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Bunged Up / Blocked Ears - Help!

I had a question today from a friend, and thought I'd write it here in case others can benefit from the answer.

We fly on Sunday... Unfortunately I’ve got a blocked left ear with a cold and wondered if Sally had any tips for a blocked ear. Dreading the flight!

A cold or other respiratory infection can cause unwanted fluid in the back of the nose/throat and inflammation of the soft tissues there. Unfortunately, humans have a Eustachian Tube, which is proof that we certainly not designed by something with any degree of intelligence!

The Eustachian Tube connects the middle ear space to the back of your throat.

The purpose of this tube is to regulate the pressure of the middle ear space. The tube and the middle ear cavity are filled with regular air, and are at regular atmospheric pressure when all is working well. The Eustachian tube is not permanently open, it has no structures (like the windpipe, which has cartilage holding it open) to facilitate that. So it opens and closes periodically when we swallow, yawn or otherwise move throughout the day.

When we have, for example, a cold, the soft tissues around the Eustachian Tube walls can get inflamed/sticky, and this keeps the tube shut, like stepping on a hosepipe.

Without that opening and closing, the middle ear cavity is closed on all sides, by the eardrum at one end and the organs of the inner ear at the other end. This creates a vacuum*, and we know how Mother Nature feels about those! The vacuum creates a difference in air pressure between the outside world and your middle ear.

The consequence of this negative pressure is that the flexible tympanic membrane (eardrum) is pulled inwards medially (towards the centre of your head). This tenses the eardrum and it doesn't conduct sound pressure as well as normal, and your hearing sounds dull because you're not hearing the higher frequencies as well as normal. Tympanometry (AKA a pressure test) tells the audiologist what's happening with pressure in the middle ear.

The dull hearing is something most of us have experienced, along with the ears eventually "popping" when the Eustachian tube finally opens up again and sound is transmitted normally. We can get this when going up a steep hill or in an aeroplane, due to the changes in atmospheric air pressure creating an imbalance of pressure until the next natural opening of the tube. Air pressure is different depending on how far you are above sea level, if you remember your high school science lessons!

We can also force our ears to pop by using the Valsalva Manoeuvre. This is the official name for pinching your nose shut and blowing your nose. The Valsalva forces air back up the Eustachian tube from your throat, which forces it to open up. It also blows your eardrums out laterally (outwards from the centre of the head), which looks frankly terrifying** when seen by video otoscope. I have not done the Valsalva since my first year of the Audiology degree.

So, if your ears feel 'blocked' it's usually not an actual blockage, it's a vacuum in the middle ear. To rectify it, you need to open the Eustachian tube. I don't recommend the Valsalva, but I know people are going to do it anyway. If you do that, you should do it very gently and slowly, stopping as soon as the ears 'pop'. Never keep on and on.

You can also swallow repeatedly, and the best way to do that with a cold is to suck on a Lockets sweet or similar to sort out the snot and sore throat at the same time!

Yawning is excellent too. For inspiration, you can look up my husband's lectures on YouTube 😀

My own method is opening the mouth wide then moving the bottom jaw side to side.

Inflammation is one of the reasons your tube is shut, so I have an ibuprofen when I have persistent blocked ears, however I'm not a medic so please don't assume I know what I'm talking about on that score. Fluid is the other cause, so I have a decongestant too. The more the merrier when it comes to cold and flu treatments, I always think, but be sure to watch the recommended doses.

Time, ultimately, will take away the blocked feeling. If symptoms persist it's worth having someone look in your ears to make sure they're not actually blocked with wax.

Finally, the dull hearing we associate with colds is very similar to high frequency hearing loss. If it's not wax and it's not a blocked Eustachian tube, you know that means it's time for a hearing test, and I can help you there. If you suddenly have this sensation of blocked-ness, with no accompanying cold or history of earwax buildups, it is essential that you let a medic or audiologist know, the same day if possible.


*If the Eustachian tube stays shut too long, negative pressure vacuums fluid from the cells and intercellular space surrounding the walls of the middle ear cavity. This is otitis media with effusion, fluid in the ear, common in children and can lead to an ear infection if it sticks around.

**like a bullfrog puffing up it's throat. The skin of the eardrum is stretched really thinly and you are just thinking ' that's going to perforate!'.

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