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Dear Dr. Spector,

For the past month my ears and the area all around my ears have had a lot of pressure, as if I were going up a mountain and the pressure gets intense but then usually pops. I feel as if my ears are getting ready to "pop" but they never do. I have some sinus drainage and a lot of headaches. I have tried everything to relieve this problem but nothing helps. When I drive, the slightest change in elevation brings extreme discomfort.

What could this be?

Traci
Zebulon, NC

Dear Traci,

The ear symptoms that you are describing are very likely due to improper function of your eustachian tubes. This is a very common problem that affects almost everyone from time to time, but in some people, it becomes persistent, and very annoying.

Your eustachian tubes connect your middle ear spaces (the air-filled areas behind your eardrums on both sides) with the back of your nose, and act to keep pressure in the ear the same as outside pressure under normal circumstances. If the pressure outside changes, like when driving through the mountains, scuba diving or going up and down in an airplane, the eustachian tubes' job is to quickly allow the flow of air from the nose into the ear, or vice versa, as shown in this picture:

The flow of air equalizes the pressure behind the eardrum with the outside world, and is necessary for proper functioning of the ear. Most people experience this as a 'pop' or 'squeak' when it happens. If this does not occur, symptoms including pressure or pain involving the ear and neck, decreased hearing (commonly described as "feeling like you're in a barrel"), and mild dizziness can occur.

The sinus drainage and headaches you have been noticing lately may actually end up being the reason for your apparent eustachian tube dysfunction (ETD). Nasal swelling from any underlying condition, such as sinus problems or allergy, commonly causes the nose to swell. This swelling can then secondarily affect the eustachian tubes, causing symptoms.

The first step to evaluate this further is a complete head and neck exam, looking for clues such as changes of the eardrum, or swelling in the nose. If the symptoms persist, or are very significant, I will usually recommend a simple intervention such as steroid containing nasal sprays into the nose, to reduce swelling in the nose itself and the eustachian tubes. If this is not helpful, more may need to be done to reduce swelling in these areas, including allergy treatments, or further interventions to help underlying sinus problems. Sometimes, I will place a tube into the eardrum to allow pressure to be relieved through the eardrum instead of through the eustachian tubes, as shown below:

This is the same procedure used in children for recurrent ear infections, but can usually be performed in the office in adults.

Often, however, the problem will resolve on its own with no treatment, but may take several weeks!

Thank you for your question!

Jared E. Spector, MD

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