Ear Infections: Is it safe to fly?

My 15 month old son has his first ear infection. He was given amoxicillin a few weeks ago, and he was fine. A few days ago he started getting diarrhea and started screaming with pain. He was given a different antibiotic with a concentrated 5 day dose. The reason he was prescribed the latter is because my wife is planning to fly to Florida for 2 weeks with my son. He is now back on amoxicillin. My question is, is it safe for him to fly?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Ear infections occur in the middle ear which is the portion of the ear that lies behind the ear drum. Ear infections generally occur when fluid builds up in the middle ear and then gets infected with bacteria. Therefore, if the fluid wasn't there, the risk of infection would be lowered quite significantly. Thankfully, the body has a way of draining this fluid called the Eustachian tube. The Eustachian tube connects the middle ear to the back of the throat, so any fluid that builds up should drain down this tube. However, in children, this tube may become dysfunctional for a number of reasons which is why they are more prone to ear infections.

The Eustachian tube has another important function by serving as an equalizer of air pressure between the outside air and the middle ear. When we go to an elevated place such as a mountain or up in an airplane, the barometric pressure drops, air leaves the middle ear through the Eustachian tube, and we feel our ears pop. When we come down from this height, the pressure increases. If you don't open your Eustachian tubes (by swallowing or other maneuvers) to let the air in and equalize the pressure, the pressure becomes too great for the Eustachian tube to open. This may lead to inflammation within the middle ear. This more typically occurs to scuba divers who do not "pop" their ears as they descend deep in the water.

So what does this mean for a child who has an ear infection with probable poorly functioning Eustachian tubes? If the Eustachian tube is completely closed, the child will most likely experience no symptoms on the plane ride. Because the tube is closed, no pressure changes will occur on the way up or down. If, however, the Eustachian tube is partially open, the child may experience problems upon descent of the plane in the form of a dull ache within the ears due to difficulty opening the Eustachian tube to equalize the pressure.

There do not seem to be any serious or long-term effects on the infected ears of children who take an airplane ride. Most commercial planes are pressurized to an altitude of 7,000 feet which allows for relatively minimal change in pressure when going up or down. At best, your son will experience no symptoms due to his Eustachian tubes being completely closed. At worst, he will have increased difficulty intermittently opening his Eustachian tubes upon descent of the plane and experience some discomfort on the way down. To help facilitate frequent opening of the Eustachian tubes, I suggest your wife offer him frequent drinks or snacks as soon as the plane begins its descent and continue this until landing if possible. Swallowing, will help open the tubes, and if done often enough, your son will never be the wiser. It often takes a half an hour or longer for the plane to make its full descent, so your wife should try to plan accordingly.

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