In order to hear, we have an ear drum that vibrates with the sound and 3 little bones located in the middle ear that move back and forth in order to transmit the sound to the inner ear where the nerves are. In order for the ear drum and the bones to move properly, the middle ear space has have a pressure equal to that of the air outside the ear. But if you change altitude, the pressure outside changes and you have to adjust the middle ear pressure. This is done through the Eustachian tube (ET), which connects the middle ear to the nose and the outside. When people blow the nose too hard, this can close the ET. Any nasal congestion, swelling can do this. A growth in the back of the nose can press on this opening too. This is why we are concerned when the ET is blocked on one side without an obvious cause, we must look for the cause. Inhaled toxins can injure the ET system too.

With blockage, patients are aware that they can’t hear as well; this is because the closure of the ET causes a vacuum to form in the middle ear that prevents the normal vibration of the ear drum. If this closure persists, the body tries to fill this vacuum and the normal air containing cells of the mastoid bone change to mucous making cells and give a condition called Serous Otitis Media or fluid filling the middle ear.

When the ET is blocked, a nasal decongestant such a Zephrex LA is useful. Proteolytic enzyme preparations with papin and bromelain (make sure you use a formula with calibrated enzyme activity) are especially helpful. Drink huge amounts of hot tea. The important thing is to be VERY gentle on trying to clear the ears because you can do more harm by forcing. You may hold the nose and try to gently force air out the ear. Or put your tongue to the top of the mouth and swallow. In my office we use the” cookie machine”, a tank of helium with a nasal adapter. When the patient says “cookie” we deliver a jet of helium to inflate the ears.