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Ear Pressure or Fullness
Pressure or fullness in the ear is termed “aural fullness,” which can be due to several different problems. This fullness can originate from the outer ear, the middle ear, the inner ear, or due to problems in the internal auditory canal and cerebellopontine angle area. In evaluating aural fullness, each chamber of the ear has to be carefully evaluated.
External auditory canal
Cerumen, debris, or hair in the ear canal can contribute to a sensation of fullness in the ear. In addition, with some outer ear canal infections, such as fungal or yeast infections, patients will have symptoms of ear fullness. These problems can be easily detected by microscopy and resolved by thorough cleaning of the ear canal. Generally irrigating the ear canal is not recommended. It is preferred that the ear canal be cleaned by instrumentation or aspiration.
Middle ear
Problems in the middle ear can include fluid, negative pressure due to a Eustachian tube dysfunction, an abnormally open (patulous) Eustachian tube, fixation of the ossicular chain or a mass or cholesteatoma in the middle ear. These problems are also easily detected by examination using a microscope. The most common disorder is a Eustachian tube dysfunction, which results in negative pressure and possibly a middle ear effusion (collection of fluid behind the eardrum). This will also result in a conductive hearing loss, if fluid is present in the middle ear. The majority of middle ear problems can be resolved with medical therapy or surgery. Eustachian tube dysfunction problems are treated with decongestants, antihistamines, nasal steroids, sometimes with oral steroids, allergy management, and antibiotics if the fluid din the middle ear is infected. Autoinflation techniques are very helpful in re-establishing air in the middle ear, and eliminate the effusion and fullness sensation.
A patulous (abnormally open) Eustachian tube is usually characterized by having fullness after getting up out of bed, and sensing relieve of symptoms when lying down (because the head is at the level of the heart, the Eustachian tube becomes more congested). Often the symptoms get worse when exercising as the Eustachian tube becomes less congested with the exercise activity. On examination of the tympanic membrane (eardrum) under the microscope, it will be seen to move in and out with respirations. Premarin nasal drops have been used to cause congestion of the Eustachian tube. An alternative technique is a hamulectomy, which results in the relaxation of the tensor veli palatine muscle, thus closing the Eustachian tube to some degree. The risk of the procedure is that it may result in a Eustachian tube dysfunction with development of middle ear fluid.
Inner ear
Increased inner ear fluid pressure, as seen in hydrops or Ménière’s disease can also result in a sensation of fullness. Often patients having a low frequency sensorineural hearing loss or experiencing a sudden sensorineural hearing loss will have a sensation of pressure in the ear.
Skull base issues
Tumors in the internal auditory canal or cerebellopontine angle can also cause a sensation of fullness or pressure in the ear. The most common lesions would include an acoustic tumor (i.e. vestibular schwannoma) or meningioma. These tumors are identified with an MRI or CT scan using a contrast material.
Referred aural fullness
Another cause of “aural fullness” may include temporomandibular joint inflammation (TMJ), giving the “referred” sensation of fullness. The sensation is labeled referred because the problem in one region is misinterpreted by the brain as coming from a different region. Additionally, aural fullness may be referred from the nasopharynx (the area behind the nasal cavity and above the soft palate). An infection or tumor in the nasopharynx could also cause a referred sense of fullness in the ear.