Ear fullness – A frustrating condition
|Abie Mendelsohn, M.D.
Assistant Professor of Otolaryngology
Director of the Head & Neck Robotic Surgery Program
About the author: Dr. Mendelsohn attended the David Geffen School of Medicine at UCLA after graduating Magna Cum Laude from Yeshiva University in New York. Here at UCLA, Dr. Mendelsohn quickly focused on voice and throat disorders and ultimately devoted an entire year towards the in-depth study of voice disorders. He continued his training in the Otolaryngology – Head & Neck Surgery residency program at UCLA where he was ultimately awarded for his teaching in the role of Chief Resident.
Many patients suffer from a sensation of pressure within the middle ears. This sensation is similar to the fullness we experience going up and down in airplanes or sensation of being deep under water. This pressure is horribly uncomfortable and severely distracting from everyday responsibilities and enjoyments. There are many causes of this symptom, and if this persists then a thorough examination is required to ensure there is nothing dangerous causing this discomfort.
Yet, most who experience this discomfort find that in fact there is nothing serious going on and they are promptly diagnosed with a condition called Eustachian tube dysfunction. Seeing many patients with this condition, I have seen that the only thing more frustrating than the fullness itself is the overall lack of understanding and treatment of this condition. So perhaps we might review the basic ideas of Eustachian tube dysfunction and the first line treatments.
The Eustachian tube is a semi-rigid tube which connects the middle ear to the upper part of the throat (it’s actual location is all the way behind the nose). The Eustachian tube acts as a pressure release valve opening to allow air to either escape when there is too much pressure in the middle ear or allow air to enter when there is too little pressure. This process sometimes comes with a burst of air heading through the tube, which can sound like a pop. In fact, actively performing this maneuver of pressure equalization is called “popping”, which most people will try instinctively. With aging, this tube becomes less compliant and has a harder time allowing air in and out of the middle ear. Other conditions many also deteriorate the function of the Eustachian tubes such as rapid weight loss, hormone imbalance, and sinonasal allergy inflammation.
With limitations of the Eustachian tube the ears remain in a state of imbalance. The first line treatment is to purposefully “pop” the ears. This exercise which should be done at least 10-times a day can help work the Eustachian tubes back into shape. It also works by offering temporary relief of the fullness. The next step is to attempt to reduce any swelling or water retention around the opening of the Eustachian tubes. Because the openings are located behind the nose, the best way to reach the openings is with a nasal spray. The first line spray is nasal steroids which many times are used for seasonal allergies, though people with Eustachian tube dysfunction should try nasal steroids even if they do not suffer from seasonal allergies. However, if there is seasonal allergies together with Eustachian tube dysfunction aggressive treatment of the allergies will many times improve the ear fullness. The combination of nasal steroids, oral antihistamines, and nasal saline irrigations will form a good foundation of nasal allergy treatment.
Ultimately, this condition is chronic and many patients require further evaluation and treatments. Yet, understanding the mechanics for this chronic discomfort can improve the day-to-day level of symptoms.