I have been travelling to Asia for some time. When I fly internationally now, if I have even slight nasal congestion, I experience severe facial pain as the plane begins its decent. It's not so bad when taking off at the start of a trip (i.e climbing altitude) but when we decend....ouch! It does help a bit if I can keep my nasal passages clear, but if they are clogged, no amount of nasal spray seems to open them up.
I tried those earplanes earplugs to help regulate the pressure. They may have helped a bit but the pain was still quite significant.
Is there anything else I can do to minimize pain on the decent when I have some nasal congestion?
I realize prevention of congestions is the best medicine but sometimes this doesn't seem possible.
Thanks in advance,
Reply: -----------------------
The pain you are describing is related to an air pressure differential that develops between the ambient air pressure and the air pressure inside your sinus cavities. Keep in mind that the sinuses are cavities of varying sizes located within the skull bone. These cavities communicate with the nasal breathing passages through tiny channels known as ostia. When the ostia become occluded the potential for air pressure differential develops. Certain individuals develop such air pressure phenomena routinely during descent on airplane flights due to congenital or acquired anatomic abnormalities in the nasal and/or sinus passages. Others may develop such phenomena only in the presence of upper respiratory conditions associated with nasal or sinus congestion, a situation in which the lining of the sinus ostia and nasal passages is swollen.
A similar problem can occur in the middle ear space causing ear pain during descent. Ear problems in fact are more common than sinus problems during airplane flight presumably due to the greater length of the eustachian tube versus the sinus ostia through which pressure equalization must occur.
The problem more commonly occurs during descent when one is traveling from low pressure at high altitude to high pressure at low altitude. When pressure equalization disturbance occurs during descent, one might consider the air chambers in the middle ear or sinuses to be a vacuum. Occasionally the vacuum effect is significant enough to cause fluid (serum or blood) to accumulate which can secondarily lead to infection in either the ears or the sinuses.
The best solution is prevention. Ideally one is best advised not to travel by air when upper respiratory conditions are present. If this is not possible, then topical and perhaps the addition of systemic decongestants may be helpful. I would suggest an over-the-counter decongestant such as Sudafed at least 1-2 hours before flight. Patients with certain medical conditions such as hypertension, heart arrhythmias, thyroid problems, prostate problems, etc. must use such decongestants cautiously. If such conditions are present I would consult with your family physician before using them. More importantly however, would be the use of topical decongestants such as long-acting oxymetazoline (Afrin) or neo-synephrine nasal sprays 1-2 hours before the flight. I would recommend their use routinely whenever it is necessary to fly when nasal congestion is present. Remember that you should not use such sprays daily for more than 3-5 days in a row to avoid rebound phenomena. It might also be helpful, particularly when significant pain has been a common occurence, to take an anti-inflammatory medication such as ibuprofen 1-2 hours prior to the flight. The same preventative measures also apply for ear problems. The ears are also frequently helped by chewing gum or drinking a beverage during descent.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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