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ASK THE DOCTOR: Why do my ears feel like they need to pop?

Since last year, my ears have felt like they need to pop. I had them syringed, but it didn’t help. I also sometimes hear hissing and they hurt. I flew to Edinburgh recently and on landing, the pain was immense and the noises were awful. What do you suggest?

Sheila Bullock, Sutton, Surrey.

To answer your question accurately, ideally I’d look inside your ear. However, the key to the diagnosis is what happened when you took the flight to Edinburgh.

A reader writes: ‘Since last year, my ears have felt like they need to pop. I had them syringed, but it didn’t help. I also sometimes hear hissing and they hurt. What do you suggest?’

On descent in the pressurised aircraft, you experienced pain and tinnitus (the perception of noise in the ears when there is no external cause). Your description leads me to believe you have Eustachian tube dysfunction, a very common condition that can happen at any age. 

The Eustachian tube connects the middle ear cavity (the space behind the eardrum) to the area behind the nose and above the throat — the nasopharynx. Its role is to equalise the pressure inside the head with that outside.

The tube is normally closed, but it opens if the air pressure either side of the eardrum needs to be regulated. It also naturally opens when we chew, yawn, or swallow — you will often hear a ‘click’, which is the sound of a valve at the end of the tube closing.

Sometimes, the tube becomes dysfunctional, usually as a result of inflammation in the nose and sinuses caused by infection or allergy. That’s because the linings of the nose, sinuses and Eustachian tubes are made from the same continuous membrane. Therefore, if you have a cold and produce mucus to fight off the virus, some of this will pour into the Eustachian tube.

Additional fluids in the form of water or juice are not necessary for exclusively breast-fed babies, even in hot weather, says Dr Scurr

Additional fluids in the form of water or juice are not necessary for exclusively breast-fed babies, even in hot weather, says Dr Scurr

This can clog the tube and stop it opening and closing, resulting in excess pressure on the eardrum, which leads to pain, popping, slight deafness and a sense of a blockage — just as you describe. It can even cause dizziness.

Your experience on the flight illustrated the problem. As the aircraft came in to land, the increase in pressure pushed air into the middle ear. If air is unable to enter the middle ear due to a blockage, it causes the symptoms you describe.

I assume you must have had a cold or some other illness which clogged the tubes.

As you write in your longer letter, your ears felt blocked and you saw the GP to have them syringed — in fact, I believe the symptom was due to Eustachian tube dysfunction, not the wax in the external ear. As such, syringing is irrelevant. The treatment of Eustachian tube dysfunction is now the challenge.

Different infections — viral colds or sinus issues — and allergies each require a different approach. Dysfunction may also be due to abnormal action of the tubes’ valves. Finding the cause would involve complex investigations.

Decongestants (such as pseudoephedrine tablets), antihistamines, or nasal steroid sprays are frequently prescribed.

I suggest you consult your GP again. A referral to an ear, nose and throat consultant in hospital may be necessary.

I always thought a little water was necessary to quench a baby’s thirst and to hydrate them, whether they were breast-fed or bottle-fed. But I heard that newborns should not be given water as it puts them off their next feed. As a new grandmother, it would be useful to know — am I right on this?

Name and address supplied.

I referred to my Bible on this matter, the Manual Of Dietetic Practice, a guide published by the British Dietetic Association. This says that additional fluids in the form of water or juice are not necessary for exclusively breast-fed babies, even in hot weather.

However, bottle-fed babies may need some extra water in hot weather. This should be tap water that’s first been boiled and then cooled as it’s not sterile straight from the tap. Don’t use bottled water as it may contain too much sodium or sulphate.

No harm can come from giving a baby water — as long as it is purified — but a mother’s milk gives everything that is needed in terms of nutrition and hydration for the first six months, including fat, carbohydrates, proteins, vitamins, minerals and water.

It also contains factors needed to strengthen a baby’s immune system and mature the digestive system. It is what nature evolved over millennia.

Another reason why water should be discouraged in the early days of breastfeeding is that it may interfere with the establishment of a mother’s milk supply. That’s because if milk is not removed, then a protein inside the breast that inhibits milk production will start to collect and stop the cells from secreting any more milk.

This helps to protect the breast against the harmful effects of being too full, but may cut off milk supply prematurely.

Water should start to be introduced at the six month mark, as the baby is weaned on to a mixed intake.

The only caveat is if the baby is ill and has a raised body temperature, then additional fluids may be necessary.

This advice has not changed over many years. I made a swift phone call before responding to your letter to check my recollection: my first son, Ben, was born in 1976 and never had anything at all except breast milk until his mother started to wean him at about six months (quite late even in that hippy era), when she had to return to work — and he is thundering on in good nick, 41 years old recently.

By the way… Patients want time with a GP, not an app 

There is no relief on the horizon from the unfurling crisis in general practice. Our minds were focused on this yet again last week, with the announcement that GP services in one area are being provided via smartphones or tablet devices.

But giving medical consultations that are not face-to-face is to give second-class care — all quality doctors agree on that.

A new study looking at GP consultation times in 67 countries reveals the extent of the parlous state of primary care in the NHS, with the UK’s average consultations among the shortest in Europe and ranked 29th in the list.

Even Egypt recommends giving 30 minutes per patient, yet here, the average GP appointment is a dismal nine minutes and 22 seconds. Most GPs will say shorter consultation times compromise quality of care.

Another significant finding was an association between physician burnout and the stress imposed by short consultations. That’s compounded by other issues we’re already aware of: exhaustion, disillusionment, a lack of funding. I could go on.

But let me highlight one key factor: the number of patients GPs look after. When I visited Cuba in March, I learnt that each doctor treats between 120 and 150 families. With such a small list, the doctor has a detailed knowledge of every patient. In the UK GPs treat patients from a list of 2,500 to 3,000 people, up to 40 patients a day.

Is it a surprise to hear this impoverished country boasts a life expectancy close to that in the UK? The reasons why are not hard to find: they start with having the time needed to give support, advice and continuity of care.

We need a major rethink about how to fund primary care and the way it is delivered. Fancy soundbites about the innovation of smartphone consultations will not cut it: doctors need more manpower and more time.