Dr. Undavia: Good. Hey guys, Dr. Undavia, Dr. Smith, Dr. Reddy from NJENT in facial plastic surgery. Today we wanted to talk to you about, you know, we get a ton of patients that will say that they really do have a lot of ear pain or they’re very muffled on planes, on ascent and descent, and we wanted to talk to you about things that you can do on your own or with the use of medications to help you, especially if this is a regular occurrence. So first, Dr. Smith, why don’t you tell us what actually happens when you experience those symptoms?
Dr. Smith: Sure, so a lot of patients, as Dr. Undavia said, with flights and sometimes even like swimming deep in the pool or even when they’re scuba diving especially, will get problems equalizing pressure within their middle ear. The middle ear space is a sinus and so it connects and ventilates in through the nasal cavity. And so just like we’ve talked about in the past, issues with sinus ventilation. that middle ear sinus can sometimes get obstructed and have issues with ventilation as well. And so that long vent that goes from the back of the nose into the middle ear space is called the eustachian tube. And different processes and different issues can arise that can cause obstruction of that eustachian tube. Usually allergies are the most common symptom for most of us throughout the year, but it can happen with viruses and other irritants too, like people who smoke or little kids that get viruses inundated throughout the school year can get eustachian tube dysfunction.
So some of that can be a little bit of age. As kids get older, the eustachian tube gets a little more wider and a little more vertically pitched and so they start to outgrow some of those things. And you know, the irritants and viruses and allergies, those things that can trigger eustachian tube dysfunction, there are different treatments that we can do to try to get more air up into that eustachian tube. So patients may feel pressure in their ear, feeling like their ears need to pop or they feel like it’s sucked in and they may try to open their jaw like frequently to try to pop that or blow and pinch their nose to try to get air, what we call insufflating into the middle ear space. And so the most common symptoms would be pressure, feeling like your ears need to pop. And sometimes you can even get a little bit of a low frequency hearing loss from the eardrum being sucked back.
So if you think of the ear drum as like an instrument, when that ear drum is taught, sound will vibrate that ear drum easier. If it gets sucked back, it doesn’t allow it to vibrate as much and can change some of the feeling of the sound coming through the middle ear space.
Dr. Undavia: That was perfect, that was perfect. Dr. Reddy, do you wanna just talk about some of the things that you could do on your own to try and help that if you do get those symptoms?
Dr. Reddy: So… If you have any eustachian tube problems, you can try to do things to open up your eustachian tube. One option would be trying different medications. The most common is a decongestant. There’s different decongestants on the market. One is Sudafed. The other is Afrin. Basically you can spray some Afrin in your nose right before you fly, usually like an hour or so before you’re taking off. And maybe 15, 20 minutes before the descent and that’ll just help open up the eustachian tube and help you equalize pressure. The other thing you can try is a steroid nasal spray, especially if you have any allergies, and that can help kind of keep your ears a little bit more ventilated long-term. It may not help immediately right before the flight, but if you can plan it out a week or two beforehand, then it can be helpful.
And then just like Dr. Smith was alluding to, constantly popping your ears when you’re… ascending and descending with altitude. And that’s basically when you close your nose like this and you kind of blow against a closed nose and you try to force air up into your ears. The medical term is called autoinsufflation, but it’s just popping your ears.
Dr Smith: One thing to note about the decongestants. So pseudoephedrine is the older school decongestant that’s available over the counter. I usually tell my patients that a couple hours before the flight to take two of the old school red tab Sudafed. Now, phenylephrine is a weaker decongestant that’s available over the counter as well. And so you may see like PE listed as the decongestant, that’s phenylephrine. It still works, but it’s a little bit weaker of the decongestant as well. So some people that may get jittery or have side effects from the pseudoephedrine may be able to tolerate the phenylephrine. One note is that if you do have blood pressure issues or any cardiac issues, you should absolutely consult with your doctor before taking those types of medications because they can cause increased blood pressure and some other risk factors.
Dr. Undavia: Which one can you use to make crystal meth?
Dr. Smith: Pseudoephedrine.
Dr. Undavia: Of course, Dr. Smith would know that one. But the other thing to know is that Afrin really doesn’t give you many side effects, but the pseudoephedrine and the phenylephrine do give you side effects. You can get palpitations. So you just be aware that the pseudophedrine and the phenylephrine are more systemic. Because you take that by mouth and the Afrin you just spray in your nose. So it’s more just localized to the nose The other thing to note is that it is much easier to equalize your ears on ascent versus descent So when you are climbing up in the plane, you really want to try and pop your ears off It because that’s gonna be easy You don’t want to start descent already behind the eight ball because you’re never gonna be able to catch up So use the ascent to get air into your ears because as you rise in the plane, air is expanding, it’ll be easier to get into your ears. But once air starts contracting as you descend, it becomes very difficult to get the air out of your ears easily. So there’s that. I wanted to talk to you a little bit about medicated nasal sprays, or medications that we could do that are prescription. Dr. Reddy already talked about Flonase. It’s now over the counter, but it’s a topical steroid that you can do. And if you know, if you can plan your flights and you know when you’re gonna be flying, you can start flow days several days before. Other nasal sprays that are available are something called azolastine. It’s also a medicated nasal spray that’s more like a topical Zyrtec or Claritin. That can help decongest your nose a little bit. And once in turn you decongest your nose, you can then decongest your eustachian tube. Other things that you can use are like oral steroids. Those can literally decongest the eustachian tube systemically. Again, that’s usually more of like a rescue medication. If you’ve already taken the flight, you’re really congested or you’re really in pain because, because your eardrum is on traction, the steroids can help reduce some of the swelling in the eustachian tube and then air can flow in between your middle ear and your nose and equalize the pressure.
Occasionally when there’s a lot of negative pressure in the ear, you can draw fluid into the ear and then that fluid can get infected and so sometimes you need to do antibiotics.
Dr. Smith: One non-prescription or non-medication thing that you can also do, which I also recommend on my like fly and dive instructions, is something called earplanes. Essentially, you know, you’re trying to equalize the pressure through your natural eustachian tube. One way to kind of help with that process is to slow down the equalization in your ear canal. And so the, these little kind of one-way valves can slow down the air pressure from the outside world in your ear canal. and allow you to try to keep up with the insufflation going through your natural vent, which is your eustachian tube. So I typically recommend those as well prior to, especially if you have any issues in the past with flying.
Dr. Undavia: Are those essentially just earplugs?
Dr. Smith: Yeah, they’re an earplug, but they do have like a valve in those as well. You can get those over the counter at CVS and Targets and big box stores and all those types of places as well.
Dr. Undavia: So let’s just advance. Let’s just assume that we’ve taken the flight, we now have symptoms, we’ve tried doing Sudafed and Afrin, maybe Flonase or Azelastine and none of that stuff is working and you’ve decided to see your ENT and your ENT talks to you about what we just talked about, maybe some steroids and that still hasn’t worked. Dr. Reddy, you want to talk about next?
Dr. Reddy: So if all of the medications aren’t enough and you’re still having persistent symptoms, then there’s essentially two… different procedures that can potentially help. The most commonly, the most common procedure for eustachian tube dysfunction is ear tubes. And we have a podcast episode, I think, on ear tubes that you guys can check out if you’d like. But essentially you’re just putting a little tube across your eardrum and it creates an artificial eustachian tube for your ears to equalize the pressure. And that can be done usually just in the office in a few minutes and it’s pretty well tolerated and most people do well. The newer procedure that’s out…
Dr. Undavia: Can I interrupt you for one second? With ear tubes, have you ever just done the cut and not the tube?
Dr. Reddy: Yeah, so you could do just the cut into the eardrum. It’s called a Myringotomy and that can also provide a temporary relief. But if you want longer term relief, you usually need a tube.
Dr. Undavia: I’ve done it where like if the patients never had this before, this is just the first time, maybe just a small cut, equalizer pressure, get rid of their pain. And then if it happens again, then you put the tube in.
Dr. Reddy: And the other option is a new option, which is called balloon eustachian tube dilation. And that’s essentially when you go through your nose and you go through the eustachian tube through the nose side and you inflate a little balloon, then you deflate the balloon. and you bring it out and you’re just trying to dilate the eustachian tube, you’re trying to make your natural eustachian tube work better. And that can also potentially be helpful. It’s a newer procedure with less data compared to what we have with traditional ear tubes, but the big advantage with this is that there’s no little tube in your ear and you don’t have to worry about getting water in your ear as well.
Dr. Undavia: Do you want to talk to them about what the procedure’s like in the office?
Dr. Smith: Sure. Yeah. with the Eustachian tube dilation, typically the first thing is to see your ENT and make sure they’re evaluating the nasal cavity, the nasopharynx, which is the back of the nose going up into the back of the throat where that Eustachian tube opening is, making sure there’s no obstructions or anything else that could be causing or leading to the issue. The procedure then, once that’s all been done and everything else has kind of been ruled out and we know that the issue is entirely with the Eustachian tube. We numb the nasal cavity up, so we use a decongestant and a mild topical numbing medication. Some of us will spray it in the nasal cavity, sometimes we’ll put a little cotton pledge in the nose first with that soaked in it to decongestant and to numb the nasal cavity. Typically we’ll use a stronger topical nasal decongestant and numbing medication as well. And once the nose is really well numbed, we’ll go inside the nasal cavity a three millimeter telescope, we take a look all the way towards the back of the nose. We evaluate and then numb up a couple little other areas in the back right along that eustachian tube so that patients feel absolutely nothing when we do this. Usually then we slide the little catheter that has the balloon on the end of it along the floor of the nose back towards that eustachian tube. Then we can actually direct that catheter with the balloon. gently into the opening of that eustachian tube. At that time, we talked to patients about, we’re gonna inflate the balloon, we’re gonna leave it in there for a couple of minutes, and we’re gonna hold that pressure in there for a couple of minutes. Some people will experience some pressure in their ears while you’re doing that, but most commonly, I would say patients don’t notice anything with the balloon in there. Afterwards, we deflate the balloon, pull it out, and just reevaluate to make sure that we got a good dilation in there.
As far as post-care, it’s pretty straightforward. Patients get up, they walk out of here, they go home. Usually Tylenol or Motrin is all that’s needed for pain after that type of a procedure because there really isn’t significant pain after the procedure. Normally we have patients rinse with either saline sprays or saline irrigations like the sinus rinses to try to flush out all the stuff that we put in there to numb the nose up and decongest. And then over the course of the next four to six weeks, you know, the eustachian tube, the swelling from the procedure manipulation starts to kind of wear off and we see, you know, how much improvement patients typically get, which, you know, is often significant improvement. Sometimes, and this depends on the ENT or the proceduralist, sometimes patients will have a tube at the same time, sometimes they won’t have a tube. Every patient’s a little bit different as far as why they need the eustachian tube dilation. Why they needed the tube. So we kind of play it patient by patient as far as, you know, whether or not they already have a tube or had one recently, et cetera.
Dr. Undavia: I think we covered it. If you guys have any other questions about Eustachian tube problems about flying or diving, call or text us at 609-710-6673 or just email us at email@example.com. and follow us for some more podcasts. All right, take care guys. Take care guys.
If you’re experiencing persistent ear pain or eustachian tube dysfunction, don’t hesitate to contact NJENT to schedule an appointment with one of our experienced ENT specialists. We offer a range of diagnostic and treatment options to help you find relief. You can visit our New Jersey office or book a virtual consultation from the comfort of your own home. If you enjoyed this episode, be sure to like and subscribe to our channel for more informative content, and tune in next time for our next discussion. Thanks for listening!