Understanding Clogged Ears

Insights from a Frisco, Texas ENT doctor about clogged ears

A clogged, full, or “underwater” feeling in the ear is one of the most common reasons people visit an ENT. Most of the time the cause is harmless and temporary: a cold, allergies, a flight, or earwax. But the same feeling can occasionally signal a sudden inner-ear hearing loss, which needs treatment within days to give the best chance of recovery. As an ear, nose, and throat doctor in Frisco, I see patients of every age with clogged ears. This guide explains how to tell the common causes apart, what helps at home, what does not, and when to be seen quickly.

Key takeaways

• Most clogged ears come from the Eustachian tube, the small passage between the middle ear and the back of the nose. It gets blocked by colds, allergies, and pressure changes.
• A sudden drop in hearing in one ear, especially on waking, is not “just a clogged ear” until proven otherwise. See an ENT or get a hearing test within a few days. Early treatment matters.
• In children, fluid behind the eardrum usually clears on its own within three months. Antihistamines, decongestants, and steroid sprays do not speed this up.
• Do not use cotton swabs or ear candles. Both can make wax impaction worse or injure the ear.
• See a doctor promptly for severe pain, drainage, fever, dizziness, facial weakness, or fullness that lasts more than one to two weeks.

What causes a clogged ear? Sort it out by the clues

Eustachian tube dysfunction, explained

The Eustachian tube is a narrow passage that runs from the middle ear to the back of the nose. It opens briefly each time you swallow or yawn, letting air in to equalize pressure and letting normal fluid drain out. When the lining of the nose and the tube swells from a cold, allergies, or irritation, the tube does not open well. Pressure in the middle ear drops, the eardrum pulls inward, and the ear feels full, muffled, or popping.

After a cold, this usually settles within one to two weeks, although it can linger longer. Adults whose symptoms last three months or more despite treatment have chronic Eustachian tube dysfunction and benefit from an ENT evaluation.

In children, the Eustachian tube is shorter, flatter, and floppier than in adults, which is one reason children get far more middle-ear fluid and ear infections. Enlarged adenoids at the back of the nose can add to the problem. See The ABCs of Adenoids.

Allergies and clogged ears in North Texas

Allergic swelling in the nose extends to the opening of the Eustachian tube, so allergy season often brings ear fullness and popping. In the Frisco area, pollen arrives in waves through most of the year:

• Winter (roughly December to February): mountain cedar (Ashe juniper) pollen blows north from Central Texas.
• Spring (roughly February to May): tree pollen, including oak, elm, ash, and pecan, with oak often peaking in March and April.
• Late spring through summer: grass pollen, including Bermuda and Johnson grass.
• Late summer and fall: ragweed and other weeds, plus cedar elm in early fall.

Timing shifts from year to year with the weather. Our Frisco pollen and allergen forecast shows current levels. For allergy-related ear fullness, a daily nasal steroid spray is the most effective over-the-counter option, but it takes several days to a couple of weeks to work fully. Non-sedating antihistamines help sneezing and itching. If symptoms are frequent, allergy testing and allergy immunotherapy can reduce them over the long term.

Flying, driving into the mountains, and diving

Pressure problems are worst during an airplane’s descent, when outside pressure rises and pushes the eardrum inward. To help:

• Stay awake for the descent, and swallow, yawn, or chew gum frequently.
• Try gentle pressure equalization: close your mouth, pinch your nose, and blow very gently until you feel a pop. Never blow hard.
• For babies and toddlers, offer a bottle, breast, or pacifier during takeoff and landing. Older children can drink through a straw or chew gum if age-appropriate.
• If you have a bad cold or sinus infection, consider postponing nonessential flights. Adults without medical reasons to avoid them sometimes use a decongestant nasal spray before descent; ask your doctor whether that is appropriate for you.
• Severe pain, bleeding, or hearing loss after a flight or dive should be checked by a doctor.

Children and fluid behind the eardrum

Fluid behind the eardrum without signs of infection (called otitis media with effusion) is extremely common in young children, often after a cold or ear infection. It can muffle hearing, and parents may notice a child turning up the TV, saying “what?” often, or seeming inattentive. Most cases clear on their own.

The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) clinical practice guideline gives clear direction:

• Watchful waiting for three months is recommended for most children.
• Antihistamines, decongestants, nasal or oral steroids, and antibiotics are not recommended for this fluid. They do not clear it faster and can cause side effects.
• A hearing test is recommended if fluid lasts three months or longer, or sooner in children at higher risk for speech, language, or learning problems.
• Ear tubes are offered when fluid in both ears lasts three months or longer with hearing difficulty, and may be considered when persistent fluid causes balance problems, school or behavior difficulties, ear discomfort, or reduced quality of life.

Learn more about ear tubes and hearing loss in children.

Earwax: the safest ways to deal with it

Earwax is normal and self-cleaning. It moves outward on its own. Impaction usually happens when wax is pushed deeper, by cotton swabs, earbuds, or hearing aids, or in people who naturally make more wax. The AAO-HNS earwax guideline recommends against cotton swabs and ear candling. Candling does not remove wax and can cause burns.

• Softening drops (over-the-counter wax drops, or a few drops of mineral oil) used for several days often help.
• Gentle irrigation at home is reasonable only if you know your eardrum is intact. Do not irrigate if you have ear tubes, a hole in the eardrum, past ear surgery, or ear pain or drainage.
• Professional removal with a microscope and small instruments or suction is quick and safe, and is the best choice if drops do not work or you have any of the conditions above.

If water rather than wax is the problem, see How to Get Water Out of Your Ears and What Is Swimmer’s Ear?.

