We've all had that feeling of blocked ears on a flight. Usually it will clear easily by blowing the nose or swallowing. But what happens if it doesn't clear? This is when you should see an ENT doctor to try and relieve the blockage. Persistent ear block can lead to pain or even hearing loss. The following article explains a little more about the what might be causing the problem and how best to treat it.​

What is the Eustachian tube?
The Eustachian tube is a cartilaginous and bony tube providing a connection between the back of the nose (nasopharynx) and the middle ear. At rest, the Eustachian tube is closed, but it opens when you swallow, yawn or sneeze. It can also be opened forcefully by raising pressure in your nasopharynx by blowing your nose and “popping” your ears. When the Eustachian tube opens, it allows the equalising of pressure between the external environment and the middle ear by allowing a small amount of air to pass through.​

What are the symptoms of Eustachian tube dysfunction?
When the Eustachian tube does not work very well, a number of different symptoms can occur. These include:
Ear block
​Pain
Feeling of fullness in the ear
Ringing in the ears (tinnitus)
Difficulty hearing
Dizziness or balance problems​

​What causes Eustachian tube dysfunction?
The main causes of Eustachian tube dysfunction are conditions that lead to swelling in the nose and nasopharynx. These include upper respiratory tract infections, allergy, pollution, and smoking. Other triggers include extreme pressure changes that occur when flying or SCUBA diving, and temporomandibular joint (TMJ) disorders. 

How is Eustachian tube dysfunction treated?
Firstly, it is important to see an ENT doctor to exclude other common causes which often produce similar symptoms (e.g. impacted ear wax, outer or middle ear infection, sudden sensorineural hearing loss, or ear drum perforation).
Once these other causes have been excluded, the ENT specialist will usually try medication to reduce the swelling which is the causing the blockage of the Eustachian tube. These include nasal decongestants (e.g. Afrin, Iliadin), topical nasal steroid sprays (e.g. Avamys, Nasonex) and antihistamines with decongestants (e.g. Telfast-D, Zyrtec-D).

If the medication doesn’t work, then the patient can consider a procedure in order to relive the symptoms. A small cut in the ear drum can be done under local anaesthetic (myringotomy). If this helps, then a small tube (grommet) can be inserted to keep the hole open. This has several disadvantages, however. In Singapore (because of the humidity), the risk of an ear infection is high – this is more likely if the patient swims regularly. It also cannot be used if the patient is a SCUBA diver.

​A promising new treatment – first described in 2011 and only available in Singapore in the last 6 years - is to use a high-pressure balloon to widen the cartilaginous Eustachian tube. Known as Balloon Dilation of the Eustachian tube or Balloon Eustachian Tuboplasty, this simple procedure restores normal tube function and can reduce or resolve the patient’s symptoms. It is usually performed under a short general anaesthetic in day surgery; however, it is increasingly being offered under local anaesthetic. During the operation, a probe is inserted into the affected Eustachian tube and a special balloon is inflated to a set diameter at high pressure (10 bar). You can see a video of the procedure here. Complications from the procedure are rare and the recovery is very quick.

If you see an ENT doctor in Singapore with a blocked nose or sinus infection, he or she will often consider allergy as an underlying risk factor. The commonest allergy in Singapore is house dust mite allergy. About 80% of the adult population in Singapore has evidence of house dust mite allergy (IgE antibodies) but only half (roughly 40%) will develop symptoms of allergic rhinitis (swelling of the nasal lining).​
Avoiding exposure to dust mites is the best strategy for controlling dust mite allergy. While you can't completely eliminate dust mites from your home, you can significantly reduce their number.
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