Devices That Help Fix Clogged Ears

Clogged ears due to eustachian tube dysfunction or fluid in the ears is one of the most common complaints seen in an ENT clinic. Beyond medications like steroids & nasal sprays or even surgery (ear tubes) to resolve this complaint, a fundamental physical maneuver the patient MUST also be doing is called "valsalva". Valsalva is the attempt to "pop" the ears by yawn, swallow, or attempting to gently blow air out the nose that is pinched shut.

The yawn and swallow are passive maneuvers to pop the ear whereby trying to gently blow air out the nose while keeping it pinched shut to create intra-nasal pressure is an active maneuver.

The key concept is that medications do not pop the ears for you... YOU have to pop the ears yourself. Medications just help accomplish this task.

Typically, when things are truly clogged and it is very difficult if not impossible to pop the ears open, actively trying to pop the ears open is key. Yawning and swallowing typically is ineffective.

However, there are patients who can't quite grasp the idea of HOW to pop the ears by nose pinching. OR, they are too scared that they might rupture their eardrums (which could happen if the nose-blowing is too aggressive).

Furthermore, what about the 2 years old who doesn't even understand how to nose-blow let alone valsalva?

As such, there are two main devices to perform the active valsalva for such individuals. Please note, I have no financial ties to either companies to disclose.

Otovent

The first is a simple balloon called Otovent (can be purchased on Amazon). In essence, you snug the balloon up against the nose and try to inflate the balloon up. The balloon itself provides the necessary and sufficient back-pressure into the nose resulting in an active valsalva. This is mainly used by children who can appreciate the visual feedback.

EarPopper

The second is an electronic device, EarPopper (also can be purchased on Amazon), that pushes air into the nose. So, rather than having the lungs "push" air into the nose to create intra-nasal air pressure, this device replaces the lungs and pushes air into the nose from the front. This device comes in two flavors: Home and Pro versions.

Please keep in mind that there's another electronic device which supposedly helps with ear popping called EarDoc which is not recommended as it uses an unproven concept.

So there you have it...

Read more about this condition here.

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

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.

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

This blog article is a reprint of the original Fauquier ENT webpage article found here.

Introduction (Click here to skip to nasal spray use) Before going into an explanation of why there are occasions when the ear doesn't feel right (ear fullness, clogged ears) or makes unusual noises (ear crackling/popping), one must understand the anatomy of how the ear works when things are normal. If your ears hurt, click here. To the right is a diagram of a normal ear with structures labelled. The middle ear space (colored in with yellow) is an air-filled region of the ear that is cut-off from the outside world except for one 1.5 inch long passageway called the eustachian tube which opens into the back of the nose (see picture or video). If the eustachian tube doesn't open normally, the middle ear space becomes isolated.

Image is a modification of that found in Wikipedia under GNU Free Documentation License.

When the eustachian tube functions normally, every single time you swallow, yawn, blow your nose, etc, your ear "pops". This popping is when the eustachian tube opens transiently allowing air to pass from the middle ear to the back of the nose which is open to the environment.

Watch video explaining this phenomenon.

SO, why does my ear feel full sometimes?

Assuming there is no earwax present which could cause symptoms of ear fullness, for most people, the ear fullness is due to their inability to pop their ears easily (or, open up the eustachian tube). Why would this cause ear fullness (and if severe enough, a persistent ear pain)? It's because there is a PRESSURE difference between the air pressure in the middle ear and the pressure outside across the eardrum. When there is a pressure difference, the eardrum either bulges outward (positive pressure) or bulges inward (negative pressure). Basically, when the eardrum bulges inward or outward, it creates a sensation of fullness for the person.

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Eardrum bulges inward when the pressure outside is greater than the pressure in the middle ear space (ie, occurs when a plane is landing or if you dive deep into water)... The first picture reveals a pressure of "30" outside the ear (remember, the ear canal is open to the outside) whereas the pressure is only "10" inside the ear. This will cause the eardrum to bulge inward until the pressure outside and inside the ear matches at "30."

Images are a modification of that found in Wikipedia under GNU Free Documentation License.

Eardrum bulges outward when the pressure outside is less than the pressure in the middle ear space (ie, occurs when a plane is taking off or if you drive up a tall mountain)... The situation is reverse from that above. With the middle ear pressure of "30" being more than the ouside pressure of "10,", the eardrum bulges outward until the pressure inside and outside matches at "10."

Images are a modification of that found in Wikipedia under GNU Free Documentation License.

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Normally, by popping your ears, the pressure difference will normalize (ie, no pressure can build up in a balloon if there is a hole) and the eardrum will go back into a neutral position. If the pressure difference is severe, the eardrum can bulge to the point it can pop like a balloon, a situation known as a perforated eardrum. Of note, people suffering predominantly from negative ear pressure are at risk of developing fluid in the middle ear which may lead to middle ear infections (otitis media) and hearing loss. So, what would cause the eustachian tube to not open up properly? Well, something could be physically blocking the opening of the eustachian tube in the nose, most notably large adenoids. In rare cases, it could even be a tumor. Endoscopy is required to evaluate for these possibilities. More commonly, the eustachian tube does not open properly due to inflammatory conditions, especially allergies, resulting in the tube becoming inflamed and swollen. That's why when people get a cold or allergies are bad, their ears also becomes affected. This condition is known as Eustachian Tube Dysfunction.

To read more about this condition and how to treat it, click here.

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