Blocked Ear: 5 Tips to Get Better

Do you know that blocked ear is a very common problem that we see at our busy ENT specialist clinic in Singapore?

There are many causes of a persistent blocked ear but here are the more common blocked ear conditions:

1. Impacted earwax
2. Swollen ear canal due to infection
3. Foreigh body stuck in ear
4. Eardrum infection with fluid trapped behind
5. Eustachian pressure tube congestion
6. Actual hearing loss!

1. IMPACTED EARWAX

Most people’s ears are self-cleaning: The wax naturally migrates outward to fall out of their ears. This means that most people do NOT need to clean or dig their ears at all. But ear-digging somehow still remains very popular. I call ear-digging “Singapore’s National Hobby”! Of course, some people have anatomical issues such as narrow ear canals, dry hard wax buildup, tortuous ear canals and so on.

Sometimes, earwax gets stuck because people dig their ears with cotton buds or wear earphones for too long. Swimming may also lead to wax impaction as the water pushes the wax deeper.

See my tips below on how to take care of your ears. Although most people do not need regular earwax removal in clinic, some unfortunately do. Stay away from ear candling as it is unhelpful. I am not a fan of irrigation with water to flush out earwax. Ear irrigation with water is a common practice at GP clinics, due to the risk of infection. Some people have an infection hiding behind the earwax or may have a perforated eardrum. So flushing the ear out with water is just bad news!

2. SWOLLEN EAR CANAL DUE TO INFECTION

Your ear canal may be feeling blocked because it is already infected and has become swollen. This means that putting eardrops into your ear is going to be difficult and painful. It is likely that not much of the eardrops is going to be able to enter your ear anyway.

It may be a bacterial or fungal ear infection (otitis externa). Telling the difference is important because you have to use either antibacterial or antifungal drops to treat your ear infection.

Using antibiotic eardrops for too long, like more than 2 weeks, is also a risk factor for growing fungus in your ear to cause more infection.

Although topical treatment usually works for ear canal infections, cleaning out your ear of any trapped debris in an ENT specialist clinic may be needed for full recovery. Sometimes, a course of oral antibiotics may be indicated if your ear infection is very severe, spreading down your neck with enlarged lymph glands.

3. FOREIGN BODY STUCK IN EAR

You may have an actual foreign body stuck in your ear! The most common object is a cotton bud because people just love to dig their ears, don’t they?!

In children, it may be a bead or plastic part of a toy that they inserted into their ear. Foreign bodies stuck in the ear are not technically emergencies but they should be removed at the next available time to prevent infection.

Sometimes, insects crawl into people’s ears , such as during camping outdoors. I had a patient who slept on the floor near his kitchen at night and woke up screaming because he felt sudden ear pain from a cockroach crawling in! Really quite gross but the correct thing to do is to apply some oil or alcohol into the ear to drown or kill the insect before its movements cause damage to your eardrum. Then head straight to the emergency department or your friendly ENT specialist in Singapore to remove the trapped insect. Sometimes, the emergency department is unable to remove the insect entirely so the remaining body parts need to be removed gently at the ENT specialist clinic.

4. EARDRUM INFECTION WITH FLUID TRAPPED BEHIND EARDRUM

In this condition known as otitis media (eardrum infection), it may have begun from your nose and sinuses due to an earlier infection. The most common cause is having caught a bad cold or flu first, which then spread to your eardrum via the Eustachian pressure tube. It may be viral or bacterial. Patients typically compain their ear feels blocked or they cannot hear clearly with muffled hearing.

If it has happened to you, you may need a course of oral antibiotics and decongestants. Topical eardrops are of little use in this case. Please do not dig your ear as this really won’t help at all.

Sometimes, the eardrum became inflamed due to a traumatic flight with difficulty popping the ears and inability to equalise the eardrum pressures. So people usually try to repeatedly blow their nose or pop their ears by straining too hard. This then causes barotrauma or pressure-related trauma to your poor eardrums. When we examine these ears, we usually see signs of bleeding or blood clots behind the eardrums. Air bubbles or fluid levels may be visible too behin the eardrum.

5. EUSTACHIAN PRESSURE TUBE CONGESTION

As described above, it may be the swelling and inflammation of you Eustachian pressure tubes which are causing your blocked ear. At our ENT specialist clinic in Singapore, we would usually check your eardrums and also the back of the nose with a small endoscope camera. We need to assess the postnasal space area which lies at the back of your nose. This is where the deeper end of the Eustachian pressure tube opens.

Sometimes we see clear signs of inflammation at the back of the nose like bleeding, swelling and yellow infected mucopus. We need to perform the endoscopy to exclude the possibility of an underlying nasal tumour which can present with a blocked ear like this.

Smokers and vapers have a higher risk of developing Eustachian pressure tube problems because the chemicals in smoke keep irritating the lining of the nose and throat. This chronic inflammation damages your Eustachian tubes after a while.

Other risk factors for Eustachian tube dysfunction include deviated nasal septum, allergic rhinitis, sinusitis and constant sniffing habits. Sniffing causes a “negative pressure” scenario at tne back of the nose to close down the nasal ends of the Eustachian pressure tubes repeatedly. If you are wondering why you or your child keeps sniffing again and again, it is probably due to poorly-controlled nasal allergies or allergic rhinitis!

6. ACTUAL HEARING LOSS!

Yes, that’s right! Sometimes, there is nothing physically blocking your ear or your nose. You feel fine except that you have this annoying blocked ear sensation and don’t hear as well compared to your other ear. Some people notice this difference when they put on their earphones or when they use their handphones.

We see about 3-4 cases every month of sudden hearing loss. It can occur to anyone at any time at any age. Sometimes, we don’t find any cause but the most common theory is viral inflammation of the inner ear. Sudden hearing loss or sudden blocked ear may be associated with dizziness, imbalance and vertigo. Tinnitus, an annoying buzzing or ringing noise in the ear, is also common with hearing loss.

Sudden hearing loss is an ENT emergency! So you need to see your doctor or friendly ENT specialist in Singapore for a checkup. You may need a course of oral steroids to maximise your hearing recovery. Intratympanic steroid injections into the eardrum may also be an option if you can’t tolerate oral steroids due to side effects. Rarely, if it happens to both ears, it may be linked to an underlying auto-immune condition such as lupus and rheumatoid arthritis.

You need an MRI scan of your inner ears to make sure sudden hearing loss is not caused by an acoustic neuroma. An acoustic neuroma is a benign inner ear nerve tumour which can present with sudden hearing loss. Many patients may not be aware that they have an acoustic neuroma if their hearing remains fine. An acoustic neuroma may only be detected as an incidental finding when patients undergo an MRI scan of their brain for other reasons such as for stroke screening.

Well, I hope my article has been helpful in teaching you all about the common problem of blocked ear!

Here are Dr Annabelle’s 5 handy tips on how to help your blocked ear get better:

1. Avoid digging your ear with cotton buds, Instead, try applying some olive oil drops to soften any existing earwax.
2. Avoid wearing earphones, especially for prolonged periods. Switch to headphones or bone conduction headphones, much kinder for your ears.
3. Try taking some decongestants such as Telfast-D or Zyrtec-D, in case your ears are congested due to Eustachian pressure tube problems from your nose.
4. Try gently pulling your ear outward, away from the side of your head. This may sometimes help to open up your ear canal and pressure tube.
5. Try yawning or opening your jaw wide which may help open up the congested Eustachian pressure tube, especially after a bad cold or flu.

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