Do you have a blocked ear and blocked nose which doesn’t seem to be getting better? In Singapore, at ENTcare Clinic, we see many patients with blocked ear and nose problems. They have already seen their GP who has prescribed antibiotics but guess what? Their blocked ear and nose are still not better! Sometimes, they also suffer headaches and ear pain as a result of this.
WHY DO MY EARS AND NOSE BECOME BLOCKED AT THE SAME TIME?
The back of your ears are connected to your eardrums by a long passage called the Eustachian tube. You have one on each side. They are important structures which control the pressures at the back of the nose and also inside your ears. When you fly, your Eustachian tubes need to open up at the right time, like when your flight lands. If they don’t pop open correctly, then there is a risk of severe ear pain and even eardrum perforation. If you hear a loud “pop” one day, it may mean your eardrum has burst!
The Eustachian tube is probably one of the most troublesome structures that ENT specialists have to manage. It is very deep, at the back of your nose and cannot be accessed via your ear unless we lift up the eardrum. Many important blood vessels including the carotid artery sit nearby. Important nerves are also located near the Eustachian tube openings.
So when your Eustachian tubes don’t open at the right time, you will feel the blocked ear sensation. Eustachian tube problems are almost always linked to something else bothering your nose. By the time you feel a blocked ear, it is already probably late in the management of your nasal condition. Meaning your poor nose is the most likely culprit contributing to the blocked ear problem!
WHAT ARE THE COMMON CAUSES OF A BLOCKED EAR AND NOSE?
- Having a bad cold or the flu
- Poorly-controlled nasal allergy (allergic rhinitis)
- Sinus infections
- Eardrum infections
- “Lazy” Eustachian tube function
1. Having a bad cold or the Flu
When your nose becomes congested during a viral infection like the flu, there is little room for airflow to enter your blocked nose. Your nose will also be full of sticky thick mucus! So don’t be surprised if the mucus starts to block your ears too.
2. Nasal Allergies (Allergic Rhinitis)
Nasal allergies are very common in Singapore, mainly due to all the house dust mites which live here. Our high humidity levels also irritate people’s noses to cause a blocked ear and nose. Sneezing, watery mucus, runny nose and itchy throat are all common causes of allergic rhinitis. It is important to undergo allergy testing to find out why your nose is always like that. Otherwise, it’s just “blind” treatment with nasal steroids and antihistamines.
3. Sinus infections
By the time your nose suffers a sinus infection, it’s often the late result of severe allergic rhinitis. When nasal allergies are not well-controlled, viruses and bacteria grow easily in the trapped mucus. So if you keep falling ill, needing multiple antibiotics, you probably have allergic rhinitis as the root cause.
Sinus infections are usually bacterial, though rarely fungal infections may occur too. If the watery mucus turns yellow or green, this is the sign of sinusitis. You will need a course of antibiotics to treat your sinus infection.
4. Eardrum infections
Eardrum infections cause blocked ear and ear pain. Sometimes, ear infections start with a sinus infection or a bad cold. Poorly-controlled allergic rhinitis can also result in blocked ear and hence, eardrum infections. Your eardrum space may fill up with thick fluid, leading to blocked ear and hearing loss. If the trapped fluid doesn’t go away, it may press on your eardrum to cause ear pain or even rupture!
Again, you need a course of antibiotics to treat your eardrum infection. If your eardrum perforates, the thick fluid will drain out through the hole as an ear discharge.
5. “Lazy” Eustachian tube function
In some patients, even when they are well, their Eustachian tubes just don’t open at the right time. These patients try to go scuba-diving or swimming but they keep getting severe ear pain. When they fly, the ear pressure can worsen during landing with risk of their eardrum bursting. Even going up in a lift in a tall building, may cause them ear pain. That’s because their Eustachian tubes close up, building up the ear pressures to lead to a blocked ear.
HOW CAN I UNBLOCK MY BLOCKED EAR AND NOSE?
The key to helping your ear and nose get better is always to find out the cause of your condition.
Some medications may help to unblock your ear and nose. For example, using a nasal steroid spray and taking oral antihistamines may help relieve the ear pressure. Your nose will also unblock with these allergy medications.
If there is ear pain, headaches and yellow mucus from your nose, then antibiotics may play a role to treat underlying sinus infection.
Using a saline sinus rinse can also be helpful to clean your nose gently to unblock your ear and nose.
Doing gentle jaw-opening exercises can help your Eustachian pressure tubes to relax and open up. This will hopefully help your blocked ear and nose to feel better. Yawning, swallowing and chewing gum move your jaw muscles which in turn, connect deep to your Eustachian pressure tubes.
MEDICATIONS FOR MY BLOCKED EAR AND NOSE FAILED: CAN SURGERY HELP?
After trying all the above medications to unblock your ears and nose, sometimes your ears and nose aren’t better. What do you do next to help relieve your blocked ears and nose?
Of course, it depends on the findings during your nose scope examination. But the following low risk procedures may help to unblock your blocked ears and nose by relieving your Eustachian tube pressures.
Please note that this list is not exhaustive though for blocked ear and nose problems.
- Balloon dilation of the Eustachian tubes
- Insertion of ventilation tubes (grommets) in the eardrums
- Correction of the deviated nasal septum (Septoplasty): The funny thing is the narrower nasal passage is usually the same side as the ear which keeps feeling blocked! This surgery also helps you to breathe more clearly so the improved airflow may reduce the chronic inflammation around the Eustachian tube opening.
- Turbinoplasties (Reduction of the enlarged “sausages” inside your nose)
- Freezing of the nerve network which controls mucus production in your blocked nose: We usually consider this if the patient has a persistent postnasal drip too.
- Adenoidectomy (The enlarged adenoid pad may block the Eustachian pressure tube openings): The removal of the excess adenoid soft tissue can help to relieve the blocked ear and nose problems.
- Other types of surgery: Some patients may suffer recurrent sinus infections not responding to medications. Or they may have nasal polyps growing inside their nose. So they may need removal of nasal polyps, which can grow to block your nose and sinuses. Surgery aims to improve the drainage of your blocked sinuses and remove the nasal polyps.
WHAT HAPPENS IF MY EUSTACHIAN TUBE IS TOO OPEN? BEWARE OF PATULOUS EUSTACHIAN TUBE!
Be mindful that sometimes a blocked ear is not always due to a “closed” Eustachian tube. When the Eustachian tube is “too open” at the wrong time, some patients may suffer a blocked ear. This problem is entirely different and termed a Patulous Eustachian Tube condition. The diagnosis and treatment of a patulous Eustachian tube is completely different from blocked ear from Eustachian tube dysfunction.
So be careful because even some ENT specialists in Singapore are not aware of this. You don’t want to have a balloon dilation done of an patulous Eustachian tube because it will make your symptoms worse!
