DR. HOOK- Say what? An earful about Eustachian tubes

the handsome doctor John Hong of Charlottesville

Ears burning? Maybe someone is talking about you! It's like that Bonnie Raitt song, "Something to Talk About." Or– could it be that you're paranoid or super egocentric? 

Really, in the end, it doesn't matter what people think about you– but then again, as I've learned on Wisteria Lane (i.e. Desperate Housewives), it does matter what people do to you: sabotage, petty alliances, arson, murder. 

So what do you do if your ear feels all plugged up? Hire a private investigator?

Eustachian tube dysfunction is something I know pretty well. I have it! I can always tell when it's going to rain because my right middle ear gets all congested, I hear my voice differently (like talking while wearing ear plugs), and there is discomfort. (Also I can tell someone is talking about me– but only nice things, of course.)

The ear has three sections. The external ear consists of the ear lobe and ear canal. The middle ear, behind the ear drum, has "instrumental" bones to transmit sound to the inner ear (kind of like the needle on a record player picking up information from the vinyl). The inner ear is the site of the balance center and also the neurological hearing center. This neurological center takes the mechanical information tapped out by the middle ear and converts it to "digital" for the brain.

The middle ear is filled with gas (and you thought you only had gas somewhere else!) and is pressure sensitive. The ear drum is the bubble casing separating the middle ear from the outside world. Gas leaks out of the middle ear through absorption by the lining of the mucous membranes, and that leads to low pressure. How does this pressure get normalized? 

Voila, the Eustachian tube! This tube originates in the nasopharynx (just above your throat that you see when you look in the mirror and say "Ah") and connects to the middle ear. So when you yawn, swallow, or valsalva (apply positive pressure), air is blown back into the middle ear, making the middle ear pressure match the atmospheric pressure.

However, if one isn't able to adjust the pressure in the middle ear well, the ear drum won't vibrate correctly. That causes impaired hearing (hmm, maybe that's the problem with people who don't listen), discomfort, a sense of being "blocked"– and worse case scenario, barotrauma. 

The main cause of barotraumas is– quoting Tattoo– "The plane, the plane!" Yes, airplane flights.

Usually, the barotraumas occur when the plane is descending to land. As the outside pressure increases during descent, the middle ear needs more air. If the passengers don't "pop" their ears open, the outside pressure can push the ear drum in and bruise it, make it bleed, and cause swelling. 

This swelling can cause havoc in the middle ear. Tinnitus (ringing in the ear) is often pulsatile, so people may worry they have a brain aneurysm since they think they hear their pulse. If trauma extends to the inner ear, some important membranes can rupture, leading to vertigo and major hearing loss. Scuba divers are also susceptible to this.

So what's a person to do? If there is Eustachian tube dysfunction due to infection (like a cold, inner ear infection), avoiding a plane flight or scuba diving is advised. If flying, a decongestant an hour before flight might help, as well as chewing gum. In particular for smokers, an ear/nose/throat evaluation for a tumor blocking the Eustachian tube is worthwhile.

Many of us have "selective hearing," but with my Eustachian tube dysfunction, I can always do the Milli Vanilli thing: "Blame It on the Rain."


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.