Ears, sinuses and the descent: the pain nobody warns you about, the cold you should not fly with, and what actually helps
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#1 Bristol, eight years, and I flew with a cold in my first year and could not hear properly for three days and thought I had done permanent damage. I had not, but I learned. Here is the ear and sinus thread, because every new joiner does what I did.
What happens
On descent the cabin pressure rises and the air in the middle ear has to equalise through the Eustachian tube. If the tube is blocked (a cold, sinusitis, allergies), it cannot, and the pressure difference pushes on the eardrum. It hurts, sometimes badly, and in the worst case the eardrum can be damaged. It is called barotrauma and it is the most common medical issue crew have and the least discussed.
The cold you should not fly with
A blocked nose that does not clear with a decongestant. Sinus pressure you can feel when you bend forward. Anything with a fever. The rule at most airlines is that a crew member who cannot clear their ears should not operate, and the sick call for a cold is a real sick call, not a soft one. The crew who push through are the ones with the three day deafness and, occasionally, the perforation.
What actually helps
Swallowing, yawning, the Valsalva (pinch the nose, gently blow) on descent, early and often, before the pressure builds. Not one big one at the bottom. Small ones from top of descent. A decongestant taken an hour before the descent, if you are only slightly blocked, and only the kind your airline's medical department is fine with. Chewing gum, which is not magic but keeps you swallowing. Staying hydrated, because dry tubes are stubborn tubes. And the special ear plugs with the filter, which some crew swear by and some find useless.
The long term
Crew who fly with colds repeatedly get chronic problems and the ENT waiting rooms have a lot of us in them. The crew who call in sick for the bad colds are the ones with normal hearing at 50. That is the trade.
The question
What has worked for you, and what did you learn the hard way?
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#2 Six sectors a day means six descents a day and the ear management is a skill you learn or you suffer. Small Valsalvas from the top, every time. A cold is a sick day for me now, without guilt. Learned it the hard way in year one, same as Claire.
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#3 ATR, unpressurised to a lower cabin altitude but faster descents into the islands, and the ears are the whole job in winter. Chewing gum is in my pocket at all times and the filtered plugs work for me, for what it is worth. Every crew member is different.
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#4 Ex ER nurse, and the decongestant point matters: some of them are not permitted at some airlines because of the drowsiness, and the medical department has a list. Ask before you take anything. A perforated eardrum is weeks off flying and it is preventable with a sick day.
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#5 @cassieatl the list from the medical department is the thing I should have mentioned. Ask, do not assume. Thank you.
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#6 Training, and the first aid block covered barotrauma for passengers and not for us, which is strange now that I read this. Small Valsalvas from the top. Saved.
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#7 Fourteen years and I have had one perforation, in year three, from flying with a cold I should not have flown with. Six weeks on the ground. I have called in sick for every real cold since and I will not apologise for one of them.