Plugged ears persist after catching a respiratory virus abroad

Dear Dr. Roach: Three months ago, I caught a respiratory virus on a trip to South America. According to my ENT doctor, my ear canals are clear, and my sinus infection (if I, indeed, had one) is all cleared up now. Labs show that I didn't have COVID or respiratory syncytial virus (RSV). I am feeling fine, and I'm back to my normal activity. But I still have plugged ears, as if they never recovered from the virus or perhaps the altitude changes I experienced on the trip.I feel as though I am living in a cave or a telephone booth as my own voice echoes in my head. My hearing is a little impaired, and my ears "click" when I move my jaw, as if they want to pop open but can't. Doctors seem to be flummoxed by this and have prescribed antibiotics, steroids, Zyrtec, and all manner of over-the-counter decongestants — none of which have had any effect.I have also been fitted with a mouth guard to wear at night, in case this problem is the result of clenching my jaw and gritting my teeth. But that is not affecting my blocked ears either. When I mentioned this condition to my friends, it was amazing how many have experienced plugged ears when returning from a trip. Some recovered faster than others; everyone recovered faster than I have.As this seems so common, doesn't anyone in the medical profession know what this is and how to heal it? — S.C.Answer: I think your doctors all suspect the same diagnosis — Eustachian tube dysfunction — but healing it seems to be the tricky part.The ear is blocked, but it's not blocked at the level of the ear canal. (Your doctors would have spotted that right away.) It's blocked at the level of the middle ear. For the ear to work properly, the air pressure inside the ear needs to be the same as the air pressure outside the ear. When they are different, there is tension at the tympanic membrane, and it bulges, leading to impaired hearing and the sound changes that you describe.Most people notice this when air pressure changes rapidly, such as when a plane ascends or descends. This happens because the pressurization of the cabin isn't perfect, and the ear pressure is higher than outside pressure during an early ascent.Your body has a structure called the Eustachian tube (ET), which equalizes the pressure by opening and letting air escape or enter. It connects the middle ear with the nasopharynx. Ordinarily, the ET will open and close multiple times per hour, especially when yawning or swallowing. Most people recognize the popping sensation that is associated with the relief of ear pressure when the ET opens and equalizes pressure.I am pretty sure that your ET isn't working right. It's probably stuck in the "closed" position (called obstructive ET dysfunction), but it's possible that it is stuck in the "open" position (called patulous ET dysfunction). Patulous dysfunction can occur after months of obstructive dysfunction, with atrophy of the lining of the nose, sinuses and ET itself.At this point, you need further investigation. Your ENT physician can do an endoscopy to look at the ET and confirm the diagnosis. They can give you advice on how to safely equalize air pressures by keeping your mouth closed and gently increasing your nasal pressure while swallowing. There are devices to help this maneuver.If this fails, a balloon procedure can open an obstructed ET. Some people may ultimately need tubes through the eardrum itself, but most people do well with the pressure-equalization maneuvers or devices.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.