Dear Dr. Donohue: I dread flying. As the plane descends for landing, my right ear gives me severe pain. I have seen an ear doctor, who found nothing wrong. I chew gum, drink water through a straw, yawn and swallow. I pinch my nose shut and blow. I take Sudafed two hours before departure and a nasal decongestant spray two hours before landing. Nothing helps. - F.S.
Dear F.S.: You have done all the maneuvers I have to offer, but tweaking them a bit might help you.
Behind the eardrum is the middle ear, a hollow with three ear bones that transmit sound to the inner ear. If the air pressure in the middle ear isn't the same as the outside world's pressure, the eardrum is pushed in the direction of lower pressure, and that's painful. Upon airplane descent, the outside pressure becomes greater than the pressure in the middle ear. Humans have a tube that connects the middle ear to the throat, called the Eustachian tube. The air pressure in the throat is the same as the outside world's pressure, and this tube allows the middle-ear pressure to equalize with the air pressure in the throat. If the tube is partially blocked, the equilibration can't be effected and the eardrum is pushed inward.
Chewing gum and drinking keep that tube open. Pinching the nose while trying to exhale through a closed mouth opens the tube. Are you doing this correctly?
Taking Sudafed helps, but take it about half an hour before descent, and use the nasal spray at the same time. You can use both before boarding the plane too. They'll help you when the plane gains altitude and the cabin loses air pressure.
Write to Paul Donohue, M.D., P.O. Box 536475, Orlando, FL 32853-6475.