Management of Ear Symptoms During Air Travel

Introduction to Ear Symptoms

The American Academy of Otolaryngology-Head and Neck Surgery recommends encouraging active swallowing during descent, particularly keeping passengers awake during landing, combined with oral pseudoephedrine 120 mg taken 30 minutes before flight departure for adults with recurrent ear pain 1

Patients with partial middle ear fluid are at highest risk for pain during descent, while ears completely full of fluid typically cause no problems, as determined by a tympanogram 1
The American Academy of Otolaryngology-Head and Neck Surgery specifically recommends keeping passengers awake during landing and actively encouraging swallowing to equalize pressure for children with middle ear effusion 1
Frequent swallowing during descent is a helpful technique to prevent ear symptoms 1

Do not prescribe antibiotics, antihistamines, intranasal steroids, or systemic steroids for middle ear effusion or prevention of ear symptoms, as they have no proven benefit and carry unnecessary risks, based on systematic reviews of randomized controlled trials 1, 2

For patients with chronic middle ear effusion, the fluid may persist for months and requires monitoring every 3-6 months until resolution to prevent long-term complications, and these patients should use the preventive strategies above for each flight until the effusion resolves 1