Why Valsalva maneuver does not unblock eustachian tube?

Question

Hi doctor,

I had an ear infection about two weeks ago and just finished the antibiotic. In the past two weeks, I have had a fluid stuck in my middle ear with no relief. There is a lot of uncomfortable pressure in my ear and my hearing is completely blocked on that side. I believe my eustachian tube is blocked. I have tried a number of decongestants and also the Valsalva method, but nothing has worked. I have a few very clear photos of my eardrum. I could show you if that helps. Also, in the past few days, bubbles are present in the fluid behind the eardrum. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen the photos. (attachment removed to protect the patient identity). It appears that after the ear infection there is some fluid accumulation inside the middle ear. We call it otitis media with effusion. This is quite common after an ear infection and usually occurs due to some remnant inflammation inside the eustachian tube that prevents the flow of mucus from the middle ear into the throat through that tube. This can be confirmed clinically by otoscopic or endoscopic examination. Additionally, the hearing loss can be quantified by pure tone audiogram (PTA) and the fluid confirmed by the B curve in impedance audiometry. Do you have any pictures of the drum or the tests? If so please share it with me. Usually, the effusion takes a couple of weeks to resolve and needs a different type of medicine than the one given for infection. You need decongestants oral and local, nasal sprays, antiallergics, and a mild anti-inflammatory agent. Do revert back to me with more details and we shall discuss what has to be done. Do not do Valsalva if there is any nasal block or congestion still as that would push the mucus further into the tubes and increase the block.