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Brian J. Buchanan, MD; Jason Hoagland, MD; Philip R. Fischer, MD

Arch Pediatr Adolesc Med. 1999;153:466-468.

Background  Young children often appear bothered by ear pain during ascent and descent while traveling on commercial airplanes. While pseudoephedrine hydrochloride is effective in decreasing the risk for earache in adults with recurrent air travel–associated ear pain, such use in children has not been studied.

Objective  To assess the efficacy and side effects of prophylactic pseudoephedrine in children traveling by air.

Design  A placebo-controlled, double-blind clinical trial.

Subjects and Methods  Children aged 6 months to 6 years were included in this study. Pseudoephedrine hydrochloride (1 mg/kg body weight) or placebo was administered 30 to 60 minutes prior to departure on commercial air flights. Caregivers noted historical details and the degree of apparent ear pain, drowsiness, and excitability with ascent and descent.

Results  Ninety-one flights involving 50 children were studied, with ear pain being reported in 13 (14%) of flights. Ear pain was not associated with a history of air travel–associated ear pain, recent ear infection, or recent upper airway symptoms. Pseudoephedrine use was not associated with a decrease in ear pain during either ascent (4% with pseudoephedrine vs 5% with placebo; P 1.00) or descent (12% with pseudoephedrine vs 13% with placebo; P 1.00). Pseudoephedrine use was, however, linked to drowsiness at takeoff (60% with pseudoephedrine vs 27% with placebo; P = .003) but not at landing (P = .39). Treatment was not associated with excitability at takeoff (P = .09) or landing (P1.00).

Conclusions  Ear pain is not uncommon in children traveling by commercial aircraft. The predeparture use of pseudoephedrine does not decrease the risk for in-flight ear pain in children but is associated with drowsiness.

From the Departments of Pediatrics, University of California, Davis (Dr Buchanan), and University of Utah, Salt Lake City (Drs Hoagland and Fischer). Mr Hoagland is now affiliated with the Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, Ohio. Dr Fischer is now with the Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.

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