The eustachian tube is a membrane-lined tube about the width of a pencil lead that connects the back of the nose with the middle ear and helps maintain balanced air pressure on both sides of the eardrum. The most common cause of eustachian tube blockage is the common cold, but sinus infections and nasal allergies are also usual suspects. A stuffy nose leads to stuffy ears because the swollen membranes in the nose can extend into the eustachian tube and block it. Also, any situation in which rapid altitude or pressure changes occur, such as air travel, riding in an elevator, diving to the bottom of a swimming pool, or scuba diving, can result in barotrauma if you do not have a properly functioning eustachian tube.

The simplest way to help clear your ears—particularly when flying—is to swallow. Yawning, chewing gum, or sucking on hard candy can help, especially just before take-off and during descent. You can also try pinching your nose, taking a mouthful of air, blowing gently (not forcefully) against your pinched nose, then swallowing. You’ll know if it worked when you hear a pop, and your ears feel less plugged.

Babies and children are especially vulnerable to ear blockage because their eustachian tubes are not yet developed and do not work as well adult eustachian tubes.  Plus, babies cannot intentionally pop their ears, but sucking on a bottle or pacifier can help. You and your children should avoid sleeping during descent because swallowing may not occur often enough to keep up with changes in air pressure.

If you have allergies, take your medications at the beginning of your flight. Over-the-counter nasal sprays (Afrin or oxymetazoline)  or decongestants (Sudafed) can also help air travelers to shrink the membranes and help the ears pop more easily. Afrin and Sudafed can be taken about 1 hour before flights to protect the ears.  However, if you are pregnant, or have heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness, consult your physician before using these medications. Extended use of decongestant nasal sprays (Afrin or oxymetazoline) can also cause more congestion than relief, and even result in a type of addiction.  Don’t use Afrin more than 3 days in a row.

If your ears fail to open, or if you are experiencing persistent pain in your ears, seek the help of an ENT (ear, nose, and throat) specialist, or otolaryngologist. They may recommend oral steroids.  Sometimes a small hole can be placed in the ear drum to help drain fluid and alleviate pain and hearing loss.  Other options include inserting small pressure equalization tubes (ear tubes) or a using a balloon to help dilate your eustachian tubes.