Flying and Ears

When is it safe to fly with glue ear or an ear infection?

Most commercial aircraft cabins are pressurised to 6-8,000 feet.

On ascent the air in the middle ear cavity expands as a response to the lower surrounding air pressure. The air is usually either absorbed or is expelled from the Eustachian tube. In normal children minor minor discomfort may occur. In glue ear with the middle ear space completely filled with fluid there is no pain as the fluid is not compressible. In a child with a severe, acute ear infection with an inflamed ear drum there may be pain as the sensitive ear drum is distorted.

During cruise it is usually only the children with inflamed eardrums who feel discomfort.

On descent the air in the middle ear cavity contracts and needs to be replaced for the ears to be comfortable. This is helped by swallowing (hence the sweets given out) and by holding one's nose and blowing. This increases the pressure at the back of the nose where the Eustachian Tube exits. The healthy ear will "pop" as the pressure is equalized. In glue ear nothing happens and in children with acute ear infections the pain may be worse.

Is it safe to fly? I do not advise travel restriction in uncomplicated glue ear. In children who find popping their ear difficult or who have a cold, a topical nasal decongestant should be used at least half an hour before descent. In allergic rhinitis steroid nasal sprays may be helpful. Children with a severe, acute ear infection are usually advised not to fly unless it is imperative. If they do, the usual problem is significant pain. I have never seen a perforated ear drum from flying with an acute ear infection though this is possible (as it is just from the disease). In children with few or mild symptoms of ear infection, flying can be covered by combination analgesics (paracetamol and ibubrufen) and nasal decongestants. Children on modern effective antibiotics usually have normal looking drums within days and should certainly be fit to fly in 3-5 days. A small proportion may still have fluid (glue ear) though this should not limit travel.