The Eustachian Tube connects the middle ear to the back of the nose (see Diagrams — Upper Respiratory Tract and Anatomy of the Ear).ย If this gets congested from a cold or allergies, pressure can build up in the middle ear.ย It’s like what happens during airplane take-offs and landings, and can hurt to varying degrees.
We can sometimes diagnose this by examining the ear with an otoscope (the instrument hanging on exam room walls), & noticing that the ear drum looks “retracted.”ย Lots of clinicians fail to appreciate the subtlety.ย However, Eustachian Tube Dysfunction is so common, that if a patient has ear pain and no other cause seems apparent, I treat with Allergy Medication.ย Patients tend to get better, so maybe I’m right (or maybe placebo worked, or maybe they would have gotten better anyway).ย I donโt give decongestants, because I donโt know of any proof that they work.ย And I never recommend common nasal sprays or drops like Afrinยฎ, Neo-Synephrineยฎ, etc; they work fine, but after 3-4 days the nose is so accustomed that it can be impossible to stop them (see Rhinitis Medicamentosa).ย
If you have ear pain, & your provider says โeverythingโs normal,โ ask โIs the TM retracted?โย [โTMโ is common medical jargon: abbreviation for “tympanic membrane,” i.e. ear drum].ย A โretracted TMโ looks pulled back, almost horizontal, because of negative pressure behind it.ย Ear discomfort PLUS a retracted TM almost always signifies Eustachian Tube Dysfunction.