The Biggest Ear Problems for Sleep Apnea Sufferers

June 10, 2010

If you have obstructive sleep apnea, chances are, you’re likely to have some sort of an ear problem. There are a number of reasons why you’re going to be prone to various ear problems, but in many cases, the problem is not actually coming from the ear. To better manage your ear issues, you first have to understand your ear anatomy, and the different types of inflammation caused by sleep apnea. In the last part of this article, I’ll go over some tips to help you solve many of your ear-related issues.

What You Must Know About Ear Anatomy

The ear drum is a thin membrane that separates the middle ear cavity from the outer ear canal. Sounds waves vibrate the ear drum, which connects via a sophisticated lever and piston amplifier system that transmits sound waves to the inner ear. Normally, the middle ear cavity should have the same pressure as the outer ear canal. This is made possible by the function of the eustachian tube, which connects your middle ear cavity to the back of your nose. Whenever you swallow or yawn, your palatal and throat muscles open up the eustachian tube temporarily, equalizing pressure between the middle ear and the nose. You can think of the middle ear as a sinus—an out-pouching from the nose into an adjacent pocket of bone or soft tissue.

Whenever you go up an elevator or descend during a flight, the atmospheric pressure either goes up or down, and this creates either positive or negative pressure in your middle ear. With very slight pressure changes, you’ll feels a bit of fullness and hearing loss, but with severe pressure changes, you may even have pain and discomfort. If you keep swallowing, then you’ll keep popping open your ears. As a result, you’ll feel anything from fullness, hearing loss, popping, clicking, buzzing, or even ringing. This is why it’s recommended that you chew gum during descents in flights, or give the baby a bottle to feed.

Causes Of Inflammation

However, if you have any degree of inflammation in your nose, then additional swelling can prevent proper equilibration of air between your middle ear and nose. A number of different causes can aggravate swelling, including viral colds, allergies, weather changes, and even acid reflux.

You’re probably very familiar with the effects that a simple cold or allergy can have on your nose and ears. In most cases, you’ll have a few days of discomfort. But in certain situations, your cold or allergy may go away, but your ears will continue to be stuffed for days or weeks. Sometimes, the vacuum pressures that are created can cause fluid to accumulate, giving you what’s called serous otitis media. Rarely, this fluid can get infected and turn into the classic bacterial infection or otitis media. Fortunately, not too many people have true bacterial infections—most never make it past the vacuum pressure or clear fluid stages.

A Vicious Cycle

If you don’t have obstructive sleep apnea, the entire process can come and go within a few days to weeks. However, if you have sleep apnea, due to the additional inflammation that’s created, a simple ear or sinus problems can linger for weeks, and sometimes even months for the following reason: Any additional inflammation in the nose or throat causes swelling which can aggravate more frequent obstructions, leading to stomach juices to come up into the throat and nose, including in the area of the eustachian tubes. Furthermore, frequent obstructions and arousals leads to an imbalance of your involuntary nervous system, where your nose is going to be overly sensitive, especially to weather changes (pressure, temperature, and humidity changes). This is called chronic or non-allergic rhinitis.

For some people using a CPAP machine can blow air into the middle ears, through positive pressure. This can be a frustrating issue that’s difficult to cure completely.

Solutions For Your Ear Problems

So if you have obstructive sleep apnea and are prone to ear problems, what can you do? The first thing to make sure of is that you’re treating your sleep apnea condition optimally. If your CPAP pressure is too low, or your dental device is undercalibrated, or your UPPP procedure was only partially effective, then you’ll still have residual obstructive sleep apnea and are still feeling the effects of intermittent obstructions and arousals.

Second, make sure that your nasal breathing is optimal. By definition, your nasal passageways will be either narrowed, inflamed, or both. Having a chronically stuffy nose can create more of a vacuum effect downstream, which allows the tongue to fall back more often when in deep sleep, due to muscle relaxation. If you’re using CPAP, then it’s likely that your pressures may be too high, which can make it uncomfortable, and even blow air into your ears. Whether through vigorous saline irrigation, allergy avoidance, medications, or surgery, it’s important to make sure you’re able to breathe well through your nose.

Lastly, it’s important to lower inflammation in your throat by making sure you’re not eating within 3-4 hours of bedtime. Having even 2-3 apnea or hypopnea episodes per hour, although acceptable, can still suction up juices into your throat. Since you’re going to suction up normal stomach juices anyway, it’s important to keep the acidity and juice volume as low as possible. The same rule applies to alcohol, since not only does it produce more stomach acid, it also relaxes your tongue and throat muscles, causing you to stop breathing more often.

