Dr. Greene, I am flying with my 3 month old. I heard that it can damage the baby’s hearing. Is that true? What can I do to help soothe her during take off and landing?

Flying can cause pain in babies’ ears, and it can temporarily reduce hearing, but it is not a cause of permanent hearing loss.

The pain results from stretching of the eardrum caused by pressure changes. As the airplane takes off, the air inside the airplane gets thinner. Most airlines pressurize their cabins to blunt this effect, but still the pressurized cabin is equivalent to air at an altitude of about 7,000 feet. The air in the middle ear space expands along with the air in the rest of the cabin. As it expands, the air is easily forced through the eustachian tube, a floppy tube that connects the middle ear to the back of the throat. The eustachian tube automatically opens from the pressure. As long as there is no active, complete obstruction of the eustachian tube, the excess air exits the middle ear with a popping sensation but little or no pain. Again, during ascent this process is spontaneous.

During descent, as the air pressure rises, the middle ear space needs extra air to re-equilibrate the pressure. It tries to suck air back in through the floppy eustachian tube. However, during descent, the eustachian tube does NOT open spontaneously. A tiny muscle pulls open the eustachian tube only during swallowing, yawning, or crying. In children, this mechanism is less efficient than in adults. The rising pressure stretches the eardrum inward and can cause pain and decreased hearing until air rushes into the middle ear space and the ears “pop”.

The next time you hear a child crying during an airplane’s descent, remember, this is one instance where crying itself helps to solve the problem.

Giving your daughter something to drink can comfort her and prevent some of the eardrum stretching. This is especially important throughout descent. Giving her acetaminophen just before the flight (and repeating it every 4-6 hours) may not prevent the eardrum stretching, but it can prevent discomfort. Children who are congested or who are a bit older might benefit from an antihistamine and decongestant before the flight, but certainly talk with your doctor before giving either to a baby so young.

With these simple precautions, you and your baby can both make the most of your flying adventure. Bon voyage!