Q. We're flying cross-country in a few days to visit my parents, but my baby was just diagnosed with an ear infection. Is it okay to fly, or will the cabin pressure make her ear infection worse?

A. Usually, doctors ask parents to use caution when flying with an infant or child suffering from an ear infection, and this is because the normal air-pressure-regulating system in the middle ear can be affected. The fluid that clogs the Eustachian tube during an infection may prevent its normal opening during changes in cabin pressure and, theoretically, may increase discomfort. That said, based on the severity of the infection and unless you're advised otherwise by your child's doctor, it's usually okay to fly.

Here's a short primer on ear infections: The Eustachian tube extends from behind the eardrum to the back of the throat. Normally, this tube is open, which allows the air pressure to equalize on both sides of the eardrum. However, an ear infection causes fluid to collect behind the middle ear and in the Eustachian tube, clogging them up so that pressure can't be equalized. This is also known as Eustachian tube dysfunction. During air travel you may have experienced some ear discomfort (especially during landing), prompting you to yawn, chew gum, or try other methods to "pop" the Eustachian tube open to relieve the pressure and discomfort. While your baby can't use these relief methods, she'll probably cry due to ear discomfort. This is good  -- the act of crying and its associated jaw movements may open the Eustachian tube. You can also try these tricks to lessen your child's discomfort:

Follow your doctor's advice. Give your child's medication exactly as your doctor prescribes, even if she seems back to her healthy self after a day or two on the medication. Also, don't be alarmed if your doctor says her eardrum has "ruptured." This simply means the fluid collected behind the middle ear has leaked through the eardrum. In fact, rupturing of the eardrum during an infection relieves the pressure and discomfort on the middle ear and theoretically, there should be less discomfort during flying. This is also why you may see some drainage from the ear following an infection. Also, be sure to inform your doctor of your travel plans within a few days after the infection in case further advice is needed.

Keep the nose clean. A few days before travel, do your best to keep your child's nasal passages clear. Every few hours, or as often as needed, squirt saline nasal spray (available over-the-counter or make your own by mixing ¿ teaspoon of salt to eight ounces of water) into your child's nose and gently suction it out or have her blow it out if she's old enough to follow directions. Also, take her into a steamy shower so she can breathe in the moist air. These measures keep the nasal passages clean, which is also likely to keep the Eustachian tube clear.

Use Eustachian tube exercises during landing. Changes in air cabin pressure usually do not affect the ears during take-off, but rather during landing. If your child is sleeping when the plane starts to descend, wake her up (this is usually the only time you should wake a sleeping child). Encourage her to talk and open her mouth widely. Try to yawn yourself to show her how to pop the Eustachian tubes open, and encourage her to blow up a balloon or blow bubbles through a straw into a glass full of water. If she's old enough, have her hold her nose and blow. Finally, if she's still breast- or bottle-feeding, feed her during landing, as the act of sucking will also help.

What about decongestants? Don't bother! While they may be of some value in relieving nasal congestion caused by allergies, studies have shown that decongestants and antihistamines are of no use during ear infections.

Enjoy your trip!

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