Ear Congestion and Eustachian Tube Issues: Causes and Solutions

Ear fullness and Eustachian tube dysfunction?

Hello, Doctor: When I was a child, I sometimes experienced sudden ear congestion (with reduced hearing) while traveling on mountain roads, which could take several minutes to recover.
When taking the bus or MRT, I occasionally experience brief tinnitus, which resolves faster than on mountain roads.
I also notice tinnitus when sitting still or changing positions (turning my head, bending down, etc.), although this is rare and resolves quickly.
Recently, I started using large over-ear headphones for about 0.5 to 1.5 hours at a time, usually taking a break after about an hour.
Whenever I take off the headphones, I feel discomfort, particularly a sense of pressure and pain in my right ear (similar to the pain of digging too deep in the ear).
The pain alleviates significantly within an hour, but I continue to feel a prolonged sense of pressure and a foreign body sensation, and sometimes even a liquid sensation in my right ear.
Discomfort can occur even after wearing the headphones for just 30 minutes (though the symptoms are milder).
My hearing is not affected, but the symptoms can persist for several days, and swallowing or blowing my nose doesn't seem to help.
I have tried both closed-back and open-back headphones, and the symptoms remain the same.
An examination at the hospital showed no significant issues in the ear, and both hearing tests and tympanometry were normal.
I have been prescribed a nasal spray and vascular medication, but they seem effective only for my nose.
After researching similar cases, I suspect it might be an issue with the Eustachian tube.
Are these symptoms related to my hypertension (146/92) and obesity (BMI over 35, with a family history of diabetes)? Is the foreign body sensation what is commonly referred to as a feeling of pressure? (I find it hard to describe.) When I wear the headphones without sound, I can hear a rhythmic pulsing in my right ear (which I do not hear when I take them off).
What could this issue be? Besides otolaryngology, what other specialties might be related to my symptoms? Thank you.

SL, 30~39 year old female. Ask Date: 2022/04/16

Dr. Zheng Jueyi reply Otolaryngology

Hello, common issues related to Eustachian tube dysfunction may arise.
If the hearing test and tympanometry from the ENT examination are normal, it may be advisable to consult a neurologist to check for other neurological function-related problems.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2022/04/16

More Info

Ear congestion and Eustachian tube dysfunction can be quite bothersome and may stem from various underlying causes. Based on your description, it seems that you are experiencing a combination of symptoms that could be linked to Eustachian tube dysfunction, which is often exacerbated by changes in altitude, pressure, or even certain activities like wearing headphones for extended periods.

Understanding Eustachian Tube Dysfunction
The Eustachian tube connects the middle ear to the back of the throat and helps equalize pressure in the ear. When this tube is not functioning properly, it can lead to a sensation of fullness or pressure in the ear, muffled hearing, and sometimes even pain. This dysfunction can be triggered by several factors:
1. Allergies and Sinus Issues: Allergic rhinitis or sinusitis can lead to inflammation and blockage of the Eustachian tube, causing ear congestion. Your history of nasal issues may suggest a link here.

2. Changes in Altitude: As you mentioned, traveling on mountain roads or using public transport can cause rapid changes in pressure, leading to temporary Eustachian tube dysfunction.

3. Earphone Use: Prolonged use of headphones, especially if they create a seal around the ear, can trap pressure and moisture, leading to discomfort and a sensation of fullness. The pain you experience after removing the headphones may be due to pressure changes that the Eustachian tube is struggling to equalize.

4. Obesity and Hypertension: Your BMI and blood pressure readings could also play a role. Obesity can contribute to inflammation and fluid retention, which may affect the Eustachian tube's function. Additionally, hypertension can lead to vascular changes that might influence ear health.

Symptoms Explained
- Ear Congestion and Fullness: This is often described as a feeling of pressure or "plugged" ears, which can be caused by fluid or inflammation in the Eustachian tube.

- Ear Pain: The pain you describe, similar to the discomfort felt when digging too deep in the ear, may indicate irritation or inflammation in the ear canal or middle ear.

- Tinnitus (Ringing in the Ears): The rhythmic sound you hear when wearing headphones may be related to muscle contractions in the middle ear or changes in pressure affecting the inner ear.

Recommendations for Management
1. Nasal Decongestants: Since you mentioned using nasal sprays, continue to use them as directed. They can help reduce nasal congestion and improve Eustachian tube function.

2. Avoid Prolonged Headphone Use: Limit the time you wear headphones, especially if they cause discomfort. Consider using open-back headphones that allow for better air circulation.

3. Eustachian Tube Exercises: Techniques such as the Valsalva maneuver (pinching your nose and gently blowing) can help equalize pressure in the ears. However, do this cautiously and avoid excessive force.

4. Consultation with Specialists: While an ENT specialist is the primary physician for ear issues, consider consulting with an allergist if allergies are suspected. A primary care physician can also help manage your hypertension and obesity, which may indirectly improve your ear symptoms.

5. Monitoring Symptoms: Keep track of your symptoms, especially in relation to activities that exacerbate them. This information can be valuable for your healthcare provider.

Conclusion
Your symptoms of ear congestion, pain, and the sensation of fullness are likely related to Eustachian tube dysfunction, possibly exacerbated by your history of nasal issues, headphone use, and underlying health conditions. Addressing these factors through medical management and lifestyle changes may help alleviate your discomfort. If symptoms persist or worsen, further evaluation by an ENT specialist or other relevant healthcare providers is warranted to rule out any other underlying conditions.

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