Infection, eustachian tube problems, more could be to blame for plugged-ear feeling
Q: I have a plugged-left-ear problem. It usually starts about 4 p.m. and lasts about three to four hours. I cough, clear my throat, yawn, close my nostrils and blow — nothing seems to help.
A: It seems like you’ve had this problem for a while, so my first suggestion is to see a doctor and start the process that would lead to a diagnosis and proper treatment.
The diagnosis of almost any ear problem starts with a few basic questions. One of the most obvious is also one of the most important: Have you lost any hearing? Sometimes people experience hearing loss as a plugged-up feeling, so some tests may be necessary to sort that issue out. Doctors also ask patients with ear complaints about dizziness, pain, ringing in the ears, or fluid discharge. The answers help steer testing and other diagnostic detective work. Ear problems with dizziness — the room-spinning kind that’s the main feature of true vertigo — might merit investigation into whether someone has Meniere’s disease, a rare condition caused by an imbalance of fluid in the inner ear. Ear pain is a good clue that the problem is a middle ear infection. Ear pain with a moist discharge is a common symptom of swimmer’s ear.
The eustachian tube helps keep the air pressure on both sides of the eardrum equal. When it’s not working well (inset), the air pressure in the middle ear drops, so the eardrum gets pushed in by external pressure.
Other important questions: Are both ears affected or just one? Did the symptoms come on suddenly or gradually? Do they persist or come and go?
Your ear may feel plugged up simply because it is — with earwax. I can’t explain the regular late-afternoon onset, but earwax blockages can wax and wane (forgive the pun!). They can get worse after a shower, for example, because the wax soaks up water. As tempting as it might be, don’t try to remove earwax yourself. Cotton swabs and pencil erasers can break off in the ear canal, which isn’t the straight passageway that it appears to be from the outside but one that bends and narrows. Let a doctor take a look.
Another possibility is that you have eustachian tube dysfunction. You can’t see the eustachian (pronounced you- STAY-shun) tube; it’s entirely inside your head, connecting the middle ear to the nasopharynx, the area at the very back of the nasal cavity near where it joins the throat. In adults, the eustachian tube is a little over an inch long and runs forward and downward from the middle ear to the nasopharynx. It’s made of cartilage and bone and is lined with a moist, mucous membrane.
Normally, the eustachian tube helps equalize air pressure on either side of the eardrum by allowing air to flow in and out of the middle ear. If it gets blocked, then there’s less pressure in the middle ear, which creates a little suction, so the eardrum gets pulled inward. This causes a full, plugged feeling in the ear and also makes the eardrum less able to vibrate, so hearing will seem a little off. If the blockage is severe and lasts awhile, the low pressure in the middle ear can pull fluids out of the surrounding tissue and blood vessels, so the middle ear fills up with fluid.
A cold or allergies can cause the lining of the eustachian tube to swell shut. When the air pressure is changing rapidly, as it does when you’re in an ascending or descending airplane, your eustachian tubes must function well to keep the air pressure on either side of the eardrums the same. When you blow out with your mouth closed and your nostrils squeezed shut to “pop” your ears, you’re forcing air up the eustachian tubes and bringing the air pressure back into equilibrium.
Some people have eustachian tubes that don’t function very well, so they get the plugged-up ear sensation rather easily from a cold or during airplane travel or without any apparent precipitating event. This may be your problem.
Bad cases of eustachian tube dysfunction can be treated by inserting little plastic tubes into the eardrum to aerate the middle ear from the external ear canal, rather than depending on the eustachian tube to do the job.
If the plugged-up feeling is constant and is affecting only one ear, then a doctor needs to check the opening of the tube in the nasopharynx to make sure it isn’t blocked by a cancerous growth of some kind.
If the plugged-up feeling comes and goes, then what can you do? While there’s no real proof that antihistamines or decongestants help, I tell patients to feel free to try them if they wish.
Patulous Eustachian Tube vs. ETD
Sorry for this long post but I am desperate. I can’t seem to find any mention in this ETD section about anyone diagnosed with Patulous Eustachian Tube (PET). I do have seasonal allergies and have had sinus surgery twice. The 2nd surgery in 2011 solved my sinus issues. My ear fullness, muffled hearing, and head pressure started abrubtly in Aug 2017. I have never previously had any ear or eustachian problems in my life. My ENT tried many things including decongestants, steroids, nasal steroid sprays, saline spray and rinses, antibiotics, diuretics, allergy shots, hearing tests, and an MRI on my head and neck to rule out the big bad stuff. He finally gave up and told me he was convinced I had TMJ. Had TMJ surgery that was both “diagnostic and therapeutic” at Emory in Atlanta, GA IN Aug 2018. TMJ specialist was honest and said he thought he might have proactively fixed some potential problems i might have had further on in life with my jaw but didnt feel that i had TMJ which was causing my ear issues. He was right, no change in any of the ETD symptoms so i move on to another ENT. More ear examinations and hearing tests showing low frequency hearing loss that was normal for my age. He suggests that putting in tubes may help and schedules procedure. morning of procedure while in his chair he decides its probably not going to help and refers me on to an Otologist instead. Finally get in to see her in Dec 2018 and more hearing tests. However she immediately notes that my medical record showed a substantial weight loss right before my ETD issues started. She looks in my ear and says that she can see my eardrums moving with each breath therefore my Eustachian Tubes are open or Patulous. She tells me to order the PATULEND drops from a Dr in CA and that it may take a couple of months but these drops would close my tubes. I have religiously done these nasal drops since Dec to no avail. I called the otologist back this week to report no change and she tells me to call a Dr Poe in Boston because he is a specialist in Patulous Eustachian Tube. I am completely frustrated and at a loss as to what to do for two reasons. 1 – I live in Atlanta and 2 – I cant seem to convince myself that i actually have PET. I do not and have never had any of the hallmark symptoms such as hearing my own voice or hearbeat. I do internally hear my the crunching or cracking of my neck or jaw loudly but I dont believe this is autophony. Bottomline is I’m looking for anyone else out there with my similar situation who has been told they have PET. And if so, does anyone know a good Dr in the southeastern USA who can help me? I cant travel to Boston and I just cant keep living like this day to day.
0 likes, 15 replies
Posted 2 years ago
Hi! I know how frustrated this situation can be, especially since it seems that there is no cure! I have been diagnosed with ETD, and my ENT told me that my Eustachian Tube was Patulous, which he described as meaning “floppy.” I too felt frustrated and like there was no cure, but after a hearing test and a pressure test in my ears it was clear I personally needed to get Pressure Equlizer tubes in my ears. I got tubes in my ears in June of 2018, and although it is not a 100% cure and my first week of healing was absoulte HELL (only in my right ear though, which is my ear that is more affected.) I will have a check up soon in a few months on the tubes in my ears, but truly this feels like the best thing I could have done for myself. I would suggest you revisit the ideas of tubes, because they truly have changed my life. The great thing is, if they don’t work– they can take them out! I wish you nothing but the best, I know how hard this is!!
Posted 2 years ago
Thank you Paige this is good to hear. I’m desperate for some improvement and don’t know any other people who have had this. I have an appointment with yet another new ENT in a couple of weeks but this one appears to have trained under Dr Poe, the PET guru. Maybe she will consider tubes. And i appreciate the heads up about the awful healing process. Would you mind keeping me updated after your next checkup? I am hopeful for you that the good results continue! Thanks again for the feedback.