The Eustachian tube (ET) is a dynamic tubular structure connecting the middle ear cavity to the nasopharynx, serving as the sole pathway for ventilation and pressure equalization within the middle ear.
It also facilitates mucociliary clearance, prevents the reflux of sound and fluid from the nasopharynx, and protects against sniff-induced high negative middle ear pressure.
The primary function of the ET is to regulate air pressure in the middle ear, thereby ensuring efficient sound transmission.
Clearance of middle ear secretions occurs via a combination of muscular peristaltic action within the Eustachian tube and the mucociliary escalator.
Any dysfunction of the ET can lead to Eustachian tube dysfunction (ETD), which may manifest as negative middle ear pressure, aural fullness, muffled hearing, hearing loss, popping sounds, tinnitus, otalgia, intermittent sharp ear pain, disequilibrium, and autophony.
Flying with Eustachian tube dysfunction (obstructive) can increase the risk of middle ear damage and, in rare cases, severe inner ear damage. The Eustachian tube connects the back of the nose to the ear, helping to equalise pressure changes. Normally, gentle swallowing, yawning, or ‘popping’ the ears allows the tube to open, protecting the ear. However, when the tube is not functioning properly, pressure equalisation does not occur, causing discomfort.
The most common acute cause of this issue is a cold, which leads to nasal congestion. Some individuals may experience Eustachian tube problems without any other contributing factors.
Saline Sprays
Using saline sprays or rinses a few days before a flight can help clear thickened mucus from the nose. During long flights, saline sprays can also help moisturise the nose, which can become dry due to the aircraft’s air-conditioning.
Intranasal Steroid Sprays
In some cases, particularly where allergies or chronic infections/inflammation are present, we may prescribe a steroid spray to be used in the days or weeks leading up to your flight.
Nasal Decongestant Sprays (Oxymetazoline)
Use 2-3 sprays in each nostril approximately 30 minutes before both ascent and descent. Brands include Drixene, Logicin, and Otrivin.
Pressure-Regulating Earplugs
Earplugs designed to help the ear equalise pressure should be worn during both ascent and descent. A common brand is ‘Ear Planes’, available for both adults and children.
Auto-Inflation Exercises
To help with pressure equalisation, chewing and swallowing during ascent and descent can help, as well as gently ‘popping’ the ears (Valsalva manoeuvre) by blowing out through a blocked nose or puffing out the cheeks. For young children (and anyone for that matter) the Otovent device can be very helpful.
Oral Medications
Under medical advice Pseudoephdrine (an oral decongestant) can be used . [Take 120mg 30 minutes before a flight ]
Similarly on oral steroid such as prednisone can be prescribed, especially in cases of signficant inflammation. It is often used daily for a day or two before the flight.
Interventional treatments
If problems persist despite the above precautions a temporary controlled perforation (myringotomy) can be performed. This is a simple in office procedure using a local anaesthetic spray on to the ear drum. The perforation is likely to stay open for a few days.
For a longer term solution a ventilation tube (grommet) can be placed to bypass the malfunctioning Eustachian tube (generally grows itself out over 6-24 months), but the ear waterproof so precautions need to be taken with water exporuse. In adults this too is usually performed under local anaesthetic in the clinic.
Insertion of collar button ventilation tube under local anaesthetic
Insertion of triune ventilation tube under local anaesthetic
Balloon dilatation of the Eustachian tube is another option but does require a general anaesthetic, albeit briefly. There is no guarantee but high proportion of carefully selected patients experience subjective symptom improvement, including the possibility of diving or flying normally without symptoms with benefits sustained up to 24 months in some cohorts, with the ear remaining waterproof.
