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Why do your ears pop when you are sick? Dr. Altman’s answer

Sound is conducted through the ear as follows:

  • The outer ear collects and directs sound waves from the environment through the ear canal to the tympanic membrane. The tympanic membrane (ear drum) is a thin membrane that separates the outer ear from the middle ear.
  • Sound waves cause the vibration of the ear drum, which in turn transmits those vibrations to three tiny bones in the middle ear, called the ossicles, which causes the ossicles to vibrate.
  • The stapes, the innermost of the three ossicles, is connected to the oval window. The vibration of the stapes transmits the sound signal to the inner ear, where it is picked up by the nerves and sent to the brain.

The ability of the ear drum to vibrate depends on equal pressures in the ambient environment and in the middle ear.

Anatomy of Human Ear

Anatomy of the Human Ear

Eustachian tube is a tube that connects the back of the nose and the middle ear space (http://www.medicinenet.com/eusta…). The primary function of the Eustachian tube is to ventilate the middle ear space and to ensure that pressure inside the middle ear and in the ambient environment remain very similar (http://en.wikipedia.org/wiki/Eus…).

The Eustachian tube is normally closed. That protects the middle ear from contamination by secretions from the nose. Swallowing or yawning opens the Eustachian tube and allows air to flow into or out of the middle ear, keeping the air pressure on both sides of the eardrum equal. That is accomplished by several small muscles in the back of the throat. In addition to regulating pressure in the middle ear, the Eustachian tube also serves to drain any secretions from the middle ear into the nose.

The Eustachian tube is lined by the same epithelium as the nose and responds to allergies, upper respiratory infections, etc the same way the nose does, that is by swelling and increasing secretions of mucus.

If the Eustachian tube is blocked, the air pressure in the middle ear is different than the pressure on the outside of the eardrum. Partial or complete blockage of the Eustachian tube can cause sensations of popping, clicking, and ear fullness.

Increased pressure in the middle ear leads to barotrauma – discomfort and possible damage in the ear due to pressure differences between the inside and outside of the eardrum.

Barotrauma commonly occurs with altitude changes, such as flying, scuba
diving, or driving in the mountains. If you have a congested nose from allergies, colds, or an upper respiratory infection, you are more likely to develop barotrauma.

The most common cause of Eustachian tube blockage is a cold. It can also be caused by sinus infections, allergies, enlarged adenoids, and some rare causes like tumors. Children are particularly prone to blockages of these tubes because in childhood the Eustachian tube is more narrow and horizontal in orientation than in adults. This leads to an increased rate of middle ear infections.

Prolonged barotrauma can lead to:

  • Ear pain
  • Feeling of pressure in the ears (as if underwater)
  • Moderate to severe hearing loss
  • Nosebleed

To relieve ear pain or discomfort, first try to open the eustachian tube and relieve the pressure.

  • Chew gum
  • Inhale, and then gently exhale while holding the nostrils closed and the mouth shut
  • Suck on candy
  • Yawn

If these maneuvers do not help, medications may be necessary to decrease congestion in the nose and Eustachian tubes.


1. Eustachian Tube Problems.  Medicinenet.  http://www.medicinenet.com/eustachian_tube_problems/article.htm

2. Ear Barotrauma.  Medline Plus http://www.nlm.nih.gov/medlineplus/ency/article/001064.htm

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