Risk factors that may increase the need for an intervention:
(1) history of barotrauma
(2) upper respiratory tract infection
(3) active allergies
(4) ENT abnormality
Infants or children who are asleep should be awakened and set upright prior to descent (Wolf).
Simple nonpharmacologic intervention:
(1) yawning
(2) swallowing
(3) chewing (gum, food, etc)
(4) performing a Valsalva maneuver (pinching the hose and blowing, other)
Complex nonpharmacologic intervention:
(1) inflating a nasal balloon (Otovent)
Pharamcologic intervention:
(1) decongestant (pseudoephedrine): 30 minutes prior to flight, with repeated dose if the flight is long relative to the drug's half-life
(2) analgesic
Most mechanical interventions should be used during descent when pressure changes are more likely to develop. Some patients may experience a delayed onset of ear pain.
