Good morning and TGIF! Welcome to another Dr Euan's ENT blog post!
Today's topic is about pressure in the ears.
Why is it that when you are high up in the air or deep below water, your head can start to feel like it's being pressed?
Usually, people pinch their noses and blow their ears to "equalize" the pressure again, but what happens when you can't do this? What else can you do instead?
Well let's find out together, shall we?
Q: Why are our ears affected by pressure?
Ear anatomy diagram showing the middle ear connection to the nasopharynx via the Eustachian tube in Purple
Eustachian Tube Dysfunction
Eustachian tube dysfunction is a condition where the tubes that connect your middle ears to your upper throat become blocked. This can lead to discomfort, hearing difficulties and a feeling of fullness in your ear. Eustachian tube dysfunction usually resolves itself in a few days. But if it doesn’t, seeking treatment is important, to prevent longer-term damage.
Q: What is "ear squeeze"?
Your eustachian (pronounced “you-stay-shee-un”) tubes connect your middle ears to the back of your throat. (Your middle ear is the air-filled chamber just behind your eardrum.) Your eustachian tubes equalize air pressure and help drain fluid from your ears. When they become clogged, it’s called eustachian tube dysfunction (ETD) or "ear squeeze"
Eustachian tube dysfunction can affect people of all ages, but it’s much more common in children. To put it in perspective, about 1% of the adult population is diagnosed with the condition. Meanwhile, approximately 70% of children develop eustachian tube dysfunction before the age of 7.
Allergies and infections (like the common cold and the flu) are the most common causes of eustachian tube dysfunction. These conditions can cause inflammation and mucus buildup, leading to blockage. GERD, or chronic acid reflux, can also cause ETD. This is because stomach acid can back up into your throat and result in inflammation. As mentioned above, altitude changes can also cause ETD.
In children, enlarged Adenoids and chronic adenoiditis are common causes of ETD. This can be resolved by Adenoidectomy (removal or reduction of adenoids).
Q: What is equalizing? Why do we "pop" our ears?
People with ETD may experience a number of warning signs. Common eustachian tube dysfunction symptoms include:
Hearing problems.
Tinnitus, or ringing in your ears.
Clicking or popping sounds.
A feeling of fullness in your ears.
Pain that mimics an ear infection.
Dizziness, vertigo or balance problems.
A “tickling” sensation in your ears.
Eustachian tube dysfunction symptoms may get worse in higher altitudes. This is called barotrauma, and it can happen while scuba diving, flying in an airplane or driving in the mountains.
Scuba diving can also cause a sensation of pressure on the ears due to the changes in water pressure as you descend deeper
The Valsalva maneuver is one way of "equalizing" middle ear pressure:
The Valsalva maneuver is one of several simple physical actions called vagal maneuvers that act on the vagus nerve to slow your heart rate. Doctors may suggest vagal maneuvers to try and slow your heart when it’s beating too fast.
To do the Valsalva maneuver, you take a big breath and hold it in by closing your windpipe at the throat with your glottis – as when you start to cough – and then pushing with your belly area as if you were straining for a bowel movement.
How to Do the Valsalva Maneuver
Your doctor will instruct you to:
Sit down or lie down.
Take a deep breath and hold it by closing your throat.
Bear down hard, as if you’re trying to go to the bathroom.
Strain hard for about 10 to 15 seconds.
Release the air when you’re done.
Wait at least a minute before you try again.
YouTube video guide on the Vasalva Maneuver by Singapore General Hospital
Q: What do I do when I can't equalize and feel pain on plane rides?
If you are unable to equalize, it is best to see a doctor and get some medications pre-flight, to avoid the pain and discomfort on board; For my patients, I usually advise them to take the anti-histamine and to do their nasal irrigation if possible upon check-in 3 hours before the flight.
On board the plane, once the plane starts to descend and the cabin pressure changes, you can then have a drink of water, as swallowing does help to open the Eustachian tube.
Try to do the Valsalva Maneuver too, and keep doing it as the plane descends.
Unfortunately, sometimes the "ear squeeze" is so severe as to cause barotrauma.
Q: When should I seek medical help?
If your ear squeeze persists for more than 2 weeks, or if you develop conditions such as sudden hearing loss, tinnitus, or vertigo, please make an early appointment to see your doctor (GP or ENT).
Q: What are the treatment options?
What are some common eustachian tube dysfunction treatments?
In most cases, treatment is not necessary because ETD often resolves on its own. However, you might need treatment if your symptoms linger for more than two weeks.
Eustachian tube dysfunction (ETD) treatment depends on the cause and the severity of your condition.
Treatments may include home remedies, medications or, in severe cases, surgery.
Home remedies
Sometimes simple home remedies can help with mild cases of eustachian tube dysfunction. To try and clear the blockage, you can:
Chew gum.
Yawn.
Swallow.
Try the Valsalva maneuver (breathing out forcefully while closing your mouth and pinching your nostrils).
Use a saline spray to clear out your nasal passages.
If you think your baby has ETD, give them a pacifier or a bottle of milk. The sucking motion may help clear the blockage.
Medications
Over-the-counter medications can help if allergies are causing eustachian tube dysfunction.
You can try antihistamines (like cetirizine or diphenhydramine) to ease your symptoms. If you have discomfort, pain relievers — such as acetaminophen or ibuprofen — they can help.
When an infection causes ETD, your healthcare provider may prescribe antibiotics. They may also give you corticosteroids to help reduce inflammation.
Surgery
Chronic eustachian tube dysfunction may require surgery.
The goal of this treatment is to bypass your eustachian tubes and address ventilation problems in your middle ears. This restores hearing issues and other symptoms. There are a few different surgical options, including:
Myringotomy. During this procedure, your surgeon makes a small incision in your eardrum to drain the fluid from your middle ear. In adults, the incisions usually stay open long enough for the swelling in your eustachian tubes to resolve before healing on their own over time.
Pressure equalization tubes. Sometimes surgeons place ear tubes into the eardrums once they make the incisions. These tubes provide proper middle ear ventilation for up to one year. Some surgeons recommend earplugs while swimming or bathing while ear tubes are in place. Typically, over time the tubes are pushed out and the drum heals. However, the tubes don’t always stay in place as long as they should and repeat placement may be necessary.
Eustachian tuboplasty (eustachian tube balloon dilation). This newer procedure involves expanding your eustachian tubes with a balloon. Your surgeon uses endoscopic instruments to thread the balloon through your nasal passages into your eustachian tube. The balloon is inflated for two minutes, then the balloon is deflated and removed.
Example of Easmed Entellus ENT Balloon for expanding nasal passages
Eustachian Tube Dilatation Therapy
YouTube demonstration video of Balloon Eustachian Tube Dilation
Well, dear friends, I hope this blogpost has given you some insight into "Ear Squeeze"; and what you can do about it.
Until next time.
Ciao!
Dr Euan
If you would like to consult an ENT Specialist concerning ear pressure, Eustachian Tube disorders, or any other ENT Conditions, please feel free to Contact Us at Euan's ENT Surgery & Clinic to make an appointment.
If you are keen to read more, here are some useful references:
REFERENCES:
1.Tucci D, McCoul E, Rosenfeld R, et al. AAO HNS Clinical consensus statement on balloon dilation of the eustachian tube [published online June 2019]. Otolaryngol–Head Neck Surg. doi:10.1177/0194599819848423Google Scholar
2.Browning GG, Gatehouse S. The prevalence of middle ear disease in the adult British population. Clin Otolaryngol Allied Sci. 1992;17(4):317-321. doi:10.1111/j.1365-2273.1992.tb01004.xPubMedGoogle ScholarCrossref
3.Tangbumrungtham N, Patel VS, Thamboo A, et al. The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2018;8(5):620-623. doi:10.1002/alr.22056PubMedGoogle ScholarCrossref
4.Vila PM, Thomas T, Liu C, Poe D, Shin JJ. The burden and epidemiology of eustachian tube dysfunction in adults. Otolaryngol Head Neck Surg. 2017;156(2):278-284. doi:10.1177/0194599816683342PubMedGoogle ScholarCrossref
5.United States Census Bureau. 2013-2017 American Community Survey 5-year Estimates: Age and Sex. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_S0101&prodType=table. Accessed February 22, 2019.
6.Patel MA, Mener DJ, Garcia-Esquinas E, Navas-Acien A, Agrawal Y, Lin SY. Tobacco smoke exposure and eustachian tube disorders in US children and adolescents. PLoS One. 2016;11(10):e0163926. doi:10.1371/journal.pone.0163926PubMedGoogle ScholarCrossref