Ear problems are an inevitable part of having obstructive sleep apnea. By knowing what can cause ear problems and how you can deal with it, you can minimize the discomfort to a point where it’s tolerable or minimal.

 

 

 

 

26 Responses to “The Biggest Ear Problems for Sleep Apnea Sufferers”

  1. RL on August 30th, 2010 6:22 pm

    This is great information Dr. Park. Thank you for posting it. I think that anything I can do to keep my immunity strong toward resisting bacterial and viral infections is important too. Basic hygiene like washing hands, and getting a flu shot are part of my defense plan.

  2. ML on November 7th, 2010 8:57 am

    Two years ago I was diagnosed with severe sleep apnea (33 times per hour) and started using CPAP machine ever since. I got used to the machine within a couple of months and my sleep quality improved significantly. However, I was under the wrong impression that higher pressure may be better, so I set my machine to 8.5, although I only need 6.0. Recenly my ears starts hurting, as if there is always pressure in both ears. My ENT doctor told me that it could be cause by the used CPAP machine which may cause some problems to the eustachian tube. Unforunately, my sleep doctor never warned me about this risk. Is this a common problem for people using CPAP machines?

  3. Steven Park on November 7th, 2010 7:02 pm

    ML,

    It is possible that too high of a CPAP pressure can aggravate ear problems, but it can also cause central sleep apneas. It’s important to work with your sleep doctor to fully optimize your sleep apnea treatment.

  4. Donna on October 15th, 2011 11:52 pm

    Thank you for your very informative articles. When I use my CPAP, I wake up in the middle of the night with ear fullness, a sinus type headache and on some night my teeth feel very sensitive. If I continue to use the machine, my nose bleeds and the headaches last throughout the day. My sleep Dr said he cant understand why this is happening as I have a hunidifier and he lowered the pressure on the CPAP. I use a saline nose wash and a cortisone nasal spray to make sure my sinuses are clear. Lately my ears always feel full, especially when I bend down. I have been to 3 ENT’s and they do not see any reason for this. I stopped using my CPAP as I can’t take headaches any longer. Any suggestions for me?

  5. Steven Park on October 16th, 2011 7:10 am

    Donna,

    It sounds like your nervous system in your nose and sinuses are overly sensitive. Think of the CPAP pressure and airflow like being a migraine trigger. What this means is that you have to look at other options for treating your obstructive sleep apnea.

  6. Julie on December 28th, 2011 5:46 pm

    Can the pressure being to high cause your esophagus/ bronchial tube to become irritated? l know that dispute the fact that l have an humidifier on my c-pap my mouth and nose still drys out each night, even when set on the highest setting! l was wondering if the rawness l feel in my down the middle of my chest could be caused by it drying me out all the way down into the tubes.

  7. Muzaffar on June 19th, 2012 2:52 am

    When I wake up in the morning, I feel pressure in my left ear, it seems as if it is clogged and i do have some difficulty in hearing, but within few hours it ends. Anyway i feel very bad and afraid of bad results of it. What is this and what should I do? Thank you very much for your answer beforehand.

  8. Sue Pearce on June 23rd, 2012 6:37 pm

    Years ago I had hearing loss in my left ear and the doctor performed a stapendectomy; removing and replacing a bone with a surgical steel pin. My question is with the testing for sleep apnea do anything to that surgical pin.

    I know I can never have an MRA because of the surgical pin. I want to make sure this test I am going to have for sleep apnea will not do anything to my hearing in that ear.

    Thanks,
    Sue

  9. Chris Hale on July 14th, 2012 4:02 pm

    I started using a CPAP nightly in March of this year. By April I experienced hearing loss as though both ears were stuffed with cotton and a visit to my ENT Dr. revealed fluid behind both ear drums. Medication & nose spray’s failed to clear this problem & as I had a trip to Sweden planned in May; I elected to have tubes placed in my 65 yr. old ears. I had several conversations with my ENT regarding the suspected relationship between my ear problems & my use of a CPAP. The Dr. assured me there was NO relationship. My hearing loss has improved only slightly and as of July my left ear now drains about 1cc of clear fluid upon waking. Could you refer me to someone in the Houston area with more experience in these issues?
    Thanks, CH

  10. Steven Park on July 14th, 2012 4:42 pm

    Sue,

    There shouldn’t be any problem getting tested for obstructive sleep apnea.

