May 8, 2021

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Why does air come out of my ear when I blow my nose? Dr. Martin Score answers your health questions


Air escapes from my ear when I blow my nose. I can even pop bubbles out of it when I’m underwater. It’s not painful but definitely can’t be true? I am 67 years old.

Carol Lawrence, Morecambe, Lancashire.

Air draining out of the ear is a classic sign of a perforated eardrum. The eardrum (or tympanic membrane) is a thin structure separating the outer ear from the middle ear.

The outer ear canal, where wax accumulates, is only 2.5 cm long and the eardrum – which is only 8 mm in diameter – can be perforated or easily burst.

Possible causes include untreated middle ear infections and physical injuries, including those caused by cotton buds (why you should avoid using them to clean your ears).

In your longest letter you say that you had previously burst your eardrum in the same ear several years ago in a swimming accident; Being able to blow air out of your ear as you describe it indicates that the healed piercing has collapsed.

Air draining out of the ear is a classic sign of a perforated eardrum. The eardrum (or tympanic membrane) is a thin structure separating the outer ear from the middle ear

This disrupted the normal operation as the air pressure inside the head was “regulated” by the Eustachian tube.

Usually, the Eustachian tube – which connects the middle ear to the area behind the nose – balances the air pressure inside the head with the air pressure outside. So, for example, when you blow your nose or land in a plane, the internal pressure rises, so the

The Eustachian tube “opens” to regulate air pressure. It also opens naturally when we chew, yawn, or swallow (you may hear a “click,” which is the sound of the valve closing again).

However, in your case, the eardrum has ruptured. A scar on it means that it will never be as strong as the original structure and at some point it must have sneezed or the eardrum was compressed, causing it to rupture again.

As a result, when you blow your nose, air is pushed into the eustachian tube by pressure, into the middle ear cavity and out through the hole (usually blowing your nose raises the pressure in the middle ear cavity tightening the eardrum).

The concern is that water may enter the middle ear cavity when swimming or showering and you end up developing an infection, which can cause complications.

For this reason, you should see your GP and refer you to an ear, nose, and throat (ENT) specialist, with the goal of surgically repairing the eardrum (usually under general anesthesia, but as a day case).

I suffer from a large goiter that causes me problems with clearing the throat and acid reflux, which causes a cough, especially at night. You have taken omeprazole but it doesn’t seem to be helping. What else do you recommend?

Michael Simons, Penzance.

The term goiter means an abnormal growth of the thyroid gland, which is a butterfly-shaped gland at the front of the neck that extends through the trachea, with a lobe on either side. A goiter can affect the esophagus (esophagus) located behind the windpipe, displace or even compress blood vessels in the neck.

Goiter in the UK is commonly associated with autoimmune disease – usually Graves’ disease, in which the thyroid gland becomes overactive.

This affects the hormone levels and I am sure your doctor will check it, indicating that you have what is called a multi-nodular goiter.

This is where the thyroid gland slowly enlarges over many years without causing symptoms, although eventually the trachea may compress, causing shortness of breath on exertion (this occurs in more than 30 percent of cases).

Some patients find that shortness of breath occurs in certain positions, for example, when bending forward. About 10 percent of patients experience a cough and a feeling of suffocation, and this may also be related to their condition.

Swallowing problems are less commonly reported – acid reflux is not a recognized symptom but can simply coincide with a goiter.

So, is your cough due to acid reflux or tracheal pressure due to an enlarged thyroid gland?

Omeprazole inhibits acid production, thus relieving reflux cough. But you haven’t found it effective, indicating that hypothyroidism is the problem.

Options include surgically removing the gland or “shrinking” it with a single dose of radioactive iodine by mouth – this reduces the gland by between 30 and 60 percent over a number of weeks.

I recommend an ultrasound to check how compressed the trachea is. A specialist thyroid surgeon can then advise you.

Acid reflux may remain, but there are more medical options that can prevent this.

Write to Dr. Score

Write to Dr. Score at Good Health, Daily Mail, 2 Derry Street, or London W8 5TT, or email drmartin@dailymail.co.uk – include your contact details. Dr. Score cannot enter into personal correspondence.

Responses should be taken in a general context and always consult your doctor about any health concerns.

In my view: Don’t worry about waiting for Covid’s second hit

Are you one of those who are still waiting to hear a second jab, with the clock ticking towards the promised 12-week time frame?

After nearly 11 weeks, I just had it, but I know some readers have waited longer than that, worried about being late.

Personally, I don’t think waiting any longer between doses is a cause for concern. But I fear the government has been bad at explaining why (not for the first time).

When I announced that the second injection (a booster for greater immune protection) would be given after 12 weeks instead of four, this seemed arbitrary and not based on evidence – which only hurt the confidence of those unsure about the vaccine.

Are you one of those who are still waiting to hear a second jab, with the clock ticking towards the promised 12-week time frame?

Are you one of those who are still waiting to hear a second jab, with the clock ticking towards the promised 12-week time frame?

The truth is, the immune system does not watch the clock. In the past, we used to give injections to infants ages three, six and nine months. Then it was changed to two months, with reinforcement at three and four months.

Evidence showed that compressing vaccine appointments did not make them less effective or less safe. The same applies to extending the Covid-19 vaccination schedule. The first link gives excellent protection; The booster boosts it regardless of timing.

In fact, research shows that with the AstraZeneca vaccine, immunity is much higher if given after 12 weeks or more (up to 91.7 percent effectiveness) compared to less than six weeks (69.7 percent).

We don’t know yet if this is true for Pfizer jab but in my view that’s a fair assumption. Those worried about waiting a little longer should be reassured.

My biggest concern remains about those who qualified but did not get the first punch, and what can be done to turn the heads of opponents of vaccination. Shouting out louder is not the answer: we need clear explanations from our top medical officers.