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During altitude changes, ear pain occurs because which condition exists?

There is no pressure difference

Earwax buildup blocks the ear canal

External air pressure outside the eardrum becomes greater than inside

When altitude changes, the air pressure around you shifts and the middle ear needs to stay in balance with that outside pressure. The middle ear is connected to the back of the throat by the Eustachian tube, which lets air flow in or out to equalize pressure. If the outside pressure becomes greater than the pressure inside the middle ear and the Eustachian tube can’t equalize quickly, the tympanic membrane is pushed inward toward the middle ear. This pressure difference across the eardrum stretches it and causes the familiar ear pain.

Earwax blocking the ear canal wouldn’t explain pain from altitude changes, since the issue is the pressure difference across the eardrum, not a blockage of airflow. If you can help the Eustachian tube equalize—by swallowing, yawning, chewing gum, or performing a gentle Valsalva maneuver—the pressure difference eases and the pain subsides.

The air inside the ear is greater than outside

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