DEAR DR. ROACH: Every time I fly, my ears bother me terribly for weeks. It seems that in the first part of the trip, my ears pop for about an hour after landing but then clear up. On the return trip, as soon as the plane begins to descend, the pressure builds despite swallowing, yawning, etc., and then they plug horribly for two to three weeks, popping on and off and affecting my hearing. I saw an ENT doctor, who just recommended a decongestant, but that didn’t help the one time I tried it.
This spoils any vacation I want to take. Please help. I really want to enjoy life and take a trip. What can I do, and why does this happen? — J.H.
ANSWER: The Eustachian tube connects the middle ear with the back of the throat. It regulates the pressure inside the air-filled middle ear so that you can hear properly across a range of pressures. If it doesn’t work properly, you can feel discomfort as the tympanic membrane (eardrum) bulges out (when, for example you are going up in a plane and the pressure outside the ear is less than inside) or bulges inward (if you are taking a dive underwater).
Yours isn’t working properly. This can happen due to infections, allergies, while pregnant or with a variety of medical conditions. Some people’s Eustachian tubes just don’t work well because of their anatomy.
I do agree with your ENT doctor that a decongestant is helpful. However, in my experience, a decongestant spray is more effective. This is the one situation in which I prescribe Afrin (I have seen too many people use it longer than the three days it should be). But one spray 12 hours before flying and another right before boarding the plane works very well for most people.