Causes and Symptoms

The eustachian tubes connect the back of the nose to the middle ear and allow air to pass between these two structures so as to equalise pressure. Following a flight particularly when a virus has caused blockage of the eustachian tubes, the sudden rise in pressure during descent can give rise to a build-up of fluid in the middle ear. This can be associated with pain if the rate of descent is rapid. Problems can similarly occur during diving.


It is for this reason patients are advised to chew gum or suck sweets during flight descent. In the vast majority of cases, this middle ear fluid build up resolves without any active treatment but can be facilitated by nasal decongestants and self-inflating the middle ear by pinching the nose and by either blowing or swallowing.

In severe cases, there is such rapid sucking in of the ear drum that it can perforate which is associated with severe pain and bleeding. The perforation however heals completely in most patients.

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