Flying with an Ear Infection: Risks, Barotrauma Prevention & When to Cancel

Flying with acute otitis media (AOM) or otitis externa is strongly discouraged. Cabin pressure changes (descent) can cause severe pain, tympanic membrane rupture, or inner ear damage.

Pathophysiology

Eustachian tube (ET) dysfunction prevents middle ear pressure equalization. Negative middle ear pressure on descent → TM retraction, hemorrhage, perforation. Ascent: gas expansion usually vents passively.

If Travel Is Unavoidable

• Pre-flight: Oral decongestant (pseudoephedrine 60 mg) 1 hr before; topical oxymetazoline 30 min before descent. Avoid in uncontrolled HTN, CAD, MAOI use.
• During Flight: Valsalva maneuver (gentle), swallowing, yawning, chewing gum. Stay awake for descent.
• EarPlanes®/EarPopper®: Pressure-regulating earplugs or auto-inflation device.
• Analgesia: Acetaminophen/ibuprofen preemptively.
• Pediatrics: Bottle/pacifier during descent; avoid decongestants <6 yrs.

Absolute Contraindications

• Recent tympanostomy tubes (check with ENT).
• Active mastoiditis, labyrinthitis, or perilymph fistula.
• Recent otologic surgery (<6 weeks).

Best option: Reschedule until infection resolves and ET function normalizes.