Ear Fullness: More Than Just a Wax Plug
- The Review Course in Family Medicine
- 10 hours ago
- 1 min read
If your patient is hearing their own voice in "surround sound," it's time to talk about the tube.
As a 2025 CMAJ article highlights, Eustachian tube dysfunction is a common but often mismanaged hurdle in primary care.
Affects ~5% of adults
Often follows infection or allergy
Overlapping symptoms with TMJ dysfunction
Before scrolling down, ask yourself: On a SAMP, which physical exam finding warrants an immediate referral to Otolaryngology to rule out malignancy?
Most cases follow a cold or diving, but don't get tunnel vision. Obstructive dysfunction causes classic muffled hearing, but keep an ear out for the "Patulous" type, where patients hear their own voice amplified. It can be incredibly frustrating for patients to feel like they're living underwater, and for us when the ear canal looks perfectly clean.
Diagnosis:
Otoscopy: Look for a retracted drum or fluid behind the membrane.
Tympanometry: Type B (fluid) or Type C (negative pressure) curves strongly support the diagnosis.
The TMJ Mimic: Check for jaw clenching or tenderness over the joint.
Red Flags: Any unilateral effusion, cranial nerve deficit or persistent otalgia needs an urgent referral.
Management:
First-line: Target inflammation with intranasal corticosteroids (e.g. Mometasone) and second-generation antihistamines (e.g. Loratadine).
Modifiable Risks: Address smoking cessation and Gastroesophageal Reflux Disease.
Barotrauma: Use oral decongestants 30 to 60 minutes (e.g. Pseudoephedrine) before a flight descent.
Surgical options: If symptoms persist beyond 3 months, consider balloon dilation or ventilation tubes.
EXAM TIP: On a SAMP or SOO, don't just treat the ear. If the patient has unilateral middle ear fluid without a preceding cold, include "Nasopharyngeal Pathology" as a differential.
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