I am often motivated to write about happenings in my life, whether with me, friends, family members or something I’ve heard or learned. Unfortunately, this time I was motivated by an ear issue my husband, Michael, experienced after 5 airplane flights, 3 high-altitude mountain drives, 2 snorkeling adventures and a respiratory virus.
In these years of pandemic, it’s difficult to think about a special season for colds or flu. But evidently, they haven’t gone away. Details become clear after-the-fact or after the season. There is not always a lot of agreement about what is currently happening or what to expect in upcoming months. That’s always rather true. (It’s also the reason we have never been able to determine with certainty WHICH flu virus will be greeted for that season, and why ingredients for shots have always been a ‘guess.’ It is possible that this is close to changing. Ah, but that’s another post.)
In 2020 and early 2021, the flu and respiratory viral cases seemed low (common colds not so much reduced). The virus and bacterial reductions were no real surprise since lots of people were social-distancing, wearing masks, staying out of public places and unfortunately often avoiding reporting problems for fear of going to the hospital.
There’s controversy over whether the flu season is still expected to be mild, but timing seems to be running amok. The CDC issued a warning in the summer (off-season) that respiratory virus (technically Respiratory Syncytial Virus – RSV) was increasing even before the fall. Not great for older adults (or children).
Ear Pain, Bleeding and Problems
There are numerous reasons for ear pain; some of which I am skipping here due to their rarity, clear causes or less common situations for adults. The skipped scenarios include trauma to the head or skull fracture, foreign objects in the ear (even ear wax, known as cerumen), Malignant Otitis Media (swimmer’s ear), ear cancer and a few other extremely rare system disorders.
Ear problems are often tied to Cold/Allergy/Flu/Virus season — directly or only indirectly. Ordinary symptoms include bleeding / discharge from the ear (otorrhea) or pressure in the ear.
The three typical problems are:
1) Ear infection
2) Ruptured eardrum
3) Barotrauma
It is not impossible that you could have more than one at the same time or that one exacerbates the other. And there are reasons why they may occur during these seasons (although year-long is still fair game).
1.Ear Infections
Undoubtedly, we have all had ear infections at one time or another, most likely as children. But we can’t rely on just ‘growing out of them’. I remember having lots of ear pain as a young child and my father (an occasional smoker) would blow warm tobacco smoke in my ear. As strange as it sounds this was not unique to him. You may remember the same. Luckily, tobacco smokers have declined in numbers, and as adults we need a different approach.
The most common infection (otitis media) is in the middle-ear (as opposed to the very outer including the ear canal, and the inner which contains all the small bones of the system). The middle ear swells up and causes fluid to build up in the sinus cavities and collects behind your eardrum.
Otitis media infections can be bacterial or viral, and often accompany other respiratory or inflammatory conditions occurring simultaneously (including bronchitis). Since our sinus cavities are linked to each other (and eustachian tube), it makes sense that anything present in your ear can also affect other parts as well, like throat and sinuses. Oh boy, sinusitis.
Remember the Eustachian Tube?
As a quick re-visit to science class, and so that we understand our own workings, here’s a reminder about the eustachian tube. Sometimes referred to as the “equalization tube,” it connects and drains from our middle ear area to a section along the back of the sinuses (the nasopharynx). Both the sinuses and the middle ear are always producing fluid, which usually either drains or reabsorbs. The major function of the eustachian tube (semi-bony and partially cartilaginous) is to equalize pressure in your middle ear with the outside world.
A take-away. To share your knowledge with others, the next time someone says their ears are popping, let them know it’s their Eustachian Tube opening and closing.
Symptoms of Ear Infections
The pressure build-up, when fluids from the throat (or nose) are suctioned into the middle ear, can tear the eardrum and cause discharge or blood to leak out. Aside from discharge of fluid, pus or blood, you might also experience other symptoms such as:
- Ear pain
- Stuffy nose
- Hearing loss (slight to severe) {Michael’s hearing loss began as the blood flow happened.)
- Fever
- Vertigo and balance issues
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On the bright side, ear infections OFTEN resolve on their own in a couple weeks even without treatment. MDs may prescribe OTC products (like acetaminophen or ibuprofen) to help with fever or pain. Sometimes they will prescribe an antibiotic (most typical is amoxicillin). However, remember that an antibiotic only works if the infection is bacterial, not viral. Unfortunately, some sources suggest that viral infections are the more common. See some alternative suggestions below.
Could it be Covid?
