Both pilots and cabin crew are generally paid hourly only for hours flown. This can vary by airline. I have flown twice with pilots who were almost incapacitated with pain from ears or sinus that would not clear so I was effectively solo in a large jet. The pain usually doesn't get really bad until you are at fairly low altitude like 5000 feet or so. Unfortunately this is when pilot's workload is the highest. Cabin crew are usually not as busy then and can take time to use nasal spray or whatever to try and get some relief.