The sensation of a blocked ear is a very common reason patients present to an ear, nose and throat specialist. Just about everybody experiences this at some point in their lifetime. When the feeling persists it can become distracting, painful or interfere with hearing.

The list of causes of a blocked ear is very extensive. One way to categorise these is to divide them into problems in the ear canal, the ear drum, the middle ear and Eustachian tube and the inner ear. All the problems described below can cause a feeling of a blocked ear.

Ear canal

The ear canal can become blocked with things like wax, dry skin, infected material (bacterial or fungal), a foreign body (eg a broken off cotton bud or an insect) or occasionally by a cyst, polyp or tumour. Surfers and swimmers can develop growths of bone called “exostoses” which gradually close over the ear canal with prolonged cold water and wind exposure.

Ear drum

The ear drum itself can become swollen from an infection on either side of it (in the middle ear or ear canal), a condition called myringitis. Pressure changes (flying, scuba diving), trauma or infections can all cause a hole (perforation) in the ear drum. More typically the ear drum is affected secondarily by problems in the middle ear.

Middle ear and Eustachian tube

The middle ear is an air filled space behind the tympanic membrane. It connects with the back of the nose via a tube called the Eustachian tube (auditory tube). It is common for viruses and bacteria which one contracts from the air via breathing to spread via the Eustachian tube up into the ear. This is called a middle ear infection and is very common in children although adults can also be affected.

The middle ear can occasionally be occupied by chronic infections, tumours or a condition called a cholesteatoma (trapped skin cells).

The Eustachian tube can cause a feeling of blocked ear either when it is blocked or too open (patulous). The Eustachian tube is lined by the same lining as the inside of the nose. This makes is susceptible to any process causing a blocked nose. These causes include hay fever (allergic rhinitis), infections, irritants and chemical (non-allergic rhinitis) and sinus infections.

A Eustachian tube which is permanently too open (patulous) can also cause a feeling of blockage in the ear. Causes of a patulous Eustachian tube include weight loss, pregnancy, medications (eg diuretics), fatigue, stress, temporomandibular joint problems and exercise.

Inner ear

The inner ear can cause a blocked ear when it becomes swollen or injured. The causes for this include infections, vascular problems, a disease called Meniere’s disease and occasionally tumours. A syndrome called “sudden sensorineural hearing loss” refers to the sudden loss of hearing and function in the inner ear. Urgent treatment for this is required.

Investigation

The first step in the investigation of a blocked ear is a careful assessment by an ear, nose and throat specialist. A hearing test (audiogram) and possible further investigations such as an MRI or CT scan may be arranged.

Treatment

Once the cause for the blocked ear has been identified, treatment can be commenced. Treatment options include a range of medications, possible injections and sometimes surgery or radiation treatment. Often no active treatment is required apart from patience to allow the condition to resolve spontaneously by the body’s natural healing mechanisms. A persistent feeling of a blocked ear should always be assessed so that sinister causes can be ruled out and appropriate treatment commenced if needed.

The ear canal can become blocked with things like wax, dry skin, infected material (bacterial or fungal), a foreign body (eg a broken off cotton bud or an insect) or occasionally by a cyst, polyp or tumour. Surfers and swimmers can develop growths of bone called “exostoses” which gradually close over the ear canal with prolonged cold water and wind exposure.