[1] Unofficial Guide to your ears series - Earwax to Eustachian tube dysfunction
Ok, so I have been seeing a lot of web posts with misleading information. Obviously, those posts were criticized in audiology communities, but it seems like there is quite a few of people who were misled by those. I just get sick of those who are trying to take advantage of this disequilibrium of health information, and especially hearing healthcare, my specialty. I normally keep this information with citations and references to be as accurate as possible, but if I start to do that it will be an endless project. So I’ll just layout what I know and learned. Oh, by the way, please don’t take what I wrote here and fight with your healthcare professional. If they say something, they are likely to be right. I’m not going to counsel you for your specific condition. Anyways, that is it for a disclaimer. Let’s dive in.
The Anatomy: Peripheral vs. Central
Your auditory system has two parts: peripheral and central. The peripheral system includes the ears and the central system includes the brain. In between, there is an internal auditory canal (IAC) that connects your ear and brain. When you see MRI or CT of IAC, that’s what it means: IAC = internal auditory canal. Most of the time when we do these imaging scans, we are trying to investigate if there is a tumor growing in there.
Earwax: The Good, The Bad, and The ‘Water-Ear-Dust’
Since there is an internal auditory canal, there should be external auditory canal, right? You are right. External auditory canal (EAC) does exist and that is where your earwax builds up. When your earwax builds up, the most likely symptom you’d experience will be what we call aural fullness, or pressure in the ear. Counterintuitively, earwax does not cause hearing loss in general, unless your ears are really plugged up with earwax (guys, please get your ears checked with your primary care or ENT if you haven’t seen one for at least 2 years.) Because of genetic differences, generally Asian populations have dry earwax and Western, Latino, and African populations have wet earwax. Fun fact, there is no exact Korean translation for earwax, it is more of ear-dust, and when they describe wet earwax, they use water-ear-dust. Anyways, unless your ears are completely plugged up, it won’t cause hearing loss. Even a small tiny hole in the midst of the earwax can let sounds in since the sound is acoustic wave.
When you feel like you have earwax because you feel some pressure or aural fullness, I prefer you to see a doctor, not trying to dig it out yourself. There are multiple cases of patients bleeding while trying to take the earwax out by themselves, or perforating their eardrums. So please just visit your doctor, or go to an urgent care, especially if it is a sudden onset.
Eustachian Tube Dysfunction (ETD)
The other thing that can cause aural fullness just like the earwax is eustachian tube dysfunction (ETD). I’m pretty sure a lot of you have heard about it. As the name stands, ETD is malfunctioning eustachian tube. Then, how should the eustachian tube function?
Eustachian tube is basically a small little tube that connects your middle ear and nasal cavity. It is a tube surrounded by muscles. When you swallow, and blow your nose, these muscles open up and let air flow in. Why is that important? Well, when you are on a plane taking off or descending, you feel your ears pressured and hearing gradually gets muffled. Sipping water or blowing your nose lets your ears pop and lets you hear better. You feel muffled because the pressure between your middle ear and the atmosphere is different. You feel better after popping because the pressure becomes equal. What if it does not open up