  11. Steven Park on July 14th, 2012 4:43 pm

    Chris,

    I don’t know anyone in the Houston area, but you may want to look for an otologist (someone who deals with ears only). Good luck.

  12. Stephanie Pharr on August 6th, 2012 12:41 am

    H Dr Parks
    I have had a long history of eustachian tube problems that resulted in cholesteotomas since early childhood. Recently about 2 years ago, I was diagnosed with severe obstructive sleep apnea (82 episodes an hour). I have always felt sleepy or drowsy since adolescence but throughout the years, I have learned to compensate and live with it. I have always wondered if OBS was linked to my middle ear problems and your article really shed light on this topic. About 5 years ago, I underwent a surgery to remove a huge cholesteotoma. The surgery was done twice with the last resulting in the restoration of my middle ear. For the first time in my life, I am able to hear out of my left ear but my right ear, which has always been normal has lost hearing. Recently, I went to an another ENT who told me that hearing in both ears are not that well and recommended 2 hearing aids, one for each ear. The doctor could not see the small cholesteotoma that a previous doctor noted after a CT and MRI. My previous doctor did not want to do surgery on the right ear because he wanted to leave me with one good ear but he wanted to keep his eye on it. To jumpstart my hearing, he used to give me shots right into the ear, which hurt really bad during the injection, but it resulted in hearing out of my right ear. Dr. Park, I’ve gone through a lot with my left ear. At five years of age, tubes were surgically placed in the left ear. Before and after the tubes, I can remember terrible earaches as a child. At 12, I had my first cholesteotoma surgery and then again in adulthood. Your article really helps.

    Thank you

  13. Sam on August 8th, 2012 12:33 pm

    I use a CPAP that is programmed at 13 by my doctor and I also use a nasal mask. But I also have had chronic ear issues in my left ear for most of my life (infections, swelling, swimmers ear) every 3 or so years I will get an infection. So it feels less strong than my right ear.

    Recently while using the CPAP I am getting ear pressure in the left ear to the point that last night I had to take off the mask to get to sleep. If I use the ramp-up the pressure is too low for the nasal mask (the one with the 2 plugs that goes into the nose, not the mask that fits over the nose).

    Will ear plugs or airplane pressure plugs help me? The ear issue is chronic long before I started using the CPAP.

  14. Brenda Burnett on October 17th, 2012 11:56 pm

    I have recently had dry ears so bad that one of them throbs. I figured out it is caused by my CPAP machine. Been using baby oil, but seems worse. I just got a script of Pramoxine HC and am waiting to see if this helpsl Any thought?

  15. Darby Day on January 3rd, 2013 5:55 am

    I was glad to read your article. Itsounds exactly like my situation. I have recently been experiencing slight hearing loss in my left ear which has been feeling plugged up. I have sleap apnea and wear a cpap mask. I noticed the pressure was on 5 instead of 4 which is what the doctor originally set it at. I turned the dialback to 4 and hope this will fixthe problem that I have been having lately. My biggest fear now is that I may have permanently damaged my ear. I hope not, I really scared about that possibility. There isn’t any pain associated with the fullness or plugged feeling in my ear. Will my ear return to normal?

  16. Nadeem on January 10th, 2013 6:22 pm

    I am experiencing the same problem as many of you. I use the CPAP machine and since then my right ear has been feeling a little clogged and its constantly popping I always have to pinch my nose and blow to try and regulate my hearing but that never really works to unclog my ear. It is very frustrating! Is there something I can do to rid my self of the clogged ear that is perhaps pressure stuck in my middle ear or Eustachian tube? I tried stopping the CPAP machine but this doesn’t work either it’s been clogged for 3 months now. Any suggestions?????

  17. Cheryl on January 14th, 2013 2:21 pm

    I started using a CPAP machine in July of last year. I had been having problems with my ears burning from toothpaste, carbonated drinks, and spices and using the CPAP made the symptoms worse. I now have a very sore tongue. The very back of my tongue, close to my ears, feels like it is inflamed and burns. My ears burn constantly, but excruciatingly upon brushing my teeth or drinking fizzy beverages. I can cut out the fizzy beverages but have to brush my teeth! I have not been using the CPAP regualarly, I try for a few days to see if it will be okay but it elevates the symptoms. Has anyone else experienced the burning ear sensation? My doctor says it is from dryness and rough teeth. My dentist says I don’t have rough teeth. What should I be doing to help this problem?