Without taking time to describe or compare these conditions of colds, flu, respiratory infections (including Covid), suffice to say that all can create ear problems. To sneak peek ahead, here is one piece of good news. While Covid and ear issues can both display with headaches and fever, ear infections are not generally a symptom of Covid, and not usually caused by it.
Not impossible of course, but it’s less likely to be Covid than other conditions. Earaches and infections are more likely related to colds, flu and respiratory virus. Check out the Cooper University comparison of Covid and Ear Infection symptoms.
Call your doctor if:
- Pain is severe or continues
- Fluid, pus, or blood leaks out of your ear
- You have a fever for more than a day
2. Ruptured or Torn Eardrum
We don’t always know for sure that this has happened. You may even have had a doc make note of scar tissue on the eardrum membrane from previous tears, totally unbeknownst to you. People can puncture their eardrum and not know unless additional symptoms (other than pain) are experienced. Often a tear will self-heal. That’s good news.
Unfortunately, it can lead to further (or sorry to say, permanent) problems if treatment isn’t appropriate. Still, even initial symptoms can be worrisome. These can include:
- Pain or discomfort in the ear
- Hearing loss
- Ringing in the ear (Tinnitus). [See Tinnitus. Is there a Sound Cure? ]
- Vertigo (a dizzy, spinning sensation)
[Usually different than the dizziness from BPPV – see MANY of Us will Experience Sudden BPPV ………… So, Now What?] - Nausea and vomiting (usually related to vertigo above)
An eardrum rupture is often caused by infection (as above) or altitude and negative pressure (as below).
3. Barotrauma or Altitude Pressure
Know that feeling of driving mountain roads and having your “ears pop?” Or worse, flying and having the sense of your ears under pressure. You might sympathize with the little kid two rows back screaming bloody-murder from the pain and unaccustomed (‘scary’) pressure. (The eustachian tube of the ‘little adult’ is smaller and more easily blocked, so negative ear pressure is more common for them.)
When it is abrupt and severe, the problem is called barotrauma (as in barometric). There are other types of barotrauma, but here I am sticking to the most common – ear barotrauma. It is not infrequent with altitude pressure from airplanes or activities like scuba diving. Barotrauma can lead to ear bleeding, as well as other indicators, often depending on the duration of the pressure and the suddenness of the situation. These symptoms include:
- Ear pain / discomfort
- Fullness or ‘stopped-up’ ear (stuffiness)
- Hearing difficulties or impaired/“muffled” hearing (eardrum isn’t vibrating correctly)
- Dizziness
- Torn eardrum (blood or discharge may leak from ear)
- Nosebleed (less common)
An accurate cause can be difficult to diagnosis as all the conditions we are considering here, (including sinus infections) can be contenders. We are at greater risk for barotrauma if, during the pressure changes, we are experiencing a flu/cold/allergy or other infection.
Barometric changes (pressure) on our eardrum pushes it inward or outward from its normal position. Usually, effects are temporary and will resolve on their own, but with severe symptoms (such as pain or bleeding from the ear) you need to rule-out infections. And then there remains the question of “is it bacterial or viral?”
Hearing loss from pressure is a real risk. It we experience barotrauma in the ear, or ear fullness that we don’t get treated right away, it can result in losing hearing in the afflicted ear. The good news again is that if the hearing loss is due to this situation, you may likely gain your hearing back and the loss will be temporary, likely reversible.
Tips and Treatments
I admit that I hardly know where to start with the number of remedies and treatments for ear problems and pressure. I am going to skip food issues or treatments that are simply preventative. I am also not listing things like hydrogen peroxide which is good for cleaning or removing wax, but not for the conditions we are covering in this post. Plus, there are certainly different remedies for ear infection / inflammation versus tips for restoring pressure balance to your ears.
More importantly, as with so many self-help issues I find some suggestions specious or even worrisome. For instance, something like Colloidal silver (sometimes recommended for alternative treatment) has been found to have dangerous side effects and can interfere with antibiotics and other meds. Perhaps it works for the bubonic plague as has been claimed, but I wouldn’t recommend it for ear issues.
I am simply going to pick-and-choose a few tips or treatments that are worthy of further consideration in my opinion. Some are self-help, others not; some categorized as ‘alternative’ and others conventional or new. They are in no particular order.
Mechanical Techniques
EarPlanes for the Air planes
These earplugs are “pressure-filtering,” designed for frequent flyers. They claim to protect your eardrum from sudden high ambient changes (ultimately resulting in ear clog). EarPlanes allow the ear to slowly adjust to the changes in pressure, avoiding sudden pressure differences. Target sells them for a mere $6.
