ASK THE DOCTOR: Eustachian tubes can easily clog
By DR. JIM MITTERANDO

Q My ears have been popping for two weeks and occasionally hurt. I have an upcoming airplane trip. What can I do to get rid of this problem? Can I fly?

A You are having problems with your eustachian tubes, which carry air from the throat to the middle ear in order to equalize pressure on both sides of the ear drum. During a cold, illness or seasonal allergy, the eustachian tube becomes congested and swollen so that it may temporarily close; this prevents air flow behind the ear drum and causes ear pressure, pain or popping just as you experience with altitude change when traveling on an airplane or an elevator. If the eustachian tube remains blocked, a vacuum can develop behind the ear drum sucking it inward and allowing fluid to accumulate. If the fluid does not drain, bacteria can multiply causing an ear infection. Sometimes fluid can persist for months producing a temporary hearing loss.

Most ear aches are not ear infections but rather pressure problems. Infants are more prone to ear aches because their eustachian tubes do not function as well. Antibiotics do not improve tube dysfunction.

If ear pain persists, you should see your doctor. In the past, all ear infections were treated with antibiotics. We now know that most ear infections resolve without any treatment so that watchful waiting is an acceptable approach.

Treatment for eustachian tube dysfunction includes pinching your nose and blowing - this forces air up the tube and pops the ear drum back into place. Scuba divers commonly employ this technique when they descend in the water.

Decongestant pills containing pseudoephedrine (Sudafed) can decrease swelling of the eustachian tube to allow greater airflow through the tube and help relieve pressure problems. Pseudoephedrine should be limited to daytime usage to avoid sleep problems.

Studies have shown that decongestants are not helpful in children younger than 5 years old and may cause side effects such as agitation and insomnia. Decongestants do not prevent ear infections in young children.

Steroid nasal sprays (Flonase, Nasonex, Nasacort, Rhinocort) may decrease the inflammation and swelling of the tubes and may help with persistent tube dysfunction.

The pressure changes associated with flying can damage ears and sinuses when you have severe nasal congestion or tube problems. It’s a good idea to avoid flying when you have these problems. If you have a bad cold or allergy and must fly, you may want to take pseudoephedrine one hour before your flight and use neosynephrine nasal spray when you board the plane. During liftoff, swallowing, yawning and chewing gum can help equalize ear pressure. When descending, you can also try pinching your nose and blowing to pop the ears.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2003 The Patriot Ledger
Transmitted Tuesday, October 07, 2003