Airplanes have been a common means of transportation for people, and those who often take airplanes know that there will be ear pain when flying and landing, and some people will also have tinnitus symptoms. What’s going on here? Let’s take a brief look at the structure of the ear: there is a layer of eardrum between the outer ear and the middle ear, and the middle ear cavity on the inside of the eardrum is called the tympanic cavity. Under normal circumstances, when we swallow or yawn, the air enters the tympanic cavity through the eustachian tube, so that the pressure inside the tympanic cavity is balanced with the pressure in the outer ear and the outside world through the eardrum. The ear pain and tinnitus that occur after an airplane ride are related to the damage to the middle and inner ear caused by the change in air pressure during takeoff and landing of the airplane, which is called ear pressure injury. When the aircraft rises, the external air pressure decreases and the pressure inside the tympanic chamber is relatively high to form a positive pressure. When ascending about 60m (equivalent to a decompression of 0.7KPa), a mild ear swelling can be felt and the tympanic membrane bulges outward. As the height increases, the swelling and bulging of the eardrum become more obvious, and hearing loss occurs. When rising to 150m (2.0KPa reduction in air pressure), a “ticking” sound can be heard in the ear, which is the sound of gas inside the tympanic chamber rushing away from the eustachian tube and entering the nasal cavity. When the air pressure inside the tympanic chamber reaches equilibrium with the external air pressure, the ear symptoms disappear, and the above phenomenon may recur periodically when the flight continues. Aircraft fly at an altitude of 8,000-10,000m, and the air pressure at this altitude is lower than the ground. During the flight, the air pressure inside the tympanic chamber is already lowered, and as the air pressure slowly rises with the landing of the aircraft, the air outside the tympanic membrane will push the tympanic membrane toward the smaller pressure chamber, causing ear pain, a feeling of pressure in the ear and hearing impairment. Since the eustachian tube is closed, outside gas cannot enter the tympanic chamber automatically. Only when swallowing can the eustachian tube be opened and the air pressure inside and outside the tympanic chamber be balanced, the tympanic membrane is reset and the symptoms disappear. This is the best way to balance the internal and external pressure. Some airlines will provide candy for passengers to eat when the plane lands, which is used to relieve discomfort such as earache. As already mentioned, ordinary swallowing and rapid chewing movements allow air to enter the eustachian tube. However, some people’s eustachian tubes do not open as easily and swallowing alone is not enough to get the air pressure in the ear back up quickly. For example, if someone has a narrower than normal eustachian tube, or if there is an obstruction in the eustachian tube, outside air cannot reach or quickly reach the middle ear. In fact, any symptom that produces mucus in the back of the nose can cause obstruction of the eustachian tube, such as increased mucus production and swelling of the mucosa during a cold; congestion and swelling of the mucosa in the nasopharynx caused by allergies; middle ear infections, sinusitis, etc. Negative pressure inside the tympanic chamber can cause blood vessels in the submucosal tissue to dilate and cause serosal leakage or even bleeding, resulting in fluid or blood accumulation in the middle ear. The tympanic membrane itself, as the negative pressure in the middle ear increases, can become invaginated, congested, peeled from the mucosa and fiber layer, or even perforated. However, the air pressure on a civilian airplane is unlikely to cause tympanic membrane perforation. How can I avoid ear pain on airplanes? To avoid ear pain and other complications, patients with respiratory infections, including colds, ear infections, and sinus infections should avoid air travel. However, if you do not wish to change your itinerary due to these, the following points are particularly important: 1. Anything you can do to open the eustachian tube to let air in will help relieve ear pain, such as swallowing, chewing, yawning, and exhaling through your mouth will all work. 2. The most important thing is to stay awake when the plane lands. Only when you are awake can you relieve the earache by various methods; so ask the flight attendants to wake you up before the plane lands! 3. For babies, drinking milk or sucking on a pacifier when the plane lands can encourage them to swallow and prevent earache. 4. Vasalva pinch and puff method: Inhale, then pinch your nose, close your mouth and slowly puff to let the gas enter the eustachian tube, when you can feel the eardrum rise up and hear a muffled “puff” as the gas is pushed into the middle ear. Repeat as long as you feel uncomfortable in your ear until the plane lands. 5. Air pressure injuries to the middle ear should be prevented. When you have a cold, it is advisable to use 1% ephedrine solution in the nose before the flight so that the nasal cavity is clear and the eustachian tube is not occluded. If the symptoms of earache are mild and the tympanic membrane is mildly congested after getting off the plane, the earache can be cured by itself after resting for a few hours or 1 to 2 days. What should I do if my earache symptoms do not get better? If the eardrum is obviously congested and there is fluid in the tympanic chamber, the eustachian tube can be blown open to allow the fluid to escape. At the same time, ultrashort wave therapy can be performed to promote the absorption of fluid. If the fluid or blood does not absorb after treatment, tympanocentesis or tympanotomy is feasible.