Quick Maneuvers
Some of these are known intuitively, and suggested by health care providers. I caution that if you use the Valsalva Maneuver, do so VERY gently. Maybe start with the video (#3) instead.
Valsalva Maneuver
— Pinch your nose
— Close your mouth
— Try to breathe out air forcefully with a closed mouth. (That’s the typical direction, again, I say ‘gently’ blow out air.)
You often suddenly hear popping or (if congested) high-pitched sound. It will most often open or ‘pop’ your ears. It can be uncomfortable. You should caution children to have a ‘light touch.’
Toynbee Maneuver (‘softer’ than Valsalva)
— Pinch your nose
— Close your mouth
— Try to swallow (multiple times if needed)
I have also read of a Lowry technique which combines these two (consecutively, I assume).
Negative Pressure Release maneuver by Dr. Justin Lin. Entitled “Pop or Drain Your Ears and Relieve Sinus Pressure | How to Drain Eustachian Tubes | Physical Therapy”. I recommend this video for safe and simple procedures for mild blockage of eustachian tube.
Head up
No, that’s not a show of support, but a reminder that your head bent downwards will increase the feeling of ear pressure; as it increases pressure on your sinuses and your ear. At least for a little while, attempt making a nice bed-nest with a good number of pillows behind you that allow you to sleep with your head up.
If you are a side-sleeper, and can’t manage to get comfortable sleeping with your head up, sleep with the problem ear facing up instead of into the pillow. If the affected ear is down (into the pillow) it can irritate your ear even more.
Hot and Cold
Steam (or wet sauna) is helpful to clear sinuses and release some ear clog. Warm showers come close BUT with an uncertain ear problem or infection you should plug your ear before a shower.
After promoting heat (or steam) it may sound counterintuitive to suggest cold, but it often works. Applying a cold pack to the affected area, or sinuses, for 20 minutes may produce some sudden relief from the ear pressure. (Make sure not to apply ice directly to your face; cover all kinds of frozen packs with a thin towel.)
Conversely, just as many health care providers will recommend a warm compress. Place a hot/warm washcloth over your sore ear. Many heating pads actually have a material in them to wet and place back in the pad. The heat from the warm compress is said to ease pain and discomfort. So, the choice is whether you wish to address pain or ear clog. OR you can do the hot pad for 10 minutes and then the cold.
Professional Care – Complimentary and Conventional
Ear bleeding is always a reason to seek professional care. If bleeding of the ear is difficult to diagnosis, imaging tests like an X-ray or CT scan might be ordered. Lab tests MAY help determine an infection.
ENT (Ear-Nose-Throat) or Otolaryngology
Old and new treatments. If hearing problems from blockage persist, ‘ear tubes’ have been considered. This procedure has always had some drawbacks, for children as well. Still, you might face the decision if that is what your ENT prefers or is used to. However, a new procedure, minimally invasive, is called Balloon Eustachian Tuboplasty. It doesn’t sound great, but apparently can last for a very long time with little recovery issues. With anesthetic, a ‘balloon’ is inserted through the nose to the tube and inflated for a couple minutes or more, then deflated and removed. This equalizes pressure and then allows a sufferer to ‘pop’ their own ears when there is pressure.
Acupuncture & Chiropractic
Acupuncture is not a recommended cure for stuffy ears, but it can release ear pressure. It probably won’t happen in one session, but that’s difficult to know and depends on severity of your symptoms. Chiropractic for the child’s ear has been widely studied (a couple studies are in the reference section), but for the adult ear (with less study) the idea of general improved healing though the nervous system (especially from the cervical region) is the goal. More directly, chiropractic adjustments may help reduce tight muscles in the neck and around ear, allowing trapped fluid to drain. Like acupuncture, quickness in relief will depend on symptoms and severity.
Herbals
Most herbs are taken as capsules or tinctures for systemic issues and to combat many conditions, including bacteria, virus, or other agents. For the purpose of this post, Goldenseal might be the best of herbals to approach ear conditions with an oral treatment. Most times, for ears, topical oils are the more common consideration.
Avoid Oils in Ear?
Conventional and Alternative docs don’t always agree on this one. Many say avoid against attempts to ‘flush’ blood or fluids out of the ear with water or oil. AND avoid moistures in the ear canal until the situation is resolved. Many oils (herbals) have great benefit, but we might want to pick and choose times carefully (like after ear bleeding is resolved and problems clearly diagnosed).
Some herbalists say that if you are sure of the cause, there may be benefit in herbal mixtures, such as Lemon-Eucalyptus Essential oil. This is a powerful anti-inflammatory and can help the inflammation of an otitis media infection. If you were to decides to use this, it’s generally prescribed for not more than a 20% product.
Oils used in Inhalation
Different from flushing the ear as mentioned above, certain oils used in a steam inhalation have great healing properties. Some of the truly notable ones are:
Tea Tree Oil considered one of the best to kill ear infection with its antiseptic action. Steam inhalation helps reach infection faster by spreading vapors to all tissues of the sinuses and respiratory system.
Lemon-Eucalyptus Oil – as mentioned above.
Garlic Oil. Often the #1 suggestion from complimentary physicians, and the reason is clear. Garlic has properties that fight bacterial, fungus and viral infections. For those who wish to avoid a prescription antibiotic (for fears of antibiotic resistance or development of allergies), garlic is both a ‘natural antibiotic’ and a remedy in case the infection is not bacterial. [See reference section.]
For any patient, young or old, if the approach is “watchful waiting” (which is quite reasonable), you might still step in with garlic during the meantime. I personally hesitate to fill the air with garlic fumes, so should an exception be made for garlic oil eardrops?
As I mentioned some docs say avoid topical applications (in the ear) of oils. Other doctors, pharmacists and older people from more self-help eras, believe that application of garlic can ease an earache. If you notice, many eardrops (both commerical and herbal) have garlic oil as an ingredient due to its potency and effectiveness on multiple fronts.
A typical recommendation is: Garlic oil eardrops (2 warm drops in ear 2 x daily). Best if this can be done followed by 10-15 minutes resting with infected ear up. You can also mix garlic paste in olive oil to produce a home-made type.
Some DIY folks make more preventative products with garlic and take it orally when needed. One ‘recipe’ calls for 350 g of crushed garlic clove in glass jar with lid, pour 250 grams of a rum, or other spirit, with a high ABV (alcohol by volume) over the garlic. Seal and place in refrigerator for 10 days, after which it can be used like an oral tincture, taking a full dropper’s worth 1-2 x daily. I am sharing this and yet admit it has never ‘called my name’ so to speak. Love to know what others think.
FINAL THOUGHT
I can’t finish Michael’s story here, as we are still in the middle of it, and still taking stock. In the meantime, let me add this thought. Prevention, even an ounce, is always better than the cures. However, if the cures are needed, pick carefully, and don’t hesitate to seek professional advice if hearing is at risk. Hear that? ?
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References:
13 home remedies for ear infections and earaches | SingleCare
7 best natural antibiotics: Uses, evidence, and effectiveness (medicalnewstoday.com)
Acupressure & Acupuncture Therapy Points For Hearing Loss (hearingsol.com)
Antimicrobial effect of garlic (Allium sativum) – PubMed (nih.gov)
Antimicrobial properties of Allium sativum (garlic) – PubMed (nih.gov)
Balloon Eustachian Tuboplasty | McGovern Medical School (uth.edu)
Barotrauma And Mechanical Ventilation – PubMed (nih.gov) Diaz R, Heller D. Barotrauma And Mechanical Ventilation. 2021 Aug 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31424810.
Causes And Risk Factors For An Ear Infection – HealthPrep.com
CDC-HAN-443-Increased-Interseasonal-RSV-Activity-06.10.21.pdf
Chiropractic care for the child’s ear. Parent Portal (icpa4kids.com). Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors – PubMed (nih.gov);
Colloidal Silver | NCCIH (nih.gov) [For warnings in this case.]
COVID-19 and Ear infection | Cooper University Health Care (cooperhealth.org)
Ear Barotrauma | Pressure In Ears Symptoms & Best Treatment (hearingsol.com)
Ear Care: Cleaning, Harm Prevention, Hearing Loss Symptoms (clevelandclinic.org)
Ear Infection Prevention: How To Prevent Ear Infections (webmd.com)
Ear Infection Remedies & Natural Treatments – Dr. Axe (draxe.com)
Herbal Home Remedies For Ear Infection: 10 Effective Ingredients (naturazi.com)
Holland, Kimberly. What Causes Ear Bleeding? Health line. Medically reviewed by Stacy Sampson, D.O.—Updated March 29, 2019
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Title Photo of man and woman with ear muffs by Unknown Author is licensed under CC BY-SA
