Have you ever wondered why your ears pop when you fly on an airplane? Or why, when they fail to pop, you get an earache? Have you ever wondered why the babies on an airplane fuss and cry so much during descent? Ear problems are the most common medical complaint of airplane travelers, and while they are usually simple, minor annoyances, they occasionally result in temporary pain and hearing loss.
It is middle ear that causes discomfort during air travel because it is an air pocket inside the head that is vulnerable to changes in air pressure. Normally, each time (or each second an third time) you swallow, your ears make a little click or popping sound. This occurs because a small bubble of air has entered your middle ear, up from the back of your nose. It passes through the Eustachian tube, a membrane-lined tube about the size of a pencil lead that connects the back of the nose with the middle ear. The air in the middle ear is constantly being absorbed by its membranous lining and resupplied through the Eustachian tube. In this manner, air pressure on both sides of the eardrum stays about equal. If, and when, the air pressure is not equal the ear feels blocked.
The Eustachian tube can be blocked, or obstructed, for a variety of reasons. When that occurs, the middle ear pressure cannot be equalized. The air already there is absorbed and a vacuum occurs, sucking the eardrum inward and stretching it. Such an eardrum cannot vibrate naturally, so sounds are muffled or blocked, and the stretching can be painful. If the tube remains blocked, fluid (like blood serum) will seep into the area from the membranes in an attempt to overcome the vacuum. This is called “fluid in the ear,” serous otitis or aero-otitis.
The most common cause for a blocked Eustachian tube is the common cold. Sinus infections and nasal allergies are also causes. A stuffy nose leads to stuffy ears because the swollen membranes block the opening of the Eustachian tube.
Air travel is sometimes associated with rapid changes in air pressure. To maintain comfort, the Eustachian tube must open frequently and wide enough to equalize the changes in pressure. This is especially true when the airplane is landing, going from low atmospheric pressure down closer to earth where the air pressure is higher. Actually, any situation in which rapid altitude or pressure changes occur creates the problem. You may have experienced it when riding in elevators or when diving to the bottom of a swimming pool. Deep sea divers, as well as pilots, are taught how to equalize their ear pressure. You can learn the trick too.
Swallowing activates the muscles that open the Eustachian tube. You swallow more often when you chew gum or when mints melt in your mouth. These are good air travel practices, especially just before take-off and during descent. Yawning is even better. Avoid sleeping during descent because you may not be swallowing often enough to keep up with the pressure changes. If yawning and swallowing are not effective, pinch your nostrils shut, take a mouthful of air, and force the air into the back of your nose as if you were trying to blow your nose. When you hear a pop, you’ll know you have succeeded. You may have to repeat this several times during descent.
Babies cannot intentionally pop their ears, but popping may occur if they are sucking on a bottle or pacifier. Feed your baby during the flight, and do not allow him or her to sleep during descent. Children are especially vulnerable to blockages because their Eustachian tubes are narrower than in adults. Even after landing you can continue the pressure equalizing techniques, and you may find decongestants and nasal sprays to be helpful. If your ears fail to open or if pain persists, you will need to seek the help of a physician who has experience in the care of ear disorders. The ear specialist may need to release the pressure or fluid with a small incision in the ear drum.
Many experienced air travelers use a decongestant pill or nasal spray an hour or so before descent. This will shrink the membranes and help the ears pop more easily. Travelers with allergy problems should take their medication at the beginning of the flight for the same reason. However, avoid making a habit of nasal sprays. After a few days, they may cause more congestion than relief.
Decongestant tablets and sprays can be purchased without a prescription. However, they should be avoided by people with heart disease, high blood pressure, irregular heart rhythms, thyroid disease, or excessive nervousness. Such people should consult their physicians before using these medicines. Pregnant women should likewise consult their physicians first.
Swimmer's ear is an infection of the outer ear structures. It typically occurs in swimmers, but since the cause of the infection is water trapped in the ear canal, water from bathing or showering may also cause this common infection. When water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing infection and irritation of the ear canal. If the infection progresses it may involve the outer ear.
Treatment for the early stages of swimmer’s ear includes careful cleaning of the ear canal and eardrops that inhibit bacterial growth. Mild acid solutions such as boric or acetic acid are effective for early infections. For more severe infections, if you do not have a perforated eardrum, ear cleaning may be helped by antibiotics. If the ear canal is swollen shut, a sponge or wick may be placed in the ear canal so that the antibiotic drops will be effective. Pain medication may also be prescribed.
Follow-up appointments are very important to monitor progress of the infection, to repeat ear cleaning, and to replace the ear wick as needed. Your otolaryngologist has specialized equipment and expertise to effectively clean the ear canal and treat swimmer’s ear.
