The bane of many pilots is a tiny, flaccid tube which connects the middle ear to the back of the throat. It's normally closed. In an ascent, the eustachian (pronounced: U-STAY-SHUN) tube opens for a second or two, permitting higher pressure air from the middle ear to flow out, equalizing the pressure inside the ear with that of the cabin (see Figure 1). This process, often accompanied by a slight crackling, is rarely a problem.
On the way down, however, things get tougher. Now there is high pressure on the outside, and low pressure trapped in the middle ear. The collapsed eustachian tube is like a hose with a crimp in it, and it doesn't open as readily as it did when you were upward bound. You're now in the position of trying to force water back into the hose. Any nasal congestion will make the problem a lot worse, since it puts additional pressure on the collapsed tube, making it even more difficult to get it open. If you can't get the tube open, you have what's known as an ear block. Contrary to the belief of some pilots, this is not a hit in the head from an NFL lineman, though if you ever get an ear block, you may well feel like you've got an entire football in your ear.
If you don't equalize the pressure, the results will be somewhere between excruciating and devastating. As the pressure differential builds, your eardrum bows inward, pressing on sensitive nerves. If the pressure differential is too great, the eardrum ruptures. This is not generally considered to be fun by any but the most bizarre of pilots.
The first line of defense against ear block is to stop descending, and even to climb back up to a higher altitude. The lower you go, the greater the pressure differential, and the less likely you will be successful at springing that trapdoor open.
The second thing to do is to swallow, yawn, or tense the muscles in your throat. You might even try a technique called the "Frenzel" maneuver. This involves jutting your jaw forward so that you look something like the comic book character Dick Tracy (Figure 2). Of course, he didn't jut his jaw forward because of a middle ear problem. He did it because is made him look tough. What you're trying to do is straighten the eustachian tube out a bit to give it the best chance of opening and equalizing the pressure (it also helps you look tough which makes it easier to get help from line service personnel).
No go? OK, time for the heavy artillery. What virtually every pilot and flight instructor will tell you to do is perform the Valsalva maneuver, in which you close your mouth, pinch your nose, and breath out in short puffs against the closed nostrils. You might think twice before doing this maneuver. The Valsalva maneuver is potentially damaging, and it's unfortunate that it has been so blithely handed down as the way to clear a closed eustachian tube. Even airline flight attendants will tell passengers to perform the Valsalva maneuver.
What's the right answer? Though almost nobody has heard of it, the Toynbee maneuver is a far preferable way of opening the eustachian tube. The Toynbee maneuver is a variation of the Valsalva maneuver. Both start by closing off the nostrils (pinch them closed). However, in the Toynbee maneuver, instead of blowing against the closed nostrils you simply swallow.
Swallowing with your nostrils closed off has the effect of decreasing the size of the oropharyngeal (mouth and throat) space, much as if you had stepped on one end of an inflated balloon. This increases the pressure of the air in that space on the eustachian tube, and with any luck at all the e-tube pops right open. If not, keep swallowing slowly, but do not blow. You can damage your inner ear, and even when it's successful, the Valsalva maneuver can force unwanted material into the middle ear. Take a tip and Toynbee.
Remember, do NOT fly with a cold or other upper respiratory infection, even a little one. The bad news is that I know you will eventually ignore this advice. The good news is that I know you will probably only ignore it once, because the resulting ear block will be a very memorable experience.
An upper respiratory infection is like standing on the garden hose. The water just doesn't have much chance of getting through. When it comes to your ears, there is no such thing as a ?minor? cold. The least bit of fluid and gunk in your head will compress the eustachian tube and make equalizing the pressure on descent almost impossible.
Now that you know better, share the information with your passengers. Don't subject them to the pain and possible injury of an ear block.
If you do land with an ear block, and it doesn't clear shortly after landing, give your doctor a call. On several occasions?one concerning me, another concerning a passenger?I had to climb back up to altitude to reduce the pain of ear block. A more gradual descent eventually helped relieve the pain.
For more information on this subject, see "Medical Briefing: Don't Fly With A Cold."
Related Articles
