Eustachian tube occlusion

I think I am on to an overlooked area of hearing aid fittings. I have either tried or purchased just about every hearing aid made in the last 50 years. The first was worn on a strap around my neck with wires to the ear molds. One of the best was Starkey analog canal aids. As my hearing got progressively worse feedback became a bigger problem with canal aids and I have been forced to wear behind the ear aids. This was great for audiologists and manufacturers as they could pop a dome on the end of tube and “voila”, you were fitted. The common complaint I had with all of the aids was that clarity was terrible soon after they were in my ear. The belief out there is that the greater loss one has the less venting is needed. Hearing authorities seem to think that venting is primarily to allow the high frequency sounds to enter through the vent. While this may have some merit I think most fitters are overlooking a serious problem that is being created. That is to minimize or remove any venting in the case of domed open fit aids is disabling the eustachian tubes ability to balance pressure and creating occlusion. I was already in the final stages of testing for cochlear implants with voice recognition testing scores of around 40% with background noise. The following week I tried custom molds that were supposed to provide more power allowing for better clarity and a richer sound. The first testing with these molds was about the same as with the domes but I agreed to try them anyway. Convinced that I needed cochlear implants I went back for a final testing the next day. Voice recognition went from 42% to 78% with custom molds overnight! I now believe that this was because the lack of venting in the domed earpieces and when I first tested the custom molds my eustachian tubes had not had time to balance the pressure. I had always known that altitude changes made significant changes in my hearing and numerous visits to ENTs always indicated that my Eustachian tubes were functioning normally. What no one ever considers is that unvented fittings create the same problems, especially when changing altitudes. It was to the point of telling people I can hear your voice fine but I can’t understand what you are saying and I knew it was my ears and not them. Convinced that it was an occlusion problem I was ready to find an ENT that would perform the new balloon dilation procedure that would open up the Eustachian tubes but I am going to give the new vented molds a longer try and will not ever consider unvented molds or open fit domes again. If it weren’t for the follow up tests I would have been talking to surgeons for an irreversible implant. So please be aware that your ears need air to circulate through the Eustachian tubes and to the outer ear for balance and proper hearing.

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Yes, I’ve often wondered about that. Unbalanced pressure on either side of your eardrum will drastically alter hearing perception.

All the modern molds and even closed domes I’ve seen are vented. (Of course you’ve seen a lot more than me). But for instance, Phonak has these flanged “power domes” that I don’t believe are vented. I guess you normalize the pressure as you wiggle them around in fitting, but if the ambient pressure changes once they’re in, you’ll get an imbalance (via the Eustachian tube) if they’re not vented.

Perhaps the Phonak Power Domes are intended for temporary use. But that’s not how they’re purveyed.

I don’t see how a dome can be properly vented. The audiologist that sold me the current aids cut a slice on each side of the inner dome and said that was all I needed. It didn’t alter the problem one bit and the custom mold is the only way to get sufficient venting in my opinion.

Double power domes are used in most cases for low frequency losses like mine. Yes, you are correct in that you want some kind of pressure equalized by moving them around, otherwise you get an occluded effect as well. These domes are a quick fit solution and not a one size fits all. Many opt for custom moulds with a vent to suit their needs.

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I’m hoping we can have an audiologist reply. My understanding is that unless the eardrum is not intact, what happens in the outer ear is not going to have any impact on the eustachian tube.

If you manage to get some kind of airtight seal in the outer ear, I guess it would be possible to create some suction or additional pressure on the ear drum, but I don’t think this is having any impact on the eustachian tube. Here’s a diagram: https://www.webmd.com/cold-and-flu/ear-infection/picture-of-the-ear#1 Note: Tympanic Membrane is the same as ear drum.

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I am aware of this documentation and have normal test results for ear pressure. Still no explanation as to how my speech recognition testing can fluctuate so dramatically or why the holding my nose and exerting pressure will frequently cause my hearing to improve. I can only sense that if I can often elevate my hearing ability this way when no altitude changes are taking place that my Eustachian tubes must somehow be closing. I too am hoping for a better explanation and some answers. This got too close for comfort when told that a cochlear implant was my only hope.

I’m not an audiologist but I’m an engineer with 3 1/2 years of medical school. I think there’s a simple point of anatomy/physiology here.

And sorry if I’m being a stickler for language and logic, but it’s not a matter of anything having an impact on the Eustachian tube. It’s a matter of the Eustachian tube being open to equalize pressure at the eardrum.

If the Eustachian tube is occluded, ambient pressure is not equalized at the eardrum, and the eardrum will be flexed in one direction when there is an atmospheric pressure change on the outside, and this will attenuate the transmission of sound to the cochlea. Especially low frequencies that require more displacement of the eardrum.

BUT… all that being said, forcing pressure on one side to improve hearing is not a sign of Eustachian tube occlusion.

Ricorny, this suggests to me that (1) you simply still have trapped too much pressure on the outer side of the eardrum (from the HA dome insertion?), and (2) the Eustachian tube is probably functioning normally because there is ambient pressure behind the eardrum (on the inside).

Why do I conclude that? If you exert pressure as you describe and it “pops” and then is better after the pop with no more pressure exerted, I would say that there is Eustachian tube occlusion and there was a pressure gradient across the eardrum and you cleared it by forcing air up the Eustachian tube.

But since you need to apply constant pressure, and the sound worsens when you stop applying pressure, it suggests that there is ambient pressure on the inside (working Eustachian tube), but too much pressure on the outside. And the pressure returns to ambient on the inside (again, working Eustachian tube) when you stop exerting pressure.

Ergo, I think we’re back to issues of venting the dome.

Maybe try inserting a piece of plastic alongside the dome, like the thin plastic of the outer-ear retainer flap if you have one with your receivers, or else a little piece of monofilament that’s used to clean out BTE tubes. This may deform the edge of the dome enough to let air through and not build up pressure on the inside.

Or just put a couple of layers of a thin strip of cellophane tape along one edge of the dome.

Or get an extra dome, heat up a large-bore sewing needle or pin with a lighter, and melt a hole in the dome If you melt a small hole, the hole will stay open, as opposed to just puncturing the dome with the needle, in which case the pliable rubber will tend to re-seal around the puncture.

Boy, it’s been awhile and I needed to go back and reread. Still not sure what you’re saying. My best guess is that you’re saying the unvented molds created a perfect seal creating either pressure or suction (air pressure greater or lesser than what the eustachian tube is exposed to), thus creating unequal pressure?

Yes. Specifically, when you put occluding domes/molds in without venting, the act of insertion pressurizes the air between the domes and the eardrums.

Since behind the eardrum, in the middle ear, the pressure will be ambient (assuming the Eustachian tubes are open), if you pressurize the air on the outside of the eardrum (between eardrum and dome), you will put a permanent flex on the eardrum inward for the duration of the pressure difference.

Vent holes in the domes should allow the pressure between the domes and the eardrum to normalize with ambient, if the vent holes aren’t too tightly compressed.

I gave myself a REAL SORE ear early this week along these lines. It’s true that I hear maybe 15-20% better when I JAM my aids into the ear canal, sealing off ALL cracks. But the result of that is that my new silicone tips left compression sores BAD in my left ear, and tender in the right. For a whole day, I wore NO aid in the left ear. Helen Keller met her cousin, Suzie Keller. One-eared hearing is simply not good enough for me.

There has to be a balance between occlusion, comfort and hearing (without feedback leakage). I have found these silicone tips better than the softer, double-dome power domes I’d worn BUT I had to have my audi plug up the vents till they were nearly sealed.

There must be some pinprick openning cuz I’m able to clear my ears when plugging my nose and blowing. Speaking of which, I highly recommend THIS spray - PressureEaze - for clearing ears! No kidding, 3 deep inhales up each nostril (while plugging the other nostril), tilt head back, wait 10 sec and you should be able to clear your ears, even if it’s been years since that was possible.

+1 on the PressureEze! It really helps to clear the Eustachian tubes.

^^^ Yeah, you are a believer! It was a near-religious experience for me to almost immediatly clear my LEFT ear - which I had not been able to do in easily 20-odd years?

I don’t even need to spritz up daily - maybe just a couple times a week to keep my ears “clearable”. A miracle!

It’s hard for me to imagine that tight of a seal that couldn’t be broken by a little jaw or chewing movement. If they really form that tight of a seal and jaw movement doesn’t work, I’d think backing them out a touch or having them made a little smaller would be appropriate.

Wondering about pressure eze: https://www.pressureze.com/

What is in it? I know normal nasal spray based on salt water don’t do much. And I know that the medicine is rather bad for prolonged use.

Can’t see your hearing loss, but my first guess would be that the problem wasn’t the venting, but that domes were inappropriate for your hearing loss and you needed molds.

From the PressureEze label:

“INGREDIENTS Blended Salts and purified water. (Ingredients Certified Natural, Non-GMO, Kosher, Vegan, Gluten-Free. No BPAs. Free of drugs, preservatives, alcohols, sweeteners, and additives.) Sterilized For Your Safety!”

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Regular usage of saline spray can be remarkably effective for some people. You’re absolutely right that decongestant sprays, although very effective in the short term aren’t good for long term usage in that there tends to be a “rebound” effect. Steroid nasal sprays (fluticasone, etc.) can be helpful, are available over the counter and are fine for longterm usage. Azelastine, available by prescription (antihistamine spray) is also ok for longer term usage, as is just taking a daily antihistamine like cetirizine (without an additional decongestant)

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@FredTX I read that, too. Didn’t find it too helpful, though. Especially BlendedSalts ™ is kind of an obfuscation.

I’ve tried all approaches described by @MDB. Most don’t work too well for me. I’ve been washing my nose with a neti cup for the last weeks and it does alliviate some, but it is rather a chore to do it daily.

That’s why I am that interested!

I have no idea what constitutes “Blended Salts”; all I know is that PressureEze works for me when I need to get the tubes cleared, which is usually a couple of times a week.