unclog your ears during a flight, but many air travelers are not aware of these techniques. In a survey of air travelers published in 2014 in the Journal of Laryngology & Otology, while 84 percent of participants reported experiencing ear symptoms, 30 percent were unaware that there was any way to prevent the pain—let alone that there were a variety of easy, effective ear-clearing techniques they could do right in their seats.
Do-it-yourself techniques to clear your ears
Three active maneuvers may help you avoid or reduce ear pain when flying, particularly during the descent, when pressure changes are likely to be the most problematic for your ear. If you do any one of them correctly, you will feel and hear your ears "pop." Whichever maneuver works for you, it may have to be repeated many times during the descent to keep your ears clear. And you have to do it as soon as the plane starts descending; wait too long and it will be difficult if not impossible to clear your ears. (For this reason, it’s important to make sure you’re awake when the plane starts its descent. If you like to sleep during flights, set an alarm on your phone or ask your travel mate to wake you up.)
The Valsalva maneuver. Take a deep breath, pinch both nostrils shut with your fingers, close your mouth, and attempt to exhale through your closed nose. Don’t be overly zealous with this maneuver, as there is an off-chance that you could rupture your eardrum.
The Toynbee maneuver. Pinch your nostrils shut and close your mouth while swallowing. (Sipping water makes this easier.)
The Frenzel maneuver. Pinching your nostrils shut while making a "k" sound.
You can also try "passive techniques" such as yawning, chewing gum, sucking on lozenges or hard candy, or swallowing frequently (again, sipping water can help). These all help keep the Eustachian tubes open. Though there are no studies comparing these measures, they may work better on the ascent than the descent.
Devices to unclog your ears
If self-help techniques aren’t enough, you can buy special earplugs with a regulator (often ceramic) designed to slow the flow of air—and, therefore the pressure changes—between the environment and your ear. Although there isn’t clear evidence that these types of earplugs work, they're inexpensive (about $6 to $9 a pair) and there’s no harm in trying them. They’re sold online, in drugstores, and at airport shops under a variety of brand names.
Another type of device to unclog ears mimics the Valsalva maneuver (see above) and can be useful for people—especially children—for whom that maneuver is difficult to do. It consists of a nozzle that you insert into one nostril and a balloon that you attach to the other end of the nosepiece. While pinching the other nostril closed, you attempt to blow up the balloon with the first nostril until it's the size of a grapefruit. One well-known brand is Otovent. An older Danish study in the Journal of Laryngology and Otology found that children were significantly more likely to successfully clear their ears using Otovent than with the Valsalva maneuver.
A third type of device works on the opposite principle as the Otovent. With one nostril closed and the device inserted into the other, you push a button that sends puffs of air up your nasal passage, helping clear your Eustachian tube while you swallow. Brand names include EarPopper and Eustachi. Both can be purchased online (the EarPopper requires a prescription in the U.S.).
Medications to prevent clogged ears
If you know you have problems with your ears when you fly, you can try nasal or oral decongestants, which shrink mucus membranes, including those of the back of the nose and Eustachian tubes. An older (1998) study in the American Journal of Emergency Medicine recruited a small number of subjects with a history of ear pain during air travel. Those who took an oral decongestant containing pseudoephedrine half an hour before departure were significantly less likely to have ear symptoms than those using a nasal-spray decongestant, which was not much better than a placebo. Since the descent is hardest on ears, take the oral decongestant an hour before descent.
For people with nasal congestion from allergies, antihistamines may also help prevent ear pain during flights, since they help shrink swollen mucus membranes.
Originally published July 2016. Updated January 2019.
Also see How to Avoid Getting Sick on a Plane.