Feeling pressure or pain inside your ears may be a sign of an ear infection. But if you have to catch a flight soon, you may wonder if flying with an ear infection is a smart move or not. Will antibiotics help to ease the pain? Is it better to wait for the infection to clear up, and then catch a flight? These questions may pop up if your ears don't feel too good before travelling. Irrespective of the health status, experiencing ear pain or discomfort due to pressure changes while flying is pretty common. So, imagine flying with pain in your ears due to the infection!

What is ear barotrauma or an airplane ear?

Ear barotrauma, also referred to as airplane ear, occurs when there is an abrupt shift in air pressure, particularly on flights, scuba diving or driving up and down hills. "Our middle ear contains a tiny tube, the eustachian tube, that balances air pressure. When this tube becomes obstructed, pressure is built up, leading to ear pain, discomfort or a feeling of popping," says ENT expert Dr Shashidhar TB. It is one of the most common health problems for people travelling by air, according to research published in AIMS Public Health.

Some people experience ear pain while flying. Image courtesy: Adobe Stock

What are the signs of ear barotrauma?

Ear barotrauma has several signs that may show up when the pressure inside the ear is not balanced properly. Common symptoms are:

• Ear pain
• A sense of fullness or pressure in the ear
• Decreased or muffled hearing
• Dizziness
• Sometimes, there is ringing in the ears.
• In some instances, fluid or blood might come out from the affected ear.

One of the most important signs is muffled hearing, where the sounds are dull or fuzzy. "This happens because the eardrum is unable to vibrate normally when the pressure is not equal, and it gets difficult for the sound waves to easily travel through," says the expert. It feels as if your ear is plugged during a plane landing. "People suffering from a cold, sinus or ear infection, or allergy are at greater risk of developing ear barotrauma since their Eustachian tubes might already be swollen or clogged," says the expert.

Can you fly with an ear infection?

It's usually not good to fly with an ear infection, particularly if it is in the middle ear. A study, published in Clinical Evidence, showed that even without an ear infection, around 10 percent of adults and 22 percent of children might experience changes in their eardrum after flying.

During a flight, air pressure in the cabin is rapidly changed on takeoff and landing. "In a normal ear, the Eustachian tube would usually equalise this pressure in your ear. But when you have an infection in the ear, the tube may be blocked or swollen from fluid accumulation or inflammation," explains the expert. This also makes it difficult for the ear to acclimate to pressure changes, causing immense pain, a clogged sensation, or even eardrum damage.

If you travel by air with an infection, you can get more pain than normal. Pain may increase, and there's a higher risk of ear barotrauma, in which pressure hurts the ear. "Kids are particularly at risk because their Eustachian tubes are smaller and easier to clog," says Dr Shashidhar.

Flying can affect both ear barotrauma and different types of ear infections, such as middle ear infections, which are otitis media. "It's not only barotrauma that causes problems with air travel, any condition of the ears with inflammation, fluid accumulation or blockage within the ear is exacerbated with pressure shifts in the airplane," says the expert.

Outer ear infections not as susceptible to pressure changes, but the air in the cabin can be dry, which can irritate the ear canal and worsen the symptoms. "Middle ear infections are the most likely to result in severe discomfort when flying since they affect the part of the ear directly affected by pressure changes," says the expert.

Can you fly with an ear infection on antibiotics?

These infections usually clear up on their own, but sometimes they can last longer than 2 to 3 days, and so antibiotics may be given, as per the US Centers for Disease Control and Prevention.

Flying with an ear infection on antibiotics varies with how bad the infection was and how well your body is responding to the medicine. "Antibiotics decrease swelling and eliminate the infection, but the Eustachian tube can still be blocked in the early days," says Dr Shashidhar.

When the tube is not completely open, pressure changes on the flight still cause ear pain or discomfort. It is safer to wait for a few days after initiating antibiotics, preferably until ear pain reduces.

Wait for the infection to clear up before flying. Image courtesy: Adobe Stock

How to treat ear infections?

Here's how to treat ear infections:

• Warm compress: Place a warm washcloth on the infected ear for 10 to 15 minutes. This may decrease pain, increase blood flow, and relieve pressure in the ear.
• Antibiotic ear drops: "Mostly used for outer ear infections, these drops kill bacteria and minimise inflammation," says the expert. Use them only when prescribed by a doctor.
• Oral antibiotics: For infections of the middle ear, antibiotics are given if there are more than 2 to 3 days of symptoms or a severe infection, particularly in kids.
• Keep ears dry: Moisture can worsen ear infections. "Do not swim, and use earplugs or cotton balls while bathing. Keeping ears dry helps speed up healing and prevents further irritation," says the expert.

An ear infection can cause a lot of discomfort. So, it is better to wait until the infection is completely cured before travelling by air. Resting, adequate medication, and keeping ears dry can help recovery, and make flying more comfortable.