Recurring ear blockage needs treatment or possibly surgery

Q. I have been having a problem with my ears since 2007. I have been to several ear-nose-and-throat doctors, but they all tell me I have dysfunctional Eustachian tubes and then give me medication.

My complaint is that my ears always feel plugged. I have tried several different medications, such as antibiotics, prednisone, nasal sprays and others. Most don't work. The one I am currently trying works sometimes but not all the time. My doctors have even gone as far as ordering a CT scan, but nothing abnormal was found. Please help me!

A. If several ENT physicians have diagnosed you with Eustachian-tube dysfunction (ETD), then I must assume they are correct. However, that doesn't mean there is no help for you. For your benefit, I will first discuss what this disorder is and then go into the various treatment options.

ETD is caused by a chronic blockage of the Eustachian tubes, which lead from the sinuses to the eardrum and equalize pressure within the ear. When a blockage occurs, it cuts off the space from the outside environment that creates a vacuum that can pull the eardrum backward into the ear, leading to pain, pressure and/or hearing loss. A common, temporary cause of this is flying. "Popping" the ears can reduce or resolve the symptoms.

In long-term blockages, fluid can accumulate within the tube, causing worsened symptoms and a feeling of the ear being plugged. (If bacteria get into the fluid, they can lead to middle-ear infection.) Common causes of ETD include inflammation or irritation of the nasal lining (owing to the flu, colds, etc.); pollution; cigarette smoke; nasal allergies; and more. Obesity can lead to fatty deposits near the passageway of the Eustachian tube and rarely, more serious conditions such as nasal polyps, a skull-base tumor or a cleft palate can be the cause.

ETD is most common in children because of an anatomical narrowing and flattening of the Eustachian tube. By about age 6, this changes into the common down-sloping shape seen in adolescents and adults.

Treatment depends on the cause. Allergies are a leading problem, so most physicians attempt to reduce the inflammation and allergic response. Allergy medications, nasal decongestants and steroids, such as prednisone, are commonly used. Self-inflation techniques may be advised in order to re-establish equalized pressure. The easiest way to do this is to blow up a balloon, which can be done several times a day if necessary. If these fail to provide results, further investigation is required to determine the underlying cause. If the dysfunction persists (as yours has), surgery may be an option. There are several types, but which one is done depends on the cause and severity of symptoms. Another important factor is whether or not there is a significant amount of fluid present.

Speak with your physician about whether surgery is an option.

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