Virtual Medical Centre

Staying Healthy During Plane Travel

• How does air travel affect health?
• Cabin air quality
  • Cabin humidity
  • Cabin air pressure
• Ears and air travel
  • How to manage blocked ears
  • Decongestants and nose sprays
• Risk of infection

How does air travel affect health? 

Around 2 billion people travel by air every year. For most, this experience is rarely troublesome; however, travelling by airplane can be a distressing and uncomfortable experience for some people.

Air travel over long distances can expose you to a number of factors that may have an impact on your health and wellbeing. The environmental conditions inside the cabin of an airplane flying at 12,000 metres are vastly different to those on the ground. The plane environment subjects your body to reduced atmospheric pressure, reduced availability of oxygen, relative humidity, noise and vibration. Additionally, there is the risk of acquiring an infection from fellow passengers. Time zone changes can affect performance and enjoyment of your holiday at your destination.

Everyone is affected differently by air travel. People with less than optimal health are at an increased risk of suffering health related problems while travelling on a plane. These may range from minor issues such as dry skin or motion sickness, to more serious ones such as developing a blood clot.

Health risks can be minimised by planning carefully and taking some precautions before, during and after the flight. Some general advice that will help make your in-flight experience more bearable and holiday more enjoyable include:

• Make sure you are as healthy as possible by getting enough rest before leaving.
• An optimal immune system will protect you from catching any colds or other bugs from other passengers.
• Plane food is generally heavily processed and refined, and full of starches and sugar which can make you feel sluggish, so consider taking some healthy snacks such as fruit or nuts.
• Try to avoid alcohol and caffeine, and drink as much water as possible before and during the flight.

Cabin air quality

Effects of cabin air humidity

The humidity in cabin aircraft is usually very low, around 20%, meaning that the air is very dry. Such low humidity can cause dryness of the skin, mouth, nose and other mucous membranes.

Using moisturising lotion on the skin and a saline nasal spray to moisturise the nasal passages can help counteract these effects. For contact lens wearers, using glasses during the flight instead will help prevent the discomfort and irritation of dry eyes.

Effects of cabin air pressure

The cabin air pressure is lower than the air pressure at sea level. The result of this is that less oxygen is taken up by the blood, and gases within the body expand. Healthy passengers adapt reasonably well to these changes, but the very young, the elderly and anyone with a medical condition (e.g. heart or lung disease, anaemia) may not be able to tolerate the lower oxygen level very well. Such passengers can request an additional oxygen supply during the flight.

As the plane takes off, the oxygen in the cabin lowers and your respiratory system adjusts by increasing the rate and volume of breathing. This can make you feel drowsy and you may have difficulty concentrating.

Another consequence of the lower cabin air pressure is swelling or oedema of the legs and feet. Sitting still for extended periods of time leads to the accumulation of excess fluid in the tissue, which may cause the lower limbs to swell. This condition, also known as ‘jet flight leg’, is more common in women over 30 and people with varicose veins. The severity of swelling is related to the cabin temperature and cruising altitude of the aircraft. It tends to become worse the longer the flight and the lower the cabin pressure. Elastic compression stockings applied before the flight can help prevent swelling in those who have recurrent moderate or severe jet flight leg.

Ears and air travel (barotitis media)

As the plane ascends or descends, discomfort may be felt in the ears and sinuses. This is because the pocket of air inside the middle ear is very sensitive to changes in the surrounding air pressure. As an airplane climbs, the pressure in the cabin lowers, causing gases to expand. When the plane is descending, the increasing pressure causes gases to contract. 

Normally as the plane ascends, air escapes from the middle ear, resulting in a popping sensation in the ear. When the plane descends, the air needs to flow back into the middle ear through the Eustachian tube. This action serves to maintain equal pressure on both sides of the ear drum. If it doesn’t happen, the ears and sinuses may feel blocked and painful until the pressure is relieved.

When the Eustachian tube is blocked, the middle ear pressure cannot be equalised, so the air already there is absorbed. This creates a vacuum, sucking the ear drum inward and stretching it. As a result, sound is muffled. If the tube stays blocked, fluid can leak into the area and cause serous otitis. Children have much smaller Eustachian tubes and so are especially vulnerable to blockages.

How to manage blocked ears

Swallowing, chewing and yawning can help relieve some of the pain of blocked ears. Swallowing activates the muscle that opens the Eustachian tube, and occurs more often when chewing gum or sucking on mints. These are good to do, especially before take off and during descent. Sleeping during descent should be avoided because it reduces the number of times that you automatically swallow.

If your ears remain blocked, you can try the 'Valsalva manoeuvre'. This involves pinching the nose and closing the mouth, while trying to breathe out through the mouth. Care should be taken when performing this technique to avoid using too much force. The pressure created by the cheek and throat muscle should be sufficient.

Ear pain is experienced by about 15% of children during descent. Babies cannot intentionally pop their ears, but popping can be induced by giving them something to suck on, such as a bottle or pacifier (dummy). To prevent discomfort while the plane is descending, do not allow them to sleep. Older children should chew gum, or they can be instructed to perform the Valsalva manoeuvre.

Individuals with a cold or ear, nose or sinus infection should avoid flying because the inability to equalise pressure may result in pain and injury. If travel can’t be avoided, applying decongestant nasal drops just before flight and again before descent may help.

Decongestants and nose sprays

Decongestant pills or nasal sprays can be use an hour before descent to prevent blocked ears. Decongestants help shrink the membrane and help the ears pop more easily. Travellers with allergy problems should take their medication at the beginning of the flight.

Decongestant tablets and sprays should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease or excessive nervousness. Pregnant women should consult a doctor before using decongestants.

If your ears will not unblock even after landing, you can continue to use the techniques suggested above. If your ears still fail to unblock and continue to be painful, consult a doctor, who may have to release the pressure by making a small incision in the ear drum.

Risk of infection

The air inside a plane is changed 20-30 times per hour. The cabin air is carefully controlled and most ventilation systems recirculate 50% of the air after it has passed through filters, which trap particles, bacteria, fungi and viruses.

Infections may be transmitted between passengers who are seated near each other when an infected person sneezes or coughs, or by touch. If you are concerned and are sitting beside someone who is ill, you can ask to move to another available seat. Some other measures that can be taken include carrying antiseptic wipes to clean seat handles, and using an antibacterial hand gel to wash your hands.