Middle ear barotrauma during flight is a painful disorder experienced by passengers who cannot properly regulate their middle ear pressure in response to the changing cabin pressures during ascent and descent. Previous reports emphasized the important role of poor Eustachian tube function in disease pathogenesis but paid little attention to other moderating factors. Here we describe a mathematical model of middle ear pressure regulation and simulate the pressure response to the changes in cabin pressure experienced over typical flights. The results document buffering mechanisms that decrease the requisite efficiency of active, muscle-assisted Eustachian tube opening for disease-free flight. These include the relative difference between destination and departure elevations and the ratio of maximum tympanic membrane volume displacement to middle ear volume, where greater absolute values require lesser efficiencies for disease-free flight. Also, the specific type of functional deficit is important since ears with a completely obstructed Eustachian tube can be less susceptible to barotrauma than those with a Eustachian tube that passively opens but fails to dilate in response to muscle activity. These buffering systems can explain why some children and adults with poor Eustachian tube function do not experience middle ear barotrauma.