Having spent five days at high-altitude (at 3,500 meters above sea level), I caught a slight cold and a runny nose. Usually the advice from doctors is that you shouldn't fly when you have a cold because your ears are more susceptible to be blocked. On a short-haul flight from Jiuzhaigou to Shenzhen (via Chongqing), my eardrums took some battering during decent and they just became totally blocked. I couldn't hear anything.
For the first leg of the flight, I felt pretty good at altitude, however when it was time to descend into Chongqing, I experienced the worst ear pain ever. I couldn't hear anything. My head felt as if it’s in a vase, and descending increased the pressure more. Why did this happen?
The key way to learn this is to know that a human head has holes in it. These holes include the eight major sinuses, which are paired in either cheek, the forehead, between the eyes, and a deeper pair far behind the eyes. Each cavity holds anywhere from a milliliter to four or five tablespoons of air. Inside our heads, each of our sinus cavities "communicates" with - has an opening to - the nose. This opening, however, is quite small and may be only one millimeter across. Under normal circumstances, this opening is large enough to let air travel freely between its sinus and the lining of the nose. As we gain altitude, the air pressure around us drops so, the pressure inside our sinuses is higher than the outside.
The sinuses don't expand like a balloon does because air flows through the communicating channel to the nose, thus equalizing the pressure. The reverse happens on descent. However, the big problem here is that if we have a cold or other upper respiratory infection, the mucous membranes that line the inside of all our airways, swell and become inflamed. When this happens, the tiny communicating channels can easily become blocked. Then, pressure in the sinuses may be great enough to force air out through a narrowed channel, taking bubbling bits of mucous with it. That causes the squeaking sound we hear as the pressure equalizes. This swelling and inflammation acts like a flapper valve. It lets air out, but it doesn't let air back in.
The pain was excruciating- it felt like the end of the world. To open the Eustachian tubes under normal circumstances, use the Valsalva maneuver. I did what you should do- that is to pinch my nose shut, close my mouth, and tried to exhale gently through my nose. It should have forced the pressure into both ears and I should have felt my eardrums pop. It sadly didn’t work.
The pressure differential - increasing ambient pressure causing low pressure in the sinuses - can be so great that the sinus lining literally can be ripped right off the bone.
For the eardrum to vibrate properly, air pressure on both sides has to be equal. The Eustachian tube connects the middle ear to the back of our throat.
As we gain altitude, air can spontaneously bubble out of the middle ear. The small muscle in the back of the throat acts like a flutter valve. During descent, the muscle must hold our Eustachian tubes open, which allows air to pass through them and equalize the pressure in our middle ears. If we can't do this, the outside pressure can push the eardrum inward enough that it might rupture. And, that’s exactly what happened to me. A ruptured eardrum will usually heal on its own in two to three weeks. But I didn’t have the luxury of waiting two or three weeks at the ground. My next flight was to Kuala Lumpur in two days and then after three days in Kuala Lumpur I was expected to fly to Kathmandu (again at high-altitude), and then after a week in Kathmandu, I had a 12-hour flight to London!
I decided to go and see the doctor in the Accident & Emergency department of the local expat hospital in Shenzhen, and have my ears checked out. The doctor used sound therapy to clear the ears- took less than 10 seconds and cost about US $20. Basically he pushed a tiny pipe into the eardrum and with a couple of ‘bleep’ sounds, the air was cleared. With antibiotics in hand for the next six days, the only piece of advice was: “Navjot, don’t fly for at least two weeks”. I had no choice it seems. Just hoped that it would not happen again!
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