Ear Fullness

What is Ear Fullness?

Ear fullness is a sensation that your ear feels blocked or filled with pressure, much like the feeling you might experience during a flight or when you have a cold. It can affect one or both ears and can vary in intensity from mildly annoying to severely uncomfortable.

This sensation can be temporary or persistent, depending on the underlying cause. While ear fullness is often not serious, it can sometimes indicate a more significant issue that needs medical attention.

Common Causes of Ear Fullness

I would categorize the causes of ear fullness into "obvious ones" and "less obvious ones".

The obvious causes are the ones easily diagnosed by otoscopy (examining the ear with a handheld illuminated device or with a microscope), because there is a clear abnormality of the ear canal, eardrum or middle ear:

• Foreign Body or Growths: A foreign object, cysts, or growths in the ear canal or middle ear can block the ear, causing fullness.
  
  
• Earwax Buildup: Excessive earwax can block the ear canal, leading to a feeling of fullness and sometimes reduced hearing.
  
  
• Middle Ear Infections (otitis media): Infections can cause fluid buildup behind the eardrum, leading to pressure and fullness.

If you're reading this article, chances are you're dealing with ear pressure and have been told that "everything looks just fine" inside your ear. In my practice as a neuro-otologist, the first three diagnoses listed below are by far the most common I encounter in patients where the ear canal and eardrum are normal on examination. This is even more true for young healthy individuals with no other medical problems. I also list a few other "less obvious causes" to consider: 

• Eustachian Tube Dysfunction: This occurs when that tube, which connects the middle ear to the back of the nose to help balance pressure in your ear, becomes blocked or doesn’t open properly, often due to allergies, a cold, or an natural weakness of the Eustachian tube.
  
  
• Patulous Eustachian Tube: In this condition, the eustachian tube remains abnormally open, causing you to hear your own breathing and voice echoing inside your ear, which creates a sensation of fullness.
  
  
• Temporomandibular Joint (TMJ) Disorders: Problems with the jaw joint, located close to the ear, can cause a sensation of fullness or pressure in the ear. Very common in individuals clenching or grinding their teeth at night.
  
  
• Sinus Infection or Inflammation: Inflammation and congestion in the sinuses can also affect the ears, causing a sensation of fullness.
  
  
• Cochlear hydrops: This disorder is caused by a buildup of pressure in the inner ear, leading to episodes of fluctuating hearing loss and a feeling of fullness in the ear. It can sometimes be a precursor to Ménière's disease, which would manifest with vertigo spells.  
  
  
• Barotrauma: Rapid changes in altitude or pressure, such as during flying or scuba diving, can cause ear fullness due to pressure imbalances (this could be categorized in the obvious causes if there is associated eardrum hemorrhage or perforation). 
  
  
• Acoustic Neuroma (vestibular schwannoma): It's a benign tumor on the hearing and balance nerve, and can press on structures in the ear causing fullness, hearing loss, and imbalance. This would rarely present with only ear pressure, so it's certainly not among the top diagnoses to consider.
  
  

When to Consult a Healthcare Professional

You should consider consulting a healthcare professional if the sensation of ear fullness persists for more than a few days, is accompanied by severe pain, hearing loss, dizziness, or discharge from the ear. These could be signs of a more serious condition that needs treatment.

Early consultation can help identify the cause and prevent potential complications. If you experience any of these symptoms, don’t hesitate to seek medical advice.

How Ear Fullness is Diagnosed

When you visit an ENT specialist, the diagnosis will typically start with a detailed medical history to understand your symptoms and any relevant background information.

You will be asked about :

• The onset, duration, and intensity of your ear fullness
• Any associated otologic ("ear") symptom: hearing loss, tinnitus, vertigo,  ear pain or drainage 
• Recent cold, flu or other respiratory tract infections
• History of ear infections in young age or any ear procedures 
• Smoking status
• Seasonal allergies
• Nasal congestion or other sinus-related symptoms 
• Jaw clenching or grinding
• Acid reflux (heart burn)
• List of current medications

The physical exam will include a micro-otoscopy to inspect the ear canal and eardrum closely, and a nasopharyngeal endoscopy to examine the nasal passages and Eustachian tubes. Additionally, a pinched-nose Valsalva maneuver (while looking at the eardrum under the microscope) might be performed to assess the function of the Eustachian tube and middle ear aeration status. A tuning fork test would allow screening for any hearing loss. Sometimes, a neuro-vestibular exam might be performed if you have associated dizziness.

Diagnostic tests for ear fullness are often needed if the initial examination doesn’t provide a clear answer. To avoid unnecessary or costly investigations, I never order all tests at once; instead, I proceed with a step-wise approach to rule-out the most common causes first:

 

• Audiogram (Hearing Test): By far the most important test to obtain in any individual suffering from ear fullness if the physical exam is normal. It is essential to exclude the possibility of underlying hearing loss that presents itself as a sensation of ear pressure.
• Tympanometry: This measures how well the eardrum moves in response to pressure changes, helping to diagnose middle ear problems. 
• Electrocochleography (ECoG): This tests allows us to measure the pressure of the inner ear.
• Eustachian Tube Function Tests: These tests assess how well your eustachian tube is working to equalize pressure in your middle ear. They may include methods like performing a Valsalva maneuver (blowing while pinching the nose) or a Toynbee maneuver (swallowing while the ear pressure is measured) to see if the tube is functioning properly.
• Allergy Testing: If allergies are suspected as the cause of eustachian tube dysfunction, allergy testing may be advised.
• CT or MRI Scans: These imaging tests may be ordered if there is a concern about tumors, structural issues of the middle or inner ear, or infection/inflammation deep within the ear or surrounding areas. Because they are costly and involve radiation (in the case of the CT scan), these are usually the last tests I order.
  
  

Treatment Options for Ear Fullness

The treatment for ear fullness depends on the underlying cause. This section provides an overview of treatment options, but for more comprehensive details, I would recommend visiting the articles that focus on these specific disorders.

In situations where the physical exam and most investigations turn out to be normal (a situation that is unfortunately quite common for ear pressure), the exact cause of ear fullness isn't immediately clear. Because the condition is benign, we would often initiate empiric treatment. This involves starting treatment based on the most likely suspected cause, such as using intranasal corticosteroid sprays for suspected eustachian tube dysfunction. The goal is to relieve symptoms while monitoring the response to treatment. If symptoms persist or worsen, more specific diagnostic tests may be ordered to pinpoint the exact cause, or another form of empiric treatment may be tried for the second most likely diagnosis. This "trial and error" process may take a few attempts to find the correct treatment that alleviates the symptom, pointing us towards the right diagnosis. 

Below are some examples of treatments:

For Eustachian tube dysfunction, decongestants, antihistamines, or nasal sprays might be recommended to reduce inflammation and open the tube. Sometimes, we recommend placing a tympanostomy tube (tube accross the eardrum) to help ventilate the ear, or proceed with surgical Eustachian tube dilation. 

 

For patulous Eustachian tube, a special formulation of Vitamin C nasal drops could be recommended.

 

For TMJ disorders, treatment might involve physical therapy, jaw exercises, or bite guards to address the jaw issues.

 

Middle ear infections may require antibiotics if they are bacterial, while sinus infections might be treated with decongestants or other medications.

 

In the case of cochlear hydrops, treatment could involve dietary changes such as low-salt diet, diuretic medications, or sometimes surgery (controversial).

 

For barotrauma, the focus is on relieving pressure through swallowing, yawning, or chewing gum, and in severe cases, medical intervention might be needed.

By understanding the potential causes and treatments for ear fullness, you can take steps to address the issue early and seek proper care if symptoms persist