Ear Pain Causes

Have you ever experienced that you suddenly have a ‘clogged feeling’ in your ear? Sometimes the ‘clog’ comes by itself or after a common cold, other times when driving up a hill or when your airplane is landing. This plugged feeling can be slightly painful or reduce your hearing, and sometimes you also hear a high or a low pitched sound (tinnitus).

WORDS DR. BEATE ABRAHAM-NILSEN

DO YOU HAVE A FEELING OF PRESSURE IN YOUR EAR?

This plugged sensation in the ear is what we call Eustachian tube dysfunction (ETD), and it normally goes away rapidly, but the problem arises when it doesn’t, and it remains with you for weeks, months or even years.

WHAT IS THE EUSTACHIAN TUBE DYSFUNCTION (ETD)?

It is a condition affecting up to 5 per cent of the adult population. It occurs when the Eustachian tube becomes blocked or fails to open properly due to inflammation or obstruction. This plugged feeling occurs as air cannot get into the middle ear and the air pressure becomes unequal. As a result the middle ear becomes destabilised and if left untreated, in more severe cases, can cause permanent hearing damage.

WHAT ARE THE CAUSES OF THE ETD AND WHAT ARE THE SYMPTOMS?

Before we explain the causes that can lead to ETD, you need to know some basics about the ear. The ear consists of three parts; the outer, middle and the inner ear. The outer ear conducts the sound and when the sound vibrates the eardrum, this again sends vibrations to three small bones in the middle ear (malleus, incus and stapes). These three bones form a bridge from the tympanic membrane to the oval window. The sound then arrives to the inner ear.

The Eustachian tubes are small tubes that run between your middle ears and the upper throat. They are responsible for equalising ear pressure and draining fluid from the middle ear. Among problems that cause blockage to these tubes, we can include obstructions in the the throat, enlarged adenoids or tumours, inflammation and mucus due to allergies, hormones or upper air way infection, or a blockage in the middle ear such as middle ear infection or a local infection as a cholesteatoma.

The symptoms normally include a plugged feeling in the ears. Sometimes the ears feel like they are filled with water. Others are: tinnitus, vertigo, pain, reduced hearing and clicking or popping sounds in your ear. The symptoms sometimes become worse with altitude changes.

ARE THERE ANY HOME REMEDIES TO START WITH BEFORE I GO TO THE DOCTOR?

As a general advice, no matter the etiology of the blockage, yawning and chewing gum may help to equilibrate the air pressure. You might also use a saline nasal spray to help clean your passageways.

HOW CAN I GET THIS FIXED?

If the plugged sensation does not disappear by itself, you might want to go to an Otorhinolaryngologist (ENT doctor). The doctor will ask you several questions such as how long have you had the problem? Allergies? Snoring? Pain? Reduced hearing? Tinnitus? Pregnant? Medications? Stress?

The doctor will then examine your ears; this is to check that there is no earwax or infection in the outer ear conduct. If the outer ear is normal, the doctor will evaluate your eardrum and its position, look for liquid or other abnormalities in the middle ear. The doctor might ask you to close your mouth, hold your nose, and gently blow as if you are blowing your nose, this is called the Valsalva maneuver, and is used to see if the eardrum is moving. They will also conduct a further painless test to measure the function of the middle ear, called Tympanometry. The doctor will then explore your nose and throat to make sure there are no blockages, and if present will explore allergies via a prick-test for nuemoallergens.

CAN ETD BE TREATED AND WHAT HAPPENS IF YOU DON’T TREAT IT?

First you have to detect the cause. The patient is often prescribed with anti-histamines and anti-inflammatory medication, especially after a common cold or known allergies. If an allergy is identified and the problem is recurrent, you might consider allergy vaccination. Severe infections are treated with antibiotics and topical treatments, and if there is a blockage in the upper throat, this can be surgically removed.

In cases of severe ETD, this condition can cause middle ear infection, otitis media with effusion (also called glue ear) and eardrum retraction. This might require the surgical placement of tubes in the eardrum (grommets), which allows pressure to equalise in the middle ear.

Some hospitals also preform Eustachian tube balloon dilatation where the surgeon inflates a small balloon into the Eustachian tube through the nose. The inflated balloon clears a passageway for mucus and air. This treatment is used when the inflammation of the Eustachian tube is extensive and when other treatments are not helping.

DR. BEATE ABRAHAM-NILSEN

Otolaryngologist Clinica NorMed CC Elviria, oficina 2, Marbella. Tel: (+34) 952 836 377. info@clinicanormed.com www.clinicanormed.com