Workings of the Inner Ear: What Makes It Hurt?
When eustachian tubes, the tubes that connect the back of your throat and nose to your middle ear, are blocked or congested, serious pain can result.
Eustachian tubes help maintain normal air pressure in the middle ear, in response to changes in pressure in the external environment. But when sinus congestion from a cold or allergies blocks these tubes, you could develop a variety of problems, including ear infections.
What exactly is a eustachian tube? It's a small canal, about one and one-half inches long and only a few millimeters in diameter, that serves as a passageway connecting the back of your throat and nose to your middle ear, where your eardrum is located. Eustachian tubes are lined with the same kind of moist membrane that lines the nose and throat. They are typically closed, but they open with movements of the back of the nose and throat, such as those that occur when you swallow, yawn, or talk. Adult eustachian tubes are angled downward from the ear into the back of the throat, allowing for gravity drainage of middle ear fluids and mucus.
Your middle ear translates sounds that enter your outer ear into vibrations that can be understood by your inner ear and brain. To work properly, your middle ear should maintain the same air pressure as the air pressure around you. So your eustachian tubes open up periodically to circulate air throughout your middle ear, equalizing its air pressure to the pressure in the back of your throat.
Another function of your eustachian tubes is to allow any mucus buildup in your middle ear to drain out into your throat.
When Your Eustachian Tubes Malfunction
A number of things can go wrong with your eustachian tubes and middle ear, including:
Blockage due to swelling. It is not uncommon for people with sinus pressure to experience middle ear blockage due to congestion of the eustachian tubes. This swelling is most commonly caused by a sinus infection, a cold, or allergies. These conditions can cause the inner ear membranes to swell and block the tubes. A blocked eustachian tube cannot circulate air or drain mucus as it should.
Mechanical blockage. Sometimes overgrowth of tissues in the back of the nose (such as nasal polyps or the adenoids) can cause ear blockage by obstructing the eustachian tube opening. On rare occasions, a tumor can cause a blockage.
Otitis media (middle ear inflammation or infection). When sinus congestion leads to a blocked eustachian tube, fluid can accumulate in the middle ear and cause it to become inflamed. Similarly, if you have a bacterial sinus infection that spreads into your eustachian tubes, it can cause a middle ear infection, which leads to swelling and more fluid buildup. Otitis media is associated with ear pain and pressure.
Ruptured eardrum. If too much fluid builds up in your inner ear, it could tear your eardrum.
Speech, Language, and Hearing Problems
Particularly in children, eustachian tube blockages can result in:
Hearing problems. Excess fluid in the middle ear can result from a blocked eustachian tube, which can interfere with normal hearing, since fluid makes it difficult for the eardrum and bones in the inner ear to vibrate properly in response to sound. This type of hearing loss is usually temporary, but if left untreated, it can become permanent.
Speech and language problems. In young children, the hearing impairment caused by frequent middle ear infections can lead to disabilities with speaking and understanding language.
Eustachian tube-related problems are more common in children than adults, partly because eustachian tubes are not fully developed in children, and tend to be shorter and straighter than those in adults. Chronic or recurrent eustachian tube blockages are sometimes referred to as eustachian tube dysfunction.
When Outside Forces Harm the Eustachian Tubes
It’s not just allergies and infections that can cause eustachian tube issues. Other causes include:
Discomfort during air travel. Most people who have traveled by air are familiar with the sensation of increased pressure and popping in the ears, especially when the airplane is landing. This happens because your middle ear cannot keep up with rapid air pressure changes, and the pressure within your ears is lower than the air pressure around you, which increases as a plane descends. You can help keep your ears clear during air travel by doing things to open the eustachian tube, such as swallowing often, chewing gum, and yawning frequently.
Barotrauma. When the pressure in your middle ear is different than the pressure outside of your body for an extended period of time (for example during flight, scuba diving, or driving in very high altitudes), it can lead to severe discomfort, and even eardrum damage. This type of damage is called barotrauma (baro is from the word barometric, which relates to atmospheric pressure). Barotrauma can cause you to feel dizzy, have ear pain, and experience pressure in your ears. Symptoms of severe barotraumas include ear drum rupture, hearing loss, and nosebleeds.
Treatment Options for Eustachian Tube Problems
If you have persistent pain or pressure in your ears, or suspect you or your child has a eustachian tube-related problem, see your doctor. The following may help manage fluid buildup and even infection in your middle ear:
- Eustachian-tube opening strategies such as swallowing and chewing are useful, and your doctor can teach you a breathing technique called a valsalva maneuver, which if done gently, may open a clogged eustachian tube.
- Intranasal steroid sprays may help, especially if allergies are causing the problem.
- Some doctors recommend use of an oral decongestant if the eustachian tube blockage accompanies a cold or sinus infection.
- Antibiotics may be prescribed if there is a suspected bacterial ear infection.
- Surgical insertion of tubes in the eardrums helps ventilate the middle ear outwardly, via the external ear canal, and to drain fluids that way as well.
If left untreated, eustachian tube problems can lead to permanent hearing loss, serious infection, or other long-term complications. So if you or your child is experiencing problems, be sure to let a doctor know.
Find more information in the Everyday Health Ear, Nose, and Throat Center.