  18. Gordon Ryhorchuk on January 28th, 2013 9:48 pm

    I have been using a cpap machine for about 15 yrs with good results. About a year ago I noticed fluid in my ears while using it. This developes into sore and scabby parts of my outer ear and swelling. I have had ears cleaned, medication which helps for awhile but wetness and sores return. I have never used a humidifier with my machine. I am 77 yrs. of age. My Dr. seems baffled by this. Can you help. Gordon

  19. Judy Goldberg on May 10th, 2013 9:58 pm

    I use a CPAP nasal piece. The machine is set at 7. I have had problems with pulsating in my right ear and loss of hearing in that ear. Could this be related to the CPAP machine? Sometimes the noise is louder than others and sometimes it’s gone. This is driving me crazy. I’ve had an MRI, MRV, MRA a carotid artery test and nothing conclusive shows up to cause this. Do you have any ideas of what I can do about it and if it is related to the sleep apnea? Thank you

  20. rich on June 12th, 2013 5:12 am

    I am using a CPAP for sleep apnea and about 2 months ago I started feeling that my right ear was not the way it should be and I started hearing my heart beat in a soft, whooshing way. My ENT told me there is moisture in my ear and prescribed steroids and nasal spray but it still hasn’t cleared up. Just recently I began wondering if my CPAP could be a problem. My ear doesn’t hurt at all but hearing my heart beat all day long has gotten annoying. I saw your article online and will most likely make an appointment to see the sleep doctor soon. Is there another way I can get rid of that whooshing sound? Thank you.

  21. Steven Park on June 12th, 2013 6:28 am

    Your ENT should be able to help you with your condition. Unfortunately, CPAP can have certain side effects.

  22. Sue Gorgen on August 5th, 2013 1:55 pm

    Dear Dr. Park,
    I was so happy to find your site. I have been on CPAP since late September, 2012. About a month after, my ears started ringing and then i started getting a feeling of lightheadedness (not dizzy). I have also been diagnosed with high blood pressure, something that I have never had a problem with (I am 55 years old). I have been to my primary physician several times, who sent me on to two ENT’s, a neurologist and the ER (amongst these other problems, my face started tingling). The usual tests were done, but nothing wrong. I am still dealing with the high pitched ringing in my ears, which is constant, and my head feels “full”. Very uncomfortable. I am at a loss on what to do next. I have sever sleep apnea and cannot be without my machine. Does it sound like these problems can be caused by the machine? If so, what can I do to relieve it? I would be so grateful for any help or information you can give me. Thank you so much.

  23. George on January 4th, 2014 7:23 pm

    I got a new cpap machine and the sleep docter set the pressure higher on the new machine to 10 from 7.8. When I first put on the mask I could hear a loud noise of the air from the cpap machine. The air was unramped and at full pressure of 10.0 when I put on the mask.

    I removed the mask within 1 to 2 minutes. After I removed the mask I have ringing in my ears. The ringing has been going for 3 weeks. The ringing sound gets louder when I am in noisey places.

    My hearing as far as I can tell is normal with the exception of the ringing in the ears.

    Do you have any suggestions?

  24. Michael Sofiak on February 27th, 2014 9:20 pm

    I have been using a CPAP machine for approx 5 months and only recently noticed that both of my ears constantly have a slight ringing sound. After reading your article and other comments I’m worried that if I continue using the CPAP machine that it could cause permanent hearing loss. Do you have any advice.
    Thanks, Mike.

  25. April Williams on April 7th, 2014 6:54 pm

    I have been using the CPAP for 3 months now after being diagnosed with OSA. Mine is only set at 7, but I keep getting this ear fullness and pain in my right ear. The ENT I saw said it has nothing to do with the CPAP, but I never had this problem prior to using the CPAP. I have tried everything, including nasal sprays, increasing humidity, different masks, and allergy and sinus meds. nothing is helping my ear. I am not sure why my ENT does not think this is related. Should I see another ENT for a second opinion? Do I have to stop the CPAP? Thanks.

  26. Steven Park on April 8th, 2014 4:46 pm

    Ms. Williams, I see patients like you all the time. The options that I offer include stopping CPAP or trying something else for sleep apnea, or inserting pressure equilibrations tubes. They both sound drastic, but may be worth it to take care of these ear problems.

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