Middle Ear and Sinus Problems

Middle ear and sinus problems occur when pressure imbalances develop between the inside of the ear or sinus cavities and the external environment. This is often experienced during climbs and descents due to rapid changes in atmospheric pressure. The Eustachian tube, which connects the middle ear to the throat, normally equalizes pressure. However, when this tube becomes blocked or restricted, it can lead to severe discomfort and pain. Similarly, sinus cavities can become susceptible to painful pressure build-up when they are unable to properly equalize. [Figure 1]

Figure 1 The Eustachian tube allows air pressure to equalize
in the middle ear. (Pilots Handbook of Aeronautical Knowledge)

Symptoms of middle ear and sinus issues include sharp ear pain, a feeling of fullness in the ears, muffled hearing, dizziness, and, in severe cases, temporary hearing loss. Pilots may also experience sinus pressure, facial pain, and headaches. Blocked sinuses or ear canals caused by colds, allergies, or upper respiratory infections can significantly increase the risk of these problems.

To prevent or mitigate middle ear and sinus problems, pilots should avoid flying with a respiratory infection or significant nasal congestion. During climbs and descents, techniques like swallowing, yawning, chewing gum, or performing the Valsalva maneuver (gently exhaling while pinching the nose and keeping the mouth closed) can help equalize pressure. Additionally, using decongestants or nasal sprays before flying may alleviate congestion, though pilots should consult an aviation medical examiner (AME) before using any medication.

If symptoms persist during flight, the best course of action is to reduce the rate of descent or ascent to allow for gradual pressure equalization. In extreme cases, it may be necessary to level off temporarily to relieve discomfort. Maintaining awareness of personal health and avoiding flight when suffering from sinus or ear issues can prevent severe pain and ensure flight safety.