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Cold and Flu

Ear Pressure and Ringing Treatment

12/18/2008

Question:

I came down with the cold systems that are going around: deep coughing, not really stuffed up, but lots of sinus pressure. This moved into my right ear and then the left. I went to urgent care, as the pressure and pain were so severe. They put me on 500mg amoxicillin 3 times a day, and 1 clariton a day. The pain has stopped, but I feel like I`m in a tunnel. My ears ring, they feel plugged, and I`m miserable. Is there something I can do?

Answer:

Your complaints of ear plugging and sounding as if you were in a tunnel are unfortunately very common this season. The symptoms are due to poor function of the eustachian tube as a result of your viral illness. The eustachian tube connects the back of your nose and throat area with the middle ear space (deep to your eardrum). The eustachian tube is supposed to help equalize pressure on both sides of your eardrum (e.g. when you ascend or descend in a plane), and may also provide a drainage route for fluid from the middle ear space.

When the eustachian tube does not work properly, people tend to get a sense of pressure or fullness in their ears, muffled hearing, and can progress on to frank ear pain and even middle ear infection if prolonged. What we believe happens is that the eustachian tube gets congested and swollen much like your nose feels when you have a cold or the flu. The tube then basically swells shut and stops working normally. The more common course is for the eustachian tube dysfunction to resolve as your viral illness resolves and the ear symptoms to then follow suit. Some physicians will treat these symptoms with decongestants (e.g. pseudoephedrine) with the intention of decreasing the congestion in the eustachian tube and getting it to work better.

Other recommendations include "autoinsufflation" or trying to clear your ears by pinching your nose shut and then trying to blow through your nose. By doing this, you are trying to force air up through your eustachian tube to help it open again and resume normal function. Occasionally, a physician will place the patient on antibiotics if the ear appears infected on exam. But in most cases, the fluid in the middle ear is either a sterile effusion or perhaps a viral process which antibiotics will not affect.

In general, your symptoms should be monitored by your primary care physician and management should be mostly supportive. The underlying cause for your ear symptoms is the viral illness you are suffering from. When that resolves, the ear symptoms should resolve as well. Occasionally, even after the flu or cold has resolved, ear problems can persist. If ear pain, ringing, fullness, pressure or a "hollow" sound persist for 2-3 weeks after your flu resolves, then that would be the appropriate time to see an otolaryngologist, obtain a full ear nose and throat exam and probably a hearing test.

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Response by:

Daniel   Choo, MD Daniel Choo, MD
Associate Professor and Director, Division of Otology/Neurotology
College of Medicine
University of Cincinnati