Presentation: Blocked Ear Feeling

Eustachian tube dysfunction

Causes: developmental or acquired deformity narrowing the eustachian tube; inflammation/effusions. Results in a build-up of mucous membrane secretions (physiological or infective) that reduces tympanic membrane compliance, reducing its conduction of air vibrations.

Management: determine and treat the underlying cause. Decongestants, antihistamines, and steroids (oral or topical) have shown no clinical benefit for managing otitis media, though there’s anecdotal evidence they help reverse the prodrome leading to it — eTG doesn’t recommend them for this indication.

Excessive ear wax

Predisposing factors: developmentally narrow external auditory canal; excessive instrumentation with cotton buds; occupational exposure.

Symptoms: direct irritation to the external canal. Sudden blockage and hearing loss can occur when water is trapped behind wax build-up (valve-closure effect), or if the wax becomes impacted.

Examination: visualise the blockage — the TM is usually not visible.

Management: if wax is dry and impacted, soften with an oil-based preparation (e.g. Waxsol, olive oil) for 5–7 days first. Ear toileting can then be attempted if appropriate instruments are available — ear syringing needs care to avoid barotrauma; ear toileting (suction/spatula) should be done under direct observation. See Ear Syringing / Wax Management for the full syringing contraindications and complication profile.

Prevention: maintain ear canal moisture if dry; reduce exposure to foreign material entering the ear (dust, water); don’t dig at the ears blindly.

Foreign body in the ear

See Nasal Foreign Body for the nasal-specific technique and referral pathway.

Often presents in young children, but can occur at any age. Culprit objects are usually small items children place in their own ear; insects are another presentation. Late presentations often show concurrent infection/irritation of the external canal and oedema.

Approach: always visualise the foreign body and assess the risk of TM perforation or impaction — sharp or large objects, canal oedema, or an uncooperative young patient are all reasons not to attempt removal in general practice; refer to ENT instead.

“Standardised” retrieval (per current paediatric ENT practice): microsuction combined with alligator forceps is the gold-standard approach under direct visualisation. If the object is free-moving and not high-risk as above:

• Small alligator forceps retrieval under direct observation, for objects that aren’t slippery or friable (risk of pushing them deeper).
• Dry suction for small, light objects.
• Ear syringing is sometimes used, but be selective — anything that builds surface tension or becomes sticky when wet (e.g. some seeds) should not be irrigated.

Button batteries and disc magnets are a specific emergency — they can cause rapid tissue necrosis (button batteries via electrolysis against moist tissue) and need urgent ENT referral for same-day removal, not routine primary-care retrieval attempts. Multiple failed removal attempts are themselves a major driver of complications (mucosal trauma, bleeding, canal stenosis) — refer promptly rather than repeatedly trying.

Once the foreign body is removed, treat any resulting infection as otitis externa.