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Am Fam Physician. 1999;60(6):1835

Maneuvers believed to help prevent ear pain associated with air travel include chewing gum, yawning and swallowing during ascent and descent of the airplane. One study demonstrated that pseudoephedrine and other antihistamines reduce ear pain in adults when the medication is taken 30 minutes before departure. Buchanan and colleagues performed a randomized, double-blind, placebo-controlled study of children to determine if oral pseudoephedrine prevents air travel-associated ear pain in this age group. The authors also evaluated whether pseudoephedrine is more beneficial in children at high risk of in-flight ear pain because of a recent or concurrent upper respiratory tract infection than in children not considered at high risk of in-flight ear pain.

The 50 children in the study were six months to six years of age. Ninety-one flights were eligible, ranging in duration from approximately one to four hours. Excluded from the study were children who had received antihistamines or decongestants within 24 hours before traveling.

The children were randomly assigned to receive oral pseudoephedrine hydrochloride in a dosage of 1 mg per kg or a placebo. The parents were instructed to give their child the medication 30 to 60 minutes before takeoff. The parents also completed a questionnaire that elicited information about their child's history of air travel–associated ear pain, the occurrence of ear infection or symptoms of upper respiratory infection in the past two weeks, and the presence of a runny nose or earache in the 24 hours before the flight. The parents were also asked whether their child had previously experienced ear pain or drowsiness during ascent and descent. The parents ranked these features on a four-point scale, from none to severe. Children with a history of air travel–associated ear pain or current symptoms of upper respiratory infection were categorized into the group at high risk of in-flight ear pain.

Overall, ear pain was experienced in 13 (14 percent) of the 91 flights. On ascent, 4 percent (two of 50) of the pseudoephedrine group and 5 percent (two of 41) of the placebo group experienced ear pain. On descent, ear pain occurred in 12 percent (six of 49) of the pseudoephedrine group and in 13 percent (five of 39) of the placebo group.

In the subgroup of children considered at high risk for in-flight ear pain, 3 percent (one of 34) of the pseudoephedrine group had pain during ascent, compared with 6 percent (two of 31) of the placebo group. With descent, 18 percent (six of 33) of the pseudoephedrine group and 10 percent (three of 29) of the placebo group had ear pain.

Drowsiness at takeoff was reported in 60 percent (30 of 50) of the treatment group and in 27 percent (11 of 41) of the placebo group. The incidence of drowsiness during landing was similar in the treatment and placebo groups (47 percent versus 36 percent).

The authors conclude that pseudoephedrine does not appear to reduce in-flight ear pain in children, including children considered at high risk for ear pain. Pseudoephedrine appears to cause drowsiness, which some parents may consider to be of benefit, although the study did not address the appropriateness of medicating a child before flight. However, the authors point out that if drowsiness is indeed beneficial, perhaps diphenhydramine would be a more consistent and effective agent for inducing drowsiness in children before air travel.

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