Unblock ears, nose and sinuses

The causes of a sensation of having blocked ears can be considered anatomically, according to which part of the ear is causing the problem. There are three parts of the ear to think about. The outer or external ear canal on the outside of the ear drum; the middle ear which is the part of the ear between the ear drum and the inner ear; and the inner ear which as the name implies is deep inside and is the link to the brain.

The inner ear can sometimes be affected by viral infections like a cold and although this is rare, when it happens, it can cause nerve deafness. This may feel like a blocked ear. This should be treated urgently with a short course of high dose steroids aimed at reducing the risk of permanent deafness.

The middle ear is the area behind the ear drum (tympanic membrane) which contains bones called ossicles. These tiny bones, the malleus, the incus and the stapes, transmit vibrations of the eardrum caused by sound, into the inner ear. The middle ear has a ventilation tube along which fluid and air can pass into the back of the throat (pharynx). This is called the Eustachian tube and its function is to keep the pressure equal on both sides of the ear drum so that the ear drum and the ossicles are free to vibrate. Normally the Eustachian tube opens when we yawn or swallow and we sometimes notice our ears pop when we do this as the pressure equalises on either side of the ear drum.

When we have a cold the Eustachian tube becomes inflamed and blocked by swelling and mucus. This stops the pressure equalisation making our ears feel blocked and we become temporarily deaf as a result. Sometimes with a cold the stagnant mucus in our blocked ears and Eustachian tubes becomes infected causing severe pain and swelling inside the middle ear which can lead to the drum perforating and a sticky discharge from the ear. This is usually treated with antibiotics to encourage the drum to heal.

Similarly with air travel or going up and down a steep hill or long elevator ride, a difference in atmospheric pressure develops across the ear drum reducing its ability to move and making the ears feel blocked. The usual remedy in this situation is to hold your nose and blow hard to force air through the Eustachian tubes into the middle ear (known as a Valsalva manoeuvre) making the ears pop as the pressure equalises. If the tubes are inflamed and swollen this becomes impossible and the pressure difference across the ear drum tugs on it often causing pain in the ears which can be awful.

The same situation applies during scuba diving if equalisation of the pressure difference is not achieved during descent and ascent. In this case, because the pressure differences can be so large, severe damage (barotrauma) can occur. This can require surgery and may lead to permanent hearing loss.

Ear wax is a different problem altogether. The outer part of the ear naturally produces a waxy secretion, which if it accumulates in hard lumps can lead to temporary deafness by blocking the external ear canal.

Rather than take time off work to visit the doctor for diagnosis using his otoscope, then book one or several return visits for the nurse to wash out your ears, why not borrow our otoscope from Cupris and use it to send our doctors the video for diagnosis, then order Dr Morton’s Prescription^© for blocked waxy ears to free wax if needed.

Ear syringing used to be recommended as treatment by some doctors' surgeries but there is a risk of perforation or infection with ear syringing so it has become less popular recently. Regular use (every fortnight or so) of a few drops of olive oil into the external ear canal will often keep the wax from building up and hardening. It is helpful to have Dr Morton’s Prescription^© for blocked waxy ears because it comes with a pipette which you can place in the bottle of olive oil for clean storage and less mess after application. There are also some proprietary brands of wax dissolving or softening drops such as Cerumol which can be useful but occasionally cause irritation.

Cupris have designed a nifty otoscope which can be clipped onto an iphone 5 or 6 and the video sent to our doctors for analysis. If you want to borrow our otoscope click here to register your interest and we will send you one as soon as it becomes available.

A word about cotton buds. Many people are in the habit of cleaning their ears or trying to remove wax with cotton buds. This is not recommended because the 'skin' which lines the ear canal and the ear drum itself is very delicate and can be easily damaged leading to infection or perforation of the ear drum. Also, wax is rarely successfully removed in this way and more often is impacted against the ear drum making deafness worse and the wax itself harder to remove.

The external ear canal can also be blocked by debris from an infection in its own lining. This is known as otitis externa or swimmer's ear. This causes an itchy or sometimes very painful blocked ear and fluid discharge. Treatment is usually with drops which contain a mixture of antibiotics and anti-inflammatory steroids.

Sinuses are spaces that develop as out-pouches from the lining of the nose into the bones of the cheeks and brow. They are almost absent at birth but expand rapidly when your adult teeth erupt, and again at puberty. There are three groups of para-nasal sinuses:

• frontal sinuses – two sinuses found just above the eyes towards the centre of the face
• ethmoidal sinuses – a group of small sinuses found between the eyes and behind the bridge of the nose
• maxillary sinuses – found beneath the eye socket and above the upper row of teeth

When the lining of these sinuses is inflamed, more mucus is produced, and if the drainage channel from the sinus to the nose becomes blocked, high pressure develops inside these small spaces giving severe pain. Typically if you bend forward the pain is worse making you want to hold your brow and face. Stagnant mucus makes bacterial infection more likely (acute sinusitis) and subsequent chronic inflammation (chronic sinusitis) may follow.

Sinusitis can be

• acute: an infection lasting several days (usually viral)
• subacute: inflammation lasting several weeks
• recurring: >3 acute episodes in a year
• chronic: symptoms carry on indefinitely