Every weekday, a CNNHealth expert doctor answers a viewer question. On Monday, it’s Dr. Jennifer Shu, a pediatrician.
Question asked by Becky M. of Oklahoma City, Oklahoma: After taking antibiotics for a sinus infection or ear infection, what is the best way to help encourage drainage of the middle ear or eustachian tube?
I have seen many remedies online, some of which recommend using a neti pot, but I feared making the situation worse. Is it normal to still feel some congestion in the ear area even after finishing the antibiotics?
Expert answer: Thanks for your question. Sinus infections are very common, affecting more than 30 million adults in the United States each year.
In these infections, the sinuses (such as those found in the forehead, under the eyes and along the sides of the nasal bridge) become inflamed and may feel full or painful.
The eustachian tube is the channel that connects the middle ear with the back of the nose and throat. During colds, allergies, ear infections or sinusitis, the eustachian tube can become blocked by mucus and cause a person’s ears to feel clogged, with a temporary loss of hearing. These symptoms may continue for a few weeks after a cold or other upper respiratory problem has resolved.
In many instances, the sinuses and eustachian tubes will clear on their own after a few days. Treating the underlying cause of the problem (sinusitis, allergies, etc.) is the first step. Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help with the discomfort in the meantime. Some people require antibiotics to treat a bacterial infection of the ears or sinuses. In addition, it can be helpful to try other remedies to clear the head of mucus.
I consulted with Dr. Aaron Rogers, an otolaryngologist in Atlanta, Georgia, who shared the following information about some common remedies:
Nasal washes: Saline rinses, sprays and neti pots don’t directly treat the eustachian tube but can be a huge help for sinusitis and runny or stuffy noses. Be sure to clean neti pots with soap and water, and use commercial saline products or make the saline solution yourself with sterile or distilled rather than tap water.
Nasal steroid sprays: These are available by prescription and can help open up the eustachian tube.
Physical maneuvers: Chewing gum is a common way to try to keep the eustachian tubes open. You can also pinch your nose and swallow or close your mouth, pinch your nose and blow.
Nasal decongestant sprays: These medications are available over the counter (such as Afrin) or by prescription and are especially helpful when flying (use 30 minutes before takeoff and landing). They are recommended to be used for no more than about three days at a time, since longer use can cause “rebound” swelling of the nasal passages. Of note, nasal sprays containing zinc should be avoided, as they have been reported to cause the permanent loss of the sense of smell in some cases.
Oral decongestant medicines: Examples of ingredients include pseudoephedrine and phenylephrine. While the problem of rebound is less common with oral decongestants, some people experience palpitations or a rise in blood pressure.
Oral steroids and antihistamines are sometimes used, particularly in longer-lasting sinus infections; however, they may have side effects such as drying up the mucous membranes of the nasal tissue and thickening the secretions. These are not routinely recommended for the treatment of uncomplicated sinusitis or ear infections.
Since every person’s situation may be a little different, it’s always best to talk to your own physician for the most appropriate treatment for your case. Good luck!
I suggest N-Acetyl-Cysteine (NAC) 1000mg orally in the morning with some Ibuprofen and lots of water. NAC is a prescription drug that is also available on the supplement market and it is used for breaking up mucous. Ibuprofen clears up some of the swelling in the tubes. The two together work really well, in fact so well that I recommend taking it in the morning so you do not choke on or inhale your sinus drainings. Talk to your doctor before taking this if you have any issues with chronic kidney stones, you are at high risk for catching pneumonia, or if you are taking any other drugs. NAC is also used to treat acetominophen overdose and vesalgia (hangover).
I’ll tell you what I tell the doc….if aspirin/tylenol/ibuprofen etc, worked, I wouldn’t be taking time off work and spending sixty bucks for an office visit.
The pain is excruciating, and the docs could care less.
@HH I agree. I don’t think a simple ibuprofen by itself is going to work, it helps a little with pain and swelling, and when swelling goes down things can drain easier. The NAC is what I really suggest!
If there is still infection I recommend doxycycline, at least that works best for me and it is cheap.
Do NOT close your nose and blow. You can rupture your ear drum. At least thats what the ENT doctor told me. I’d double check this advice CNN before someone hurts themselves.
You are not supposed to blow full force; just enough to apply a little bit of pressure. The article should definitely clarify claims like that so that people don’t get hurt due to bad wording.
I remember the horror story I heard as a kid from the Doctor. He said he actually had a women come in holding the little bones that are in the ear. I don’t know if thats just something he tells people, either way I would not do this.
Hi Martin, Auto-inflation of the middle ear is routinely advocated for middle ear fluid, to help aerate the space and clear the fluid. The scientific literature is undecided on how much it helps, but a recent Cochrane Library Review seems to favor autoinflation because of it’s low risk. This can be done with commercial devices (Otovent or EarPopper) or done by “popping” ones ears. Yes, in theory it may be possible to create enough pressure to cause a ruptured eardrum, this is highly unlikely because it would be very painful well before the rupture (for instance some folks pinch their noses while sneezing vigorously which generates way more pressure way more quickly and almost never cause a ruptured ear drum). It sounds like your old ENT gave you a scare story, at least in part.
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