Air Travel Advice for Patients with Prior Acute Otitis Media

Risk Assessment and Prevention Strategies

• Patients with partial middle ear fluid are at highest risk for pain during descent, while ears completely full of fluid typically cause no problems during flight, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
• A tympanogram can help determine middle ear fluid status and stratify risk before travel, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
• The American Academy of Otolaryngology-Head and Neck Surgery recommends keeping the patient awake during landing and descent to prevent barotrauma 1
• The American Academy of Otolaryngology-Head and Neck Surgery suggests encouraging frequent swallowing during descent as the most effective non-pharmacologic intervention 1
• Chewing gum, drinking water, or sucking on candy can facilitate swallowing, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
• For adults with recurrent ear pain during flights, the American Academy of Otolaryngology-Head and Neck Surgery recommends oral pseudoephedrine 120 mg taken 30 minutes before flight departure 1
• The American Academy of Otolaryngology-Head and Neck Surgery advises against prescribing antibiotics, antihistamines, intranasal steroids, or systemic steroids for prevention of ear symptoms during air travel, as they have no proven benefit and carry unnecessary risks 1
• Patients with chronic middle ear effusion should use preventive strategies such as staying awake during landing, frequent swallowing, and pseudoephedrine for each flight until the effusion resolves, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1
• The American Academy of Pediatrics recommends carrying pain medications such as ibuprofen or acetaminophen in hand luggage for immediate access if ear pain develops, and avoiding alcohol before and during the flight, as it can worsen eustachian tube dysfunction 2
• For children with history of AOM, parents should actively wake them during descent and encourage drinking from a bottle or sippy cup, as recommended by the American Academy of Pediatrics 1