If a decade ago you’d asked your doctor if young children should fly with ear infections, nasal allergies or bad colds the likely answer was an emphatic no, that flying with these conditions could damage the ears. Today, if you asked, the likely answer is a conditional yes.
1. No studies exist to help make the decision. While saying “no” is prudent, doing so ruins long planned family trips, often unnecessarily. Worse, sometimes it strands families on vacation. The scenario: An infant is cranky and is feverish, or an older child has an earache. They are seen at a medical facility, a diagnosis of ear infection is made, medication is prescribed, and delay in flying is recommended. That delay may be until the pain/fever subside, or until a course of antibiotics is completed, which may be five to ten days.
2. Ear infections are greatly over diagnosed. Especially in emergency care clinics, the kind often found in resorts. Children are often seen by personnel with limited experience in examining screaming, struggling young children, in removing wax from the ear canals to visualize the ear, and in deciding if an infection is present. Not to miss an infection, treatment is prescribed, “to be on the safe side.”
3. Air travel does cause earaches. And possibly more so in young children than in adults. However, millions of children fly each year, many with the conditions described above. Yet my asking hundreds of pediatricians, pediatric ear specialists and physicians in aviation medicine I have yet to find one who has seen a case of permanent damage to a child’s ear from air travel. And no case of such damage is described in the medical literature. If it does occur, it is an extremely rare event.
4. Earaches associated with flying are caused by changes in atmospheric pressure plus the presence of mucus in the nose. As airplanes ascend and descend the changes in altitude also change the air pressure in the ears. Normally, there is no pain; a tube, the Eustachian tube, which connects the middle ear to the upper nose allows air to flow freely back and forth, equalizing pressure. However, if the tube(s) are clogged, with mucus from colds or allergies, the changing pressure may cause pain.
5. Young children who already have ear infections can fly. In fact, they are generally less likely to have pain than children with no infection. The reason: infection generally produces fluid in the middle ear. The fluid replaces the air. No air, no change in air pressure. No pain. Children who have aerating tubes in their ears (to prevent infections) can also fly safely. These tubes connect the middle ear with the outside through the ear canal, equalizing pressure.
6. When infants cry during flight, is it because their ears hurt? Older children complain of earaches during air travel, so presumably infants also experience pain. Their Eustachian tubes are narrow making blockage by mucus more likely. But, in fact, surprisingly few infants cry, considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and often uncomfortable positions and, if they are on a parent’s lap, are disturbed every time the parent moves. They do seem to cry more frequently during descent when ears are more likely to hurt, but that is also the time they are likely to be disturbed.
7. Conventional “wisdom” says to feed infants during ascent and descent, and often during flight. Allegedly, this prevents both dehydration and earaches. However, dehydration is a myth. And, at cruising altitudes, due to the changes in air pressure, the air in the stomach and intestine is already expanded by 20% (giving adults a bloated feeling.) For infants, sucking adds air and food to the stomach, which may cause fussiness and crying. On the other hand, the sucking motion may help keep the Eustachian tubes open. Feed infants no more often in flight than at home.
8. Commonly used remedies given children are of questionable usefulness. Oral antihistamines to reduce nasal secretions/congestion are no longer recommended under any circumstances. Saline nose drops/sprays and drinking lots of fluids to unplug the tubes are ineffective.
9. Preventing ear pain. Pain most commonly occurs during descent. Descent may commence before the captain announces it. Ask flight attendants to inform you when descent begins. Keep infants awake during landings. Sleep reduces the frequency of swallowing. Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) reduces pain. Give about 30 minutes before descent, if indicated.
10. Treating ear pain. Administer acetaminophen or ibuprofen. Teach older children the Valsalva maneuver: blow firmly, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times. Encourage children to swallow. Older children can try chewing gum, sucking on hard candies, yawning, and moving their jaws from side to side, maneuvers that may open the tubes.
You may reproduce this article for your organization. (Many pediatric groups do so.) Two issues per month. We are non-commercial. Our goal: to help parents keep kids healthy/safe for travel/outdoor recreation. Recently quoted in NY Times, USA Today, Travel & Leisure. Author: retired pediatrician, travel medicine expert, journalist.
Karl Neumann MD FAAP CTH