The most common symptoms of swimmer’s ear are mild to moderate pain that is aggravated by tugging on the outer ear and an itchy ear. Other symptoms may include any of the following:
An itchy ear is a maddening symptom. Sometimes it is caused by a fungus or allergy, but more often it is a chronic dermatitis (skin inflammation) of the ear canal. One type is seborrheia dermatitis, a condition similar to dandruff in the scalp; the wax is dry, flaky, and abundant. Some patients with this problem will do well to decrease their intake of foods that aggravate it, such as greasy foods, carbohydrates (sugar and starches), and chocolate. Doctors often prescribe a cortisone eardrop at bedtime when the ears itch. There is no long-term cure, but it can be kept controlled.
A dry ear is unlikely to become infected, so it is important to keep the ears free of moisture after swimming or bathing. Q-tips should not be used for this purpose, because they may pack material deeper into the ear canal, remove protective earwax, and irritate the thin skin of the ear canal creating the perfect environment for an infection. The safest way to dry your ears is with a hair blow-dryer. If you do not have a perforated eardrum, rubbing alcohol or a 50:50 mixture alcohol and vinegar used as eardrops will evaporate excess water and keep your ears dry. Before using any drops in the ear, it is important to verify that you do not have a perforated eardrum. Check with your otolaryngologist if you have ever had a perforated, punctured, or injured eardrum, or if you have had ear surgery.
People with itchy ears, flaky or scaly ears, or extensive earwax are more likely to develop swimmer's ear. If so, it may be helpful to have your ears cleaned periodically by an otolaryngologist.
Cerumen or earwax is healthy in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of ear canal skin from the eardrum to the ear opening. Old earwax is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out.
Earwax is not formed in the deep part of the ear canal near the eardrum, but in the outer part of the canal. So when a patient has wax blockage against the eardrum, it is often because he has been probing the ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper.
Under ideal circumstances, the ear canals should never have to be cleaned. However, that isn’t always the case. To clean the ears, wash the external ear with a cloth, but do not insert anything into the ear canal.
Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops, such as Debrox® or Murine® Ear Drops in the ear. These remedies are not as strong as the prescription wax softeners but are effective for many patients. Rarely, people have allergic reactions to commercial preparations.
Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax. Rinsing the ear canal with hydrogen peroxide (H2O2) results in oxygen bubbling off and water being left behind—wet, warm ear canals make good incubators for growth of bacteria. Flushing the ear canal with rubbing alcohol displaces the water and dries the canal skin. If alcohol causes severe pain, it suggests the presence of an eardrum perforation.
Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal, causing a blockage.
The outer ear is the funnel-like part of the ear that can be seen on the side of the head, plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass—narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out, and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off.
If the home treatments discussed in this leaflet are not satisfactory, or if wax has accumulated so much that it blocks the ear canal (and hearing), a physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out. Occasionally, an otolaryngologist (ear, nose, and throat specialist) may need to remove the wax using microscopic visualization. If there is a possibility of a hole (perforation or puncture) in the eardrum, consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause an infection. Certainly, washing water through such a hole could start an infection.
No, ear candles are not a safe option of wax removal as they may result in serious injury. Since users are instructed to insert the 10” to 15”-long, cone-shaped, hollow candles, typically made of wax-impregnated cloth, into the ear canal and light the exposed end, some of the most common injuries are burns, obstruction of the ear canal with wax, or perforation of the membrane that separates the ear canal and the middle ear.
Even though ear candling is an ancient practice with the intent to treat a wide variety of ear maladies including cerumen impactions, ear infections, hearing loss, tinnitus, Ménière’s disease, sinusitis, headaches, inhalant allergies, and many other conditions, the FDA has never cleared or approved marketing the products as a medical treatment.
The U.S. Food and Drug Administration (FDA) became concerned about the safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. Although there are proponents who argue in favor of the use of ear candles, the FDA is unaware of any controlled studies or other scientific evidence that support the safety and effectiveness of these devices for any of the purported claims or intended uses as contained in the labeling.
Based on the growing concern associated with the manufacture, marketing, and use of ear candles, the FDA has undertaken several successful regulatory actions, including product seizures and injunctions, since 1996. These actions were based, in part, upon violations of the Food, Drug, and Cosmetic Act that pose an imminent danger to health.
Bryn Mawr Hospital MOB North
830 Old Lancaster Road, Suite 200
Bryn Mawr, PA 19010
Main Line Health Center in Newtown Square
3855 West Chester Pike, Suite 245
Newtown Square, PA 19073
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