Medical Edge: Plugged ears may be related to Eustachian tube dysfunction

DEAR MAYO CLINIC: My ears feel plugged up, similar to the effect of cabin pressure in a plane. I was referred to an ENT specialist. She performed several tests but could find nothing wrong. Allergy pills and a nasal spray haven't helped. Is there anything else I can do?

A plugged feeling in your ears is usually the result of a difference in air pressure in your middle ear and your outer ear. The air pressure between those two areas normally is the same because of the eustachian tube. This tube connects your middle ear to the back of your nose. When you swallow or yawn, the eustachian tube opens and allows air to flow into or out of your middle ear, equalizing the pressure. If the tube is blocked, differences in pressure can occur between the two sides of your eardrum.

A blocked eustachian tube is most often caused by nasal congestion, an ear infection or allergies. Wax build-up, a growth in the ear canal or a growth in one of the tubes itself can cause the same sensation. But, these common conditions would show up on an ear exam, and it's likely your ENT physician has already ruled them out.

However, there are several conditions that could cause a plugged feeling in an ear that appears normal. Occasionally, the skin within the ear canal can become irritated absent an ear infection or other ear problem. In this situation, itching in the ear usually accompanies the plugged feeling.

This condition can be treated with a mild topical steroid cream or hydrocortisone cream. Put a small dab, about the size of a pea, on a cotton swab. Insert it about a half-inch into your ear canal, and apply the cream to the skin to relieve irritation and itching.

Another possibility is that your symptoms may be caused by a mild form of eustachian-tube dysfunction, in which the tube is obstructed and the air from your nose to your ear can't circulate properly. It may not be severe enough to cause fluid build-up or changes to the eardrum, but you can still feel the pressure.

This obstruction could be the result of swelling in the tubes. When you're exposed to pollen, dust, fumes or pollution, it all goes through your nose. If you breathe in significant amounts of these substances -- a common occurrence for people living in urban areas -- they can cause your eustachian tubes to swell, even if you don't have allergies. The tubes are only about the size of your little finger, and any swelling within them can result in a feeling of pressure.

The simplest remedy for eustachian tube swelling caused by substances in the air is to literally keep your nose clean. Twice a day, use a salt-water rinse in your nose. You can buy saline or salt-water solutions for this purpose over-the-counter at any drug store.

Spray the solution up into your nose, and use more than you would to just moisten it. It needs to be a lot to wash it out and clear the nose. I recommend my patients do this in the morning when they first get up and at night about an hour before they go to bed. You can certainly do it more often throughout the day, too, if you find that helpful. -- Larry Lundy, M.D., Otorhinolaryngology, Mayo Clinic, Jacksonville, Fla.

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