Blocked ear
A blocked or full feeling in the ear is one of the most common symptoms prompting a consultation with an ENT specialist. Almost everyone experiences it at some point — after a flight, during a cold, after swimming, or on waking. When it resolves quickly it is rarely significant. When it persists, it warrants assessment to identify the cause, because the range of conditions that can produce this sensation is wide and some require specific treatment.
Causes of a Blocked Ear
The ear can be divided anatomically into four regions — the ear canal, the eardrum, the middle ear and Eustachian tube, and the inner ear — and problems in any of these can produce a blocked or full sensation. Understanding which region is responsible requires examination and, in some cases, audiological testing.
Ear Canal
The outer ear canal is the most common site of blockage and the most straightforward to assess and treat. Wax impaction is the most frequent cause — either from natural accumulation or from wax pushed inward by cotton bud use. Dry skin, infected material from a bacterial or fungal ear canal infection (otitis externa), and foreign bodies — including fragments of cotton bud tip, insects, or debris — can all obstruct the canal and produce a blocked sensation. Occasionally a cyst, polyp, or other growth in the canal wall causes progressive obstruction.
Surfers and swimmers who spend prolonged time in cold water and wind exposure can develop bony growths within the ear canal called exostoses — sometimes called surfer’s ear. These develop slowly over years and can eventually narrow the canal significantly, trapping wax and water and causing recurrent blockage and infection.
Eardrum
The eardrum itself can become inflamed — a condition called myringitis — from infections on either side of it. Pressure changes from flying or scuba diving, direct trauma, or significant ear infections can cause a perforation of the eardrum, producing a sudden blocked sensation, hearing change, or discharge. More commonly the eardrum is affected secondarily by conditions in the middle ear behind it.
Middle Ear and Eustachian Tube
The middle ear is an air-filled space behind the eardrum that connects to the back of the nose via the Eustachian tube. This connection makes the middle ear vulnerable to infections that travel up from the nose and throat — middle ear infection (otitis media) is one of the most common conditions in childhood and a frequent cause of blocked ear sensation in adults during upper respiratory tract infections.
When the Eustachian tube does not open and close normally, the air pressure in the middle ear cannot equalise with the outside — producing the blocked, pressured feeling most people have experienced during a flight. The Eustachian tube lining is continuous with the nasal lining and is susceptible to the same conditions: allergic rhinitis, viral infections, sinusitis, and non-allergic rhinitis can all cause Eustachian tube dysfunction. Fluid accumulating in the middle ear behind a dysfunctional Eustachian tube — glue ear — is a common cause of persistent blocked sensation and hearing loss, particularly in children.
Less commonly, a blocked middle ear sensation arises from a patulous Eustachian tube — one that is permanently too open rather than blocked. This can follow significant weight loss, pregnancy, diuretic use, fatigue, or temporomandibular joint problems. Patients often describe autophony — hearing their own voice and breathing loudly in the affected ear — which worsens when upright and improves when lying down.
The middle ear can also be affected by cholesteatoma — a destructive collection of skin cells that erodes the surrounding bone — and occasionally by chronic infection or other growths. These are less common but important to identify as they require surgical treatment.
Inner Ear
Inner ear conditions can produce a blocked or full sensation, often accompanied by hearing change, tinnitus, or vertigo. Causes include viral infections affecting the inner ear, Ménière’s disease (episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness), and sudden sensorineural hearing loss — a sudden drop in hearing that requires urgent assessment and treatment. Any sudden change in hearing accompanied by a blocked sensation should be assessed promptly rather than managed with a watch-and-wait approach.
Assessment
Assessment begins with a careful history of the symptom — its onset, character, duration, associated symptoms (pain, discharge, hearing change, tinnitus, vertigo), and any precipitating events. Examination includes inspection of the ear canal and eardrum with an otoscope or microscope, and assessment of the nose and throat where Eustachian tube dysfunction is suspected. A hearing test (audiogram and tympanogram) is arranged in most cases of persistent blocked ear — the pattern of hearing change and middle ear pressure on testing provides important information about where the problem lies. Further investigation with CT or MRI is arranged where indicated.
Treatment
Treatment is directed at the underlying cause identified on assessment. Wax impaction and ear canal problems are addressed with microsuction and appropriate topical treatment. Middle ear fluid and Eustachian tube dysfunction are managed with medical treatment initially, with grommets considered where fluid is persistent and causing significant hearing loss. Perforations may heal spontaneously or require surgical repair. Cholesteatoma requires surgery. Inner ear conditions are managed with appropriate medical treatment, the urgency of which depends on the specific diagnosis — sudden sensorineural hearing loss in particular should be treated promptly.
Many episodes of blocked ear — particularly those following a cold or a flight — resolve spontaneously within days to weeks as the underlying inflammation or pressure imbalance settles. When the symptom persists beyond this, or is associated with hearing change, pain, discharge, tinnitus, or vertigo, assessment is appropriate rather than continued observation.
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Dr Roth’s Clinical Perspective
The most important distinction in assessing a blocked ear is between a canal problem — which you can usually see and treat directly — and a middle ear or inner ear problem, which requires audiological testing to characterise properly. A tympanogram in particular is a very useful and quick test: a flat tympanogram tells you there is fluid or negative pressure in the middle ear immediately, which changes the management completely compared with a normal tympanogram in someone with a canal problem.
The one presentation I want to emphasise on this page is sudden sensorineural hearing loss. Patients often present days or weeks after the event, having assumed the blocked feeling was a cold or wax. It is not — it is an inner ear emergency, and the window for treatment with steroids is narrow. If you wake up one morning with a sudden blocked sensation and your hearing is noticeably reduced in that ear, do not wait to see if it resolves. Get it assessed the same day.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS)
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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