Dr Annabelle Leong
Why do your ears and nose often feel blocked? Did you know that these troublesome symptoms of blocked nose and blocked ears commonly occur together in Singapore? If you have trouble breathing through your nose and ALSO keep suffering stuffy congested ears, then there is definitely a health problem and you should see your friendly ENT specialist in Singapore to get better.
The most common scenario where you might end up with persistently blocked ears and blocked nose problems, is when you come down with a bad cold or the flu i.e. a viral infection of the upper airways, nose and throat may spread to your eardrums through your Eustachian pressure tubes which join the back of your nose to your ears. During a bout of the flu, including a Covid infection, excessive mucus is produced in addition to swelling and inflammation of your soft tissue making up your inferior turbinates, the “sausages” of the nasal passages which normally control humidification of the airflow into your nose. Too much nasal mucus and nasal congestion leads to all this sticky thick infected secretions blocking up the openings of the Eustachian pressure tubes, in turn leading to pressure discomfort and ear pain.
You most definitely should NOT fly if you are suffering a cold, flu or have some flare-up of your allergy and sinus issues because there is a significant risk of ear pressure symptoms during the flight, especially during the landing portion of the flight. If you have difficulty equalising ear pressures during the flight, then there is a real risk of excruciating ear pain due to the tremendous pressure buildup and subsequently, your pressurised eardrums may even rupture and burst during the flight or shortly after landing. In acute traumatic eardrum rupture cases, for example during scuba diving, there may be some bleeding or discharge from your ear noted after you resurface from your dive. Ringing noises or tinnitus with some dizziness and muffled hearing may also occur. Same situation with the ear pressure equalisation also occurs when you climb heights eg mountains, swim or scuba-dive where being able to perform the Val Salva depressurisation maneouvre is important. Some patients with more sensitive pressure tube issues in Singapore even experience recurrent ear discomfort and blocked ears during their lift rides up to high floors of their condominiums, or feel the same irritating uncomfortable ear effects during their MRT ride whizzing through tunnels. So please don’t take your poor Eustachian pressure tubes for granted, as their problem is often very closely linked to what’s going on inside your nasal airways. Nasal allergies, sinus infections, influenza and common colds, all need to be properly treated before you even consider boarding the plane.
It is interesting to point out that very often, the ear which feels blocked tends to occur on the same side of the more blocked nasal passage, e.g. left blocked ear and left nasal congestion. Almost always, we notice that when patients have a blocked nose more on one side than the other, due to a deviated nasal septum making one nasal passage more narrow, then it is that same side which will often have problems with Eustachian pressure tube dysfunction. Simply put, if you have a left-sided blocked nasal passage due to a deviated nasal septum sticking out to the left, then the left Eustachian pressure tube at the back of the nose will be more likely to become swollen and congested, leading to buildup of fluid inside the ear, behind the eardrum. Hence, blocked left nasal passage and blocked left ear! Ear and hence Eustachian pressure tube problems are all associated with what’s going on with the nose, so if you want your blocked ear condition to improve, then it is important to treat your nasal problems too.
In more advanced Eustachian tube conditions in Singapore, the patient has already developed a ruptured eardrum with persistent ear infections and smelly ear discharge, which when we ask more specifically about nasal issues, we then find out actually, the patient had a blocked nose condition which was left untreated for a few years. Persistent Eustachian pressure tube dysfunction is rather unhealthy for the middle ear or eardrum, as it means the space behind the eardrum is not well-ventilated, resulting in a “negative ear pressure” which retracts or pulls in the eardrum to cause blocked ear, hearing loss, tinnitus and echoey symptoms. Therefore, it is critical to have not only your ear problems e.g. ruptured eardrum repaired if it doesn’t heal on its own, but also to make sure your blocked nose or nasal congestion problems are properly treated to prevent a repaired eardrum perforation from re-perforating later on in future from yet another blocked nose/infection.
Even more unusual, is that some patients come to see me for a second ENT opinion in Singapore for their persistent ear discharge and infection with hearing loss, having already undergone nasal surgery for their blocked nose due to deviated nasal septum and swollen turbinate “sausage” structures, but yet nothing was done about the ruptured eardrum to repair the gigantic infected hole still leaking pus! Incredible but absolutely true! They were told by their previous ENT surgeon in Singapore that they needed nasal surgery but to “leave the ruptured eardrum alone”, which is complete nonsense by the way. You need to have BOTH your eardrum and blocked nose problems treated to prevent recurrence of the same problem. Some patients may also benefit from having an additional Eustachian tube balloon dilation procedure performed at the same time as their nasal and ear surgery, a very safe way to optimise your pressure tube dysfunction. Balloon dilation of the Eustachian tube alone is unlikely to sort out your blocked nose and blocked ear conditions, so it may be paired sometimes with nasal surgery (called a Septoplasty with turbinoplasties) and eardrum repair surgery (called a Tympanoplasty or Myringoplasty).
Both these nasal and ear procedures have a highly successful outcome in giving you a nice dry safe ear with no further ear infections, as well as to help you breathe much more clearly. Some patients, for example the senior citizens, sometimes just want a dry ear without infection so that they can at least wear a hearing aid to rehabilitate their age-related degenerative hearing loss to communicate with their family and friends. Younger patients in Singapore just want to breathe more clearly, then sleep and hear better instead of constantly being bothered by their blocked nose, snoring, mouth-breathing and blocked ear with hearing loss.
You may find Dr Annabelle’s other blog entries helpful on ways to manage Eustachian tube issues: Balloon dilation of the Eustachian pressure tube.