Remember chewing gum for your next flight

So there you are, finally on the airplane, flying off for that long awaited vacation. And you’re pooped, because you’ve been working your tushy off getting everything in order, just so you could get away. You’re so exhausted, in fact, that you fall fast asleep (no mean feat in an airplane seat) and snooze right through the beverage service, the offer to buy a box of something, and the in-flight movie. You sleep so soundly, in fact, that you don’t wake up until the plane touches the ground, and instead of the pleasure of arriving, you feel a searing pain in your ear, along with the unpleasant realization that you can’t hear much out of the afflicted ear.

You try to yawn. You thrust your jaw out and move it this way and that. You try holding your nose while exhaling into the blocked passages. Nothing works. Slowly the pain ebbs, not quite going away and you still can’t hear much out of that ear.

What’s happening?

You’ve got barotitis. “Baro” for pressure, “itis” for inflammation. It all has to do with the pressure changes the ear was subject to while you slept soundly, paying no attention whatsoever.

Airplane cabins are pressurized so we can breathe at 28,000 feet, but they’re not pressurized to sea level. Rather, the air pressure is closer to what we’d experience in the mountains, at 7,000 or 8,000 feet. During the plane ride, the middle ear slowly (and painlessly) adjusts to the lower cabin air pressure. The pain you’re feeling is the pressure of the ground air, wherever you’ve landed, pushing on your eardrum. The poor eardrum can only stretch so much before it starts to complain.

Ordinarily, the middle ear is at the same pressure as the outside world. This pressure equalization comes about because of the work of the Eustachian tube, a one and a half inch long tube that connects the middle ear to the nasal passages.

The tube is closed in its usual state. Whenever the pressure gets a little unequal, like when you are driving down from a day’s skiing, a good yawn will lead to that familiar “pop.” The yawn moves a muscle that opens the tube, letting a small amount of air in, and all is well.

When the airplane is climbing, the pressure is falling on the outside of the eardrum, so the middle ear pressure is higher. This doesn’t cause the same pain, and gentle swallows let out small puffs of air, equalizing the pressure. You hardly notice.

Descending is another matter. This time, the air pressure outside the middle ear, on the outside of the eardrum, is higher than inside the middle ear. The increasing air pressure causes the Eustachian tube to collapse. A vigorous yawn or active gum chewing can open up the tube, but only if you stay on top of the process. If the pressure gets too high, the tube collapses completely, and it’ll be tough to get it to open up.

Then what? Well, it hurts. That elevated pressure against the eardrum causes inflammation and congestion in the tiny blood vessels feeding the eardrum. That congestion can lead to fluid buildup in the middle ear that helps to equalize the pressure, but the fluid can make the hearing loss in that ear last a week or two until the body reabsorbs it.

The best way to treat barotitis is to avoid it in the first place. This is where chewing gum comes in handy, keeping the jaws moving. And since allergies or a cold can increase the risk of getting barotitis, it’s not a bad idea to take a decongestant before you fly if you have the sniffles. A decongestant can sometimes help after the fact as well.

But if you’re the one who slept through the flight, not to worry. Generally barotitis resolves within a day or two, and you’ll forget it ever happened. Just don’t forget the chewing gum on the return flight!