Decongestants: a cause and cure for blocked eustachian tubes
Dear Dr. Roach: At a recent visit with my ear, nose and throat doctor, he commented that frequent use of antihistamines with decongestants can lead to blocked eustachian tubes. Is that statement correct?
I live where the humidity is often above 75%, and I use over-the-counter antihistamines with decongestants nearly every day. Otherwise, I would have red eyes and a runny nose, and sneeze frequently.
My right eustachian tube is blocked. He wanted to do an in-office procedure to unblock it, but I want to see if it resolves naturally.
What are the treatments for blocked eustachian tubes? Does the blockage ever go away on its own? -- J.V.S.
Answer: The eustachian tube is about 36 mm (about 1 1/2 inches) long and connects the middle ear with the throat. Its main job is to equalize pressure in the air-filled middle ear.
About once a minute, it opens up (such as with a swallow or yawn) to let the pressures equalize. If the air pressure inside the middle ear is different from the outside, the eardrum will not vibrate properly and sounds appear muffled.
There are several reason why a eustachian tube may not work properly. The most common is inflammation, especially from allergy, irritants or infection. Inflammation tends to prevent the tube from opening; the tube is stuck closed. Treatment of the underlying condition will help prevent the eustachian tube from being blocked, and may come in the form of decongestants, antihistamines and nasal steroids (which if you haven't tried, you should definitely discuss with your ENT or regular doctor).
I suspect the ENT doctor was warning you about excess topical decongestant use -- specifically, decongestant nasal sprays -- which can have a rebound effect when you stop using them, causing a blocked tube. On the other hand, antihistamines and decongestants used regularly can also sometimes cause the eustachian tube to be stuck in the open position. The most frequent symptom is an unusual sound to one's own voice.
If medications for a blocked eustachian tube are ineffective, there are surgical treatments. But there's rarely a need, but this could include tubes passed through the eardrum to regulate pressure and procedures to open the tube directly, such as a balloon procedure.
Dear Dr. Roach: I have stiff legs when I get up in the morning. I can alleviate the pain with stretching exercises, but it has been getting harder to totally get rid of my leg stiffness. I am 82 years old and getting stiffer each year. Is there a medicine (or secret exercise) for stiff leg muscles? -- K.B.
Answer: I'm not 100% sure it's your muscles that are sore. Most people at age 82 have some degree of joint stiffness, although it can be hard sometimes to tell exactly what structure is causing the stiffness or discomfort. In my experience, joint stiffness from osteoarthritis is a much more common cause of leg stiffness in the morning (or after prolonged sitting) than muscle pain. Regular moderate exercise is an effective treatment and preventive for both types of pain.
Muscle pain and tenderness to touch in the muscle itself should prompt a visit to your doctor. I would be especially concerned if you had tenderness in the leg muscles on an exam and were taking a medication that could cause muscle damage, such as a statin.
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.
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