Blocked Ear & Hearing Loss: How To Treat

What do you do if you suddenly notice that the hearing in our ear isn’t as good as before? What about that blocked ear feeling, as if you can’t pop your ear? It may feel like you’re on an airplane: You just can’t unblock your ears to equalise the ear pressures. Blowing your nose and pushing your jaw out are your attempts to open up the Eustachian pressure tubes. These ear pressure tubes are long tunnels joining the back of your eardrums to the back of your nose. Take a look at the picture below.

BLOCKED EAR PROBLEMS:

The Eustachian pressure tubes are probably the most troublesome structures to deal with in the ENT world because they can be unpredictable in nature and hard to access due to their deep location.

Sometimes, they may become blocked by certain problems such as mucus draining from sinus infections or nasal allergies. Other cases of blocked ear may result from nasal polyps or soft tissue growths inside your nose. Rarely, we see nose tumours which grow to block off your ear pressure tubes to cause eardrum infection and fluid buildup. This in turn will cause hearing loss.

Many people tend to blame earwax buildup as a cause of blocked ear problems but wax alone is seldom the cause of blocked ear. I would be more worried about eardrum infections, “glue” ear (fluid trapped behind the eardrum, cysts growing on or behind the eardrum and other associated nasal issues. “Glue” ear is quite common after a bad flu or cold as the Eustachian pressure tubes become congested and swollen.

Thick gluey mucus becomes trapped inside the Eustachian pressure tube and then the space behind the eardrum, leading to a blocked ear sensation. This glue ear condition is more common in children but can also occur in adults, especially if there is a history of smoking, diving or recent flights.

TREATMENT OF BLOCKED EAR PROBLEMS:

So what can be done to help a blocked ear feel better? As a busy ENT specialist in Singapore, I would normally prescribe medications such as decongestants, nasal and/or oral steroids with antibiotics if there is infection. I would allow some time for natural recovery first but sometimes, things don’t get better. So then the options for treatment for the blocked ear are:

1. Drainage of the trapped fluid (Myringotomy)
2. Drainage of the trapped fluid PLUS insertion of a ventilation tube
3. Balloon dilation of the Eustachian tube

In theory, all three options may be performed in clinic under local anaesthesia, especially in cooperative adult patients.

What is most important of course, is to check the postnasal space (back of the nose) to make sure there aren’t any masses growing inside to block the Eustachian pressure tube. We do this with nasoendoscopy, again a simple quick relatively painfree procedure in clinic. The costs of nasoendoscopy, balloon dilation of the Eustachian pressure tube and ear procedures above may be claimed from your corporate and personal insurance. They are recognised as day surgery procedures in Singapore, even though they may be done in clinic. This truly does save a lot on costs, instead of hospital admission.

Please do bear in mind that in many cases of Eustachian tube problems causing blocked ear symptoms, the root cause often arises from the nose itself. So screening for risk factors such as deviated nasal septum, nasal allergies, sinus infections and nasal polypsis is important too. If such nasal conditions are identified, then they should be treated properly, otherwise the Eustachian pressure tube issues will just recur. Procedures such as septoplasty to correct the deviated nasal septum or turbinoplasties to reduce swollen soft tissue to breathe clearly may be needed.

BUT WHAT IF THERE IS HEARING LOSS?

Although blocked ear due to fluid buildup may cause hearing loss, this is usually temporary and not too severe. All patients with blocked ear symptoms should have a hearing test as hearing loss sometimes may feel like you have a blocked ear. One easy way to test this, is to wear your earphones or headphones and turn them on. If one ear feels different from the other or sounds muffled, then you should see your friendly ENT specialist in Singapore soon.

If you’re not hearing very well at all and your hearing dropped suddenly, then sudden hearing loss may have occurred. This is an ENT emergency as you may need to start a course of steroid medications urgently to save your hearing. It usually happens in just one ear but I have seen a few cases where the hearing loss occurred suddenly in BOTH ears. This, as you can imagine, is extremely distressing for the poor patient, especially if it fails to recover. Sudden hearing loss is almost always due to an abnormal event happening in your inner ear nerve centre.

Hearing tests are important to check what type of hearing loss you may have. Your hearing loss may be conductive, meaning the problem lies with the ear canal, eardrum or ear bones (ossicles). The other type of hearing loss is nerve-related, just like the sudden hearing loss condition discussed above. Usually, this is due to a viral infection of the inner ear. An MRI scan of the inner ear is needed anyway to rule out rare tumours or strokes.

The treatment of hearing loss depends on the actual cause. Sometimes surgery has an important role to play. Here are a few ear procedures that may be performed to help you hear better. A hearing aid is obviously the non-surgical option.

Outer ear (Ear canal):

1. Canaloplasty (Widening of the narrow ear canal to prevent infection and allow sound transmission)
2. Meatoplasty (Widening of the narrow ear opening itself, usually due to scarring from previous infection)

Middle ear (Eardrum and Ear Bones):

1. Tympanoplasty or Myringoplasty (Repair of the Ruptured Eardrum): We do A LOT of this! Actually, we do A LOT of middle ear surgeries like this list!
2. Mastoidectomy (Removal of infected skin cysts or cholesteatoma growths)
3. Stapedotomy (Reconstruction of Hearing Loss with a stapes prosthesis): The stapes is the third little ear bone
4. Ossiculoplasty (Reconstruction of Hearing Loss with an ossicle or ear bone prosthesis): Usually done for the second ear bone called the incus.

Inner ear (Nerve Centre):

1. Bone anchored hearing implants: Osia, Bonebridge, BAHA.
2. Cochlear implants

We will discuss the above ear surgeries in an upcoming blog article in future.

Taking care of your hearing is the most important of course. So here are Dr Annabelle’s Tips to Look After Your Ears:

1. Do not dig your ears: There is no need to. Your ears are Self-Cleaning!
2. Avoid noisy places: Please wear ear plugs e.g. in concerts, you can buy special high fidelity ear plugs
3. Do not wash your ears: There is no need to spray water inside your ears.

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