Intranasal Treatment for Clogged Ears

A common cause of clogged ears with inability to pop them easily is due to eustachian tube dysfunction. There are a number of ways to address this annoying problem, but one of the first steps to try is intranasal medications whether in nasal spray form or nasal drop form.

The whole idea behind intranasal treatment is the fact that the ears are connected to the back of the nose via a tunnel called the eustachian tube. Watch video explanation.

Normally, when the ears are popped (also known as valsalva), the individual is opening up the eustachian tube to allow pressure and/or fluid in the ears to drain/escape out into the back of the nose. That's why when you blow your nose, you often hear a popping noise in the ears. Read more about how/why this happens here.

Patients suffering from eustachian tube dysfunction are unable to get the tunnel to open up. In this scenario, the pressure or fluid remains trapped in the ear. It's a plumbing problem in its essence.

Given the problem is the eustachian tube, intranasal medications are used to try and open up the tunnel and make it easier for the individual to pop the ears open.

Trick is... how to get the intranasal medications to where the eustachian tube is located in the very back of the nose.

There are a few ways to accomplish this... some which work better than others.

Method 1:
Use a nasal spray medication and aim the bottle to the back of the neck while keeping the head down (looking at the floor). The spray bottle MUST be perpendicular to the face. Why? Take a look at the diagram below:

If you aim the bottle towards the eye or top of the head, the medication is hitting areas of the nose where the sinus cavities are... not where the eustachian tube is located.

You have to look down and point the nasal spray bottle up towards the ceiling because all nasal spray medications use a straw that requires vertical orientation (same reason why when you drink Pepsi from a cup, the cup is upright).

Anatomically, the nasal spray "shoots" the medication straight up to where the eustachian tube is located.

Method 2:
Use an eye dropper and place a drop of the medication into the nose and have it "drain" to where the eustachian tube is located. Practically, this means filling a prescription of the nasal spray medication, opening up the bottle, and pouring the contents into an eye dropper.

This method requires positioning the head such that gravity will ensure proper movement of the medication to where the eustachian tube is located.

There are two ways to achieve this. This first way is the "Head-Tipped-Back Position".

In this position, the nasal drop will "fall" down to where the eustachian tube is located:

Mygind's Position is the alternative position which accomplishes the same thing, but the person is laying down looking up. For some people, this position is more comfortable than bending the head back.

Studies have shown that Method 2 (nasal drops) works better than Method 1 (nasal spray). However based on my personal experience in my patient population, Method 2 is not as well tolerated as Method 1. People often feel like drowning or suffocating when performing this maneuver (mini water-boarding so to speak). Also, it seems to be more irritating to the mucosal lining of the nose and throat.

And as we all know, if it is not comfortable or user-friendly, patients will not do it.

As such, I usually recommend Method 1 (nasal spray) which works "good enough". For patients who are ambitious and are willing, go with Method 2 (nasal drop).

Reference:
Techniques of Intranasal Steroid Use. Otolaryngol Head Neck Surg 130(1):5-24.
Intranasal delivery of drugs to eustachian tube orifice. The Journal of Laryngology & Otology (2011), 125: 934-939

Images taken from Techniques of Intranasal Steroid Use and Wikipedia.

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1 Out of 5 Kids With Viral URI Develop Ear Infections

According to a study published in 2011, more than 20 percent of young children with colds or other respiratory viral infections will develop middle ear infections of varying severity-including some mild infections.

This finding is not really that surprising. Even adults have ear symptoms with a viral URI including ear fullness and difficulty popping the ear. Though adults do what they can to keep the ears clear by valsalva, swallowing, chewing gum, yawning, or proactive ear popping, kids may not even know what to do when their ear feels full or otherwise abnormal let alone blow their nose.

When the ears are not ventilating properly whether in adults or kids, it leads to ear problems including fluid buildup and even infections.

Why does this occur?

With a viral URI, the mucosal lining of the nose gets swollen leading to symptoms of runny nose, nasal congestion, and even nasal obstruction. However, this mucosal swelling does not just occur in the nose, but the eustachian tube as well which connects the back of the nose to the middle ear space. When the ear "pops", what one is doing is opening up the eustachian tube to allow pressure and fluid to drain from the ear into the back of the nose. That's why yawning, swallowing, or nose-blowing causes an ear pop normally.

When the eustachian tube mucosal lining swells up, it utterly blocks the tube preventing ear popping leading to symptoms of persistent ear pressure, clogging, fullness, fluid buildup and eventually even ear infections.

Read more about eustachian tube dysfunction here.

Reference:
Clinical Spectrum of Acute Otitis Media Complicating Upper Respiratory Tract Viral Infection. Pediatric Infectious Disease Journal: February 2011 - Volume 30 - Issue 2 - pp 95-99 doi: 10.1097/INF.0b013e3181f253d5

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How to Unclog a Clogged Ear

First, one needs to know what is causing the clog before proper treatment can be initiated. There's a few assumptions here before proceeding.

• You have no ear problems typically
• There is no "pain" per se other than perhaps a pressure type pain. If there's actual PAIN present, you most likely have an ear infection and this article does not apply to you.
• You currently have no other symptoms (ie, sinus or nasal problems). An upper respiratory infection or sino-nasal problem may have triggered your ear problem, but you no longer have those symptoms anymore.
• You are older than 8 years of age.

Step 1:
Examine the ear canal with an otoscope. Look for any blockage like earwax or fluid.

If earwax is found, the first step is to get the earwax out! Although your doctor or an ENT specialist can do this for you, some rather try it at home by attempting to flush the earwax out. My personal at-home earwax flush kit favorite can be found here on Amazon.com.

Step 2:
Assuming no earwax is present, the next step is to get a hearing test. Why? The hearing nerve can become damaged causing a sense of fullness or clogged sensation. Click here to read a Washington Post article about this. Treatment must be urgently pursued as there is only a short window of time when medications can reverse the nerve damage (around 4 weeks). After this period of time, there's not much that can be done other than wait and cross-the-fingers.

Step 3:
Assuming there is no earwax and a hearing test revealed no nerve damage, you either have fluid in the middle ear (serous otitis media) or pressure (eustachian tube dysfunction).

Regardless of fluid or pressure presence, the treatment is the same. Click here to read the protocol to fix this problem.

Remember that pressure/fluid buildup in the ear is just like water/pressure contained inside an inflated (water) balloon. It needs to be "released" in a physical manner. There is no "pill" that can automatically do this for you. Watch video explanation. Read more about this here.

Mythical Treatments:
There are a couple key points to make if you have reached Step #3.

You do NOT have an ear infection and antibiotics will make little if any difference. Antibiotics help with infections and only infections. It does not get rid of pressure or fluid (ie, throwing antibiotics into a swimming pool will not make the water disappear). Other common myths also need to be dispelled:

• Sudafed and other oral decongestants do not help unless you have nasal congestion and/or runny nose.
• Antihistamines like zyrtec, benadryl, allegra, claritin, etc do not help unless you have other allergy symptoms affecting the nose.
• Saline flushes or nasal sprays also do not help unless there are associated nasal symptoms.


Products That Help Pop the Ear Due to Eustachian Tube Dysfunction or Fluid in the Middle Ear:

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Geared Toward Adults

Balloon Geared Toward Kids

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Help! My Ears Feel Clogged / Full (Eustachian Tube Dysfunction)

This blog article has been removed. 
You can find the entire article on the Fauquier ENT website here.

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