Ear Plugged Up: Eustachian Tube Dysfunction

Dear Dr. Dave and Dr. Dee,

My ear has been plugged up off and on for about 9 months. I saw an Ear, Nose, and Throat specialist a while back who said he could do one of two things: 1) do a procedure that would involve placing a tube to help drain fluid from the ear, or 2) prescribe a nasal spray instead and see if that helped.

I went with the nasal spray (Flonase), and it seems to work most of the time. I should add that I have other medical problems as well, including severe diabetes. That's why the ENT doctor ruled out surgery on my other ear in which I am almost deaf, and use a hearing aid.

Signed,

All plugged up

Dear All plugged up,

I can't overemphasize how important it is for someone with your medical problems, including severe diabetes, to continue following up with your doctor(s) on a regular basis, to get all of your questions answered. That's the only way you will be sure to make informed decisions, and faithfully execute the treatment plans prescribed by your doctors.

In the most general terms it sounds as though you are probably talking about a plugged Eustachian tube. This condition is otherwise known as Eustachian Tube Dysfunction (ETD).

The Eustachian tube connects the middle ear with the nasopharynx (or inner nose). Its purpose is to equalize air pressure across the eardrum, so that the middle ear can drain properly.

In ETD the duct is swollen shut or collapsed, the eardrum may retract, and fluid may build up in the middle ear. This may adversely affect hearing, and can provide a focus for infection. The ear feels like it's plugged up or needs to "pop" but won't. ETD often starts after a head cold, or sinus problem, or may have no obvious cause at all, but persist for months or even longer.

When an ENT doctor describes surgical placement of a drainage tube, he or she may be referring to a myringotomy tube or a Eustachian tube catheter. These tiny catheters alleviate ETD by allowing air pressure to equalize across the eardrum. Once the pressure is equalized, fluid in the middle ear can drain. The ear no longer feels "plugged up," and in some cases hearing improves.

One potentially serious complication of any surgical procedure is infection. People, such as yourself, who have diabetes are at substantially increased risk for this.

On the other hand, medicine, such as a steroid nasal spray, can often decrease edema (swelling) around the Eustachian tube and open things up, thus accomplishing the same treatment goals as the surgery, but with less risk.

Since you have a preexisting hearing impairment you are also at increased risk for worsening hearing loss. Obviously, you need to be watched closely by both your ENT specialist and your diabetes doctor.

For a better understanding of ETD take a look at this link: http://www.nlm.nih.gov/medlineplus/tutorials/otitismedia/ol199101.pdf