The Cause of In-Flight Ear Pain (Otic-Barotrauma)
Otic barotrauma occurring during air travel involves traumatic inflammation of the middle ear, caused by a pressure difference between the air in the middle ear and the external atmosphere, developing after ascent or more usually descent. The pressure difference occurs because of failure of the eustachian tube to equilibrate middle ear and atmospheric pressures. It is a common problem, presenting with ear fullness, otalgia and deafness. Severe cases may result in tympanic membrane perforation and even round window membrane rupture.
This problem is often suffered by those that have flown without issue many times before. There are over 750 million people that suffer with this ailment.
Due to the fact that some people only suffer when they have a cold etc, the pain can come as a surprise to a lot of people. Everyone is made slightly differently as we all develop at different rates. This means that the Eustachian tubes can often be more narrow on some people and this increases the likelyhood of that person suffering to a greater extent.Any slight congestion will increase this risk.
The actual problem is that the human body can only adjust to altitude(pressure) changes at a certain rate. This rate is determined by the size of the eustachian tubes. The rate of ascent/descent of an aeroplane is usually greater than what the human body can safely deal with.