Don’t miss this: sudden sensorineural hearing loss

Some people who “just have a clogged ear” actually have sudden sensorineural hearing loss: a rapid loss of hearing in the inner ear or hearing nerve, usually in one ear and often noticed on waking. It may come with ringing or dizziness. Because the main symptom feels like a plugged ear, it is often mistaken for wax or congestion, and valuable time is lost.

The AAO-HNS clinical practice guideline on sudden hearing loss calls for distinguishing inner-ear (sensorineural) loss from a simple blockage at the first visit, and for a hearing test as soon as possible. Steroid treatment, when used, is most effective when started early, and the guideline supports offering it within two weeks of onset. Most cases have no identifiable cause, but an MRI is usually recommended afterward to rule out uncommon problems on the hearing nerve.

If you suddenly lose hearing in one ear without an obvious cause such as a cold or earwax, see an ENT or get a hearing test within a few days. Our comprehensive hearing tests can tell the difference quickly.

Less common causes worth knowing

• Patulous Eustachian tube: the tube stays open instead of closed. People hear their own voice and breathing loudly and feel fullness, which often improves when lying down or bending over. It can follow significant weight loss or occur in pregnancy. Decongestants make it worse.
• Ménière’s disease: episodes of spinning dizziness lasting from 20 minutes to several hours, with fluctuating hearing, ringing, and fullness in one ear. Learn more about tinnitus.
• Jaw joint (TMJ) problems: the jaw joint sits just in front of the ear canal, so jaw strain can feel like ear fullness or pain even when the ear itself is normal.
• Persistent fluid in one ear in an adult: when fluid in one ear does not clear in an adult, an ENT should examine the back of the nose with a small scope to make sure nothing is blocking the Eustachian tube opening. This is uncommon, but it is an important part of a thorough evaluation.

What helps at home, and what doesn’t

Reasonable to try for a clogged ear from a cold, allergies, or a flight:

• Swallowing, yawning, chewing gum, and gentle pressure equalization
• Saline nasal spray or rinses
• A daily nasal steroid spray if allergies are part of the picture
• For adults only, a short course of an oral or spray decongestant, if your doctor says it is safe for you. Do not use decongestant sprays for more than three days in a row, because of rebound congestion.

Not helpful or not recommended:

• Cotton swabs, ear candling, or putting objects in the ear
• Antihistamines, decongestants, or steroids to treat fluid behind the eardrum in children
• Repeated forceful nose-blowing or hard pressure equalization, which can injure the ear
• Waiting it out when hearing has suddenly dropped without a clear cause

How an ENT evaluates a clogged ear

A visit usually includes a careful history, an examination of the ear canal and eardrum with a microscope or otoscope, a look at the nose and sometimes the back of the nose with a small scope, and hearing tests. Tympanometry, a quick, painless test of how the eardrum moves, shows whether there is fluid or negative pressure behind it. An audiogram measures hearing and shows whether any loss is a blockage problem or an inner-ear problem.

Treatment depends on the cause: wax removal in the office, allergy or reflux treatment, ear tubes for persistent fluid, or, for adults with chronic Eustachian tube dysfunction that has not responded to medical treatment, balloon dilation of the Eustachian tube. That procedure is supported by an AAO-HNS clinical consensus statement for carefully selected adults.

When to see an ENT

Seek care within a few days for:

• A sudden decrease in hearing in one or both ears
• Ear fullness with dizziness, a spinning sensation, or new ringing

Seek care urgently for:

• Weakness or drooping of the face
• Severe ear pain with fever, or swelling and redness behind the ear
• Ear drainage with fever, or bleeding from the ear after an injury

Schedule a visit for:

• Fullness that lasts more than one to two weeks, or that keeps coming back
• A child with fluid behind the eardrum for three months, or any concerns about hearing, speech, or school performance
• An adult with fluid in one ear that does not clear
• Earwax that home drops have not cleared

Frequently asked questions

How long does a clogged ear from a cold last?

Usually one to two weeks, and it often comes and goes as the cold improves. If fullness lasts longer, keeps returning, or comes with a noticeable hearing drop, have your ears checked.

Can allergies make my ears feel clogged?

Yes. Allergic swelling in the nose can block the opening of the Eustachian tube. A daily nasal steroid spray during allergy season often helps, but it takes several days to work fully.

Should I use ear candles or cotton swabs?

No. Ear candling does not remove wax and can cause burns. Cotton swabs push wax deeper and can scratch the ear canal or injure the eardrum.

My ear felt clogged when I woke up and nothing helps. What should I do?

If there is no obvious cause such as a cold or earwax, see an ENT or get a hearing test within a few days. Sudden inner-ear hearing loss is treatable, but treatment works best when it starts early.

Do decongestants help fluid behind my child’s eardrum?

No. National guidelines recommend against antihistamines, decongestants, and steroids for fluid behind the eardrum in children. Most fluid clears on its own within three months.

References

1. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1–S41. doi:10.1177/0194599815623467
2. Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. Clinical practice guideline: sudden hearing loss (update). Otolaryngol Head Neck Surg. 2019;161(1 Suppl):S1–S45. doi:10.1177/0194599819859885
3. Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update): earwax (cerumen impaction). Otolaryngol Head Neck Surg. 2017;156(1 Suppl):S1–S29. doi:10.1177/0194599816671491
4. Tucci DL, McCoul ED, Rosenfeld RM, et al. Clinical consensus statement: balloon dilation of the Eustachian tube. Otolaryngol Head Neck Surg. 2019;161(1):6–17. doi:10.1177/0194599819848423

If your ears have felt clogged for more than a couple of weeks, or your hearing has suddenly changed, I’m happy to help. You can contact my office to schedule a visit in Frisco or at the McKinney office of ENT and Allergy Centers of Texas.