This is by far the most common condition I see and discuss with patients every day. Many will presume that either their ears are filled with wax or they have an ear infection. Although either could be true, they are not the most common reasons. Once you have an understanding of the anatomy in your ear, as well as your nose and throat, it all makes sense.
Before getting into the anatomy let’s review how the ear helps us hear. Sound vibrations come in through your ear canal (the outer ear) and bounce off the eardrum which is the outer wall of the middle ear. The eardrum touches small bones in the middle ear, so when the vibrations hit it, the three small bones in the middle ear move. These movements are sent to the inner ear where they are changed into messages for the brain. This is a very simplistic explanation but it will serve its purpose to help you understand the symptoms associated with “plugged ears”.
Now, back to the middle ear where the problem of plugged ears occurs. Pressure in the middle ear has to be the same as the outer ear for the eardrum and middle ear bones to be able to move. The middle ear has one natural opening designed to be a venting tube and it is called the Eustachian tube. This is a very small passageway that connects the middle ear to the throat up high where the nose also opens to the back of the throat (the nasopharynx). Your ear pops every time you swallow, yawn, blow your nose, etc., when the Eustachian tube functions normally. This popping happens when the Eustachian tube opens, transiently allowing air to pass from the middle ear to the back of the nose which is open to the environment. Your ears will feel plugged when the Eustachian tube get blocked and can’t open to allow the air pressure to equalize.
The Eustachian tube can become blocked for a variety of reasons. The most common cause is excessive mucus and inflammation of the tube associated with a “cold” (upper respiratory infection), a sinus infection or allergies. While this condition is very short lived when caused by a cold, it can be chronic with conditions such as chronic allergies or sinusitis. Symptoms often include pressure or fullness in the ear, sharp ear pain, pain radiating down the neck, muffled hearing, crackling or popping sounds and sometimes even ringing in the ear. This is called Eustachian tube dysfunction. This can lead to a middle ear infection, but the Eustachian tube problem almost always precedes it.
Treatment for Eustachian tube dysfunction is focused on decreasing swelling and mucus production/drainage in the back of the nose and throat. This is best accomplished with the use of nasal sprays and allergy or decongestant pills. I will not go into specific medication options today because it goes beyond the scope of this blog and it is best to be seen by a medical provider to determine the right care plan.
Too often I get that look, or someone says right out, “you’re not listening; it’s my ear not my nose.” This is the reason that I feel compelled to provide this education. I’m hearing you, and in order to get the ear opened up we have to treat where it is plugged, which is usually at the back of the nose/throat. Two final words of caution:
1.Prolonged use of over the counter nasal decongestant sprays can lead to ultimate worsening of symptoms and should never be used for more than 3 days.
2.Quit digging in your ears when they are plugged. That only causes ear canal trauma and you can’t get to the problem from that side of the ear.
Michelle Douglas is a Physician Assistant at ProHealth Medical Care, offering more than 10 years experience in providing exceptional primary and urgent care to patients ranging in age from 2 months to 65 years old. ProHealth Medical Care offers $50 office visits and same day appointments. Walk-ins are always welcome!