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Clogged Ears Can Be Caused by Issues in the Outer, Middle, or Inner Ear
Interviewer: If you've ever felt like your ears are constantly clogged, you're not alone. Today we're joined by Kelly Trythall. She's a physician assistant specializing in ear, nose, and throat care at University of Utah ÐÇ¿Õ´«Ã½ and is going to hopefully help us understand what's going on when our ears don't seem to clear.
So the very first question is, what's happening when somebody feels like their ears are clogged? I'm going to suspect there's probably a lot of possible things, so let's just discuss it.
Earwax
Kelly: Yes, there are definitely quite a few reasons why the ears can feel clogged. The sensation can come from the outer ear, the middle ear, and even the inner ear, too. It all just depends on the source. Those common sources, wax, definitely, can be a reason why your ears are plugged. That would be the sensation that's coming from the . . . that's what I mean when it's coming from the outer ear.
Eustachian Tube Dysfunction
The eustachian tube is definitely another one, and living in Utah, that would be something that most people recognize if they drive up the canyon, and there are lots of elevation changes in this area of the country. And so the eustachian tube is one that is in the back of the nose and connects to the ear. And if it's not opening and closing as well as it should be, then negative pressure builds up in the ear, and that makes our ear feel plugged and clogged as well.
Hearing Loss
Other sources, believe it or not, actually, your jaw can make you feel like your ear is plugged. Just because it's in close proximity to the ear and we've got nerve endings that come to the ear, and they come to the jaw. The inner ear is also a source of fullness or plugged, and that tends to happen, actually, just with normal hearing loss. So over time, as hearing declines, we get the sensation of the ears feeling plugged, associated with the hearing loss even.
Patients Often Describe the Sensation as Muffled, Full, or Plugged
Interviewer: So when somebody comes to you and they're complaining that they feel like their ears are constantly clogged, I would imagine, well, like what are some of the words that people use to describe that? Like, I just don't hear as well, things sound kind of dull. How do people express that?
Kelly: Usually, muffled, or full, plugged, these would be the most common things people say. And then the first step here is just going to be to look in the ear, right, and say, "Oh, is it anatomically normal? Is there wax here plugging the ear?" And if not, then the next step is actually to do a hearing test.
Interviewer: Okay. I wouldn't have expected that to be the second step. I would imagine you're doing that because that would be the second most common thing.
Kelly: Yeah. Well, you know, it's important to know if there are any hearing changes in the ear because, like I said, hearing changes can bring about the plugged feeling. And so if you have a normal-looking ear, it's not plugged by wax or fluid in the middle ear, then we need to know the status of the hearing in the inner ear.
If the Ear Looks Normal, a Hearing Test Is the Next Step
Interviewer: Okay. And if you do a little hearing test and everything kind of seems normal there, then is there something beyond that, or just generally the hearing test kind of uncovers something at that point?
Kelly: If the hearing test is normal, then it tells me that it's not coming from the inner ear, and we are thinking more about either the eustachian tube being a contributor or the jaw being a contributor, because that's certainly not going to affect your hearing.
Ears Can Feel Plugged Even Without Changes in Elevation
Interviewer: So I'm going to give a little personal story. So I've had that muffled sound because of earwax, and that was fairly easy for me to kind of figure out because it was just one ear. And I went in, and sure enough, there was some earwax plugging, and they took that out, and all of a sudden I could hear like high frequencies, especially again, right. Like when I'm in my car listening to my radio, I can hear the vocals better again, and some of those higher instruments.
I've also had an instance where in the car I've been driving like you talk about, where maybe you're changing elevations, and I do the plug my nose and gently apply some pressure to try to stabilize the pressure and the eustachian tubes. But there are times when like I'm not going up and down, and I do that, and it clears up, and I hear things clearly again. And then a few seconds later, it just kind of clogs back up again. That doesn't sound like an altitude thing. What could that possibly be?
Kelly: You know, it is actually still related to the eustachian tube because the eustachian tube is a muscular tube, and those muscles are actually contracting and expanding hundreds of times a day. And so it is doing that, even when you're not changing elevations, to keep your ear feeling normal. It's just that when you are changing elevations, it's really having to do it. But even when you're at the same elevation, you have to equalize your ears, too. And that's why when you do that, I call that an auto-insufflation, where you plug your nose and blow out the nose to kind of you're forcing air up the eustachian tube and equalize it.
Nasal Congestion and Allergies Can Directly Impact Ear Pressure
Interviewer: All right. And if it's clearing up and then quickly it's not clearing up, is there something going on in there that I should be concerned about, or that I could see you for, that would help where I can hear?
Kelly: Yes, for sure. You know, if it's not clearing up, then (a) you probably have to look a little closer at the source. Or is there fluid that's there too, then that's like blocking you from being able to open it up that way. And so that's where that exam is really important, and knowing: Is it normal looking? Is the hearing normal to revisit what the source is if it's not improving?
Interviewer: Got it. Like, if you have allergies or anything of that nature, can that impact your ears feeling clogged a lot?
Kelly: Totally. When you have allergies or when you're sick with a cold and have lots of nasal congestion because the eustachian tube is in the back of the nose, all that swelling and congestion that's happening is reducing the eustachian tube's ability to equalize the ear. So the tube's a little bit more swollen. It's not able to open and close as well because of that. And that tends to be why our ears feel more plugged when we're sick or have lots of nasal mucus and congestion.
Jaw Tension or Muscle Tightness Can Mimic Ear Fullness
Interviewer: Are there some other common causes that can cause the eustachian tubes to have some sort of an issue? I guess that's really kind of where a lot of the variables are, right? Like, if the jaw is in alignment or not, then that's pretty cut and dry, right, or no? You tell me.
Kelly: Sometimes, yeah.
Interviewer: Okay.
Kelly: And sometimes it has to do with the surrounding muscles of the jaw. So not the actual joint itself being aligned, but just the musculature that works it. If there's tension or tightness in those, it can create a plugged feeling. A lot of times, I think with the jaw, people do start to experience some pain too, which would not be super common, not as common with the eustachian tube.
Over-the-Counter Remedies
Interviewer: Is there anything that somebody can do on their own, as opposed to coming into a professional to have that looked at, to perhaps take some steps to try to clear if they're finding that the sensation of being plugged all the time is bothersome to them?
Kelly: So you can certainly try some over-the-counter medications to manage allergies or an acute cold. But if it's something that's lingering and is not getting better, it's worth having checked out because of those other potential sources and, actually, the fact that hearing loss can be a source of fullness. So we need to get more information as to why those things are not helping you.
If You've Tried Home Remedies Without Success, It's Time to See a Specialist
Interviewer: So, in my instance, I would like to be able to not have that plugged feeling and I just, like I said, I feel as though that I can kind of clear them, and then within a second, or even sitting at my desk here a second or two, it kind of goes back to that plugged state again. Is that something you think you could actually help with if I came in and you took a look at my ears?
Kelly: Yeah. So, with the proper evaluation and exam with a normal ear, if we decide that it is a eustachian tube issue, there are other ways to equalize the ears, such as using PE tubes or pressure equalizing tubes, like you would put in a kid. You can do that in adults. Sometimes it's helpful for that plugged feeling, sometimes not. But that's a discussion of risk and benefit, right, with your provider, and an important step to kind of getting to the bottom of it.
Interviewer: Do you have anything that you would like to say to somebody listening who is experiencing this issue right now?
Kelly: I would say that if this is an issue that you have tried medications for at home, those over-the-counter things, and it's not getting better, then definitely something that you should have looked at by a medical professional and to determine that the ear is normal and if the hearing is okay. And then discuss potential sources.