Ears clogged? Popping? Clicking?

It doesn’t matter what time of year it is, most days bring at least one patient complaining of their ears being clogged, popping, or clicking.  Some folks say they “can’t hear” and it usually comes on rather suddenly versus very slowly over a period of weeks or months.

Sometimes it follows a cold.  Other times it accompanies allergy season.  I like to let the patient tell me their story, as in, “tell me what happened” or “tell me about it” so they know I am listening and tuned in to hear clues about what additional questions I may need to ask.  When I start to ask questions, it’s called a “drill down”.  Think of it as a funnel.  I start by asking broad large questions, like catching everything going through. Then, as I pick up clues, I funnel the questions down and ask more focused questions. Usually by then I have only a few things I think could be going on.  That term is called “differential diagnosis”.  So the funnel goes from a big wide mouth to a tiny, little one with only a few things medically wrong which could fit through the opening.  That’s the drill down.  It guides my physical exam and what differential diagnoses I feel could be in the mix.

So when a patient states they have popping and clicking and feel like they are “hearing under water” or “everything sounds far away” or they “can’t pop their ears”, I am usually pretty sure they have fluid in their ears or their ears are clogged up due to something such as ear wax or allergies.

That’s about time when I take a look.  Let’s say I see fluid or the exam guides me to believe the issue is allergies.  One thing I use is a 4-5 day course of Sudafed (regular is fine) or my favorite is Fluticasone proprionate (Flonase).  It has a light steroid in it which shrinks the area in the ear enough to help open things up.  For allergies, it’s a nice medication.

Now here is the most important thing: it’s how you use it!  I tell my peeps it’s about HOW you use the nasal spray.  When you go to spray it, hold the bottle.  Then CROSS YOUR ARMS.  By doing this, you angle the tip of the bottle so that it points towards your sinus cavity and ears versus going right straight down the back of your throat.  Then you spray and sniff VERY lightly.  Not even enough to sniff a flower.  It should feel as if it is going to run out of your nose for about 10 seconds.  But it won’t.  Your nose is like a sponge.  If you spray and sniff and you can taste it down the back of your throat, you sniffed too hard.  Your throat may feel great but it sure won’t do anything for your sinuses or your ears.  I’m sure there are videos on YouTube by the manufacturer as to how to use this medication the best way.  But that’s how I tell my patients to use it and most of them have reported pretty good relief.  Remember to be patient.  It can take about 2 weeks to get relief.  The ears are tough little buggers and don’t want to drain fast.  They may pop a little more before they heal.  If it lasts longer, then go see your health care provider.  Again, I’m not giving you medical advice, I’m just ruminating about what’s worked for me and my patients.

It sure is helpful to have something to fix your ears.  I’ve had patients return after a course of this nasal spray and tell me they were so sure it wouldn’t work, and, wow, weren’t they surprised when it did.  Sometimes NPs have to work just a bit harder to win over patients.  That’s okay.  I have a lot of time to win them over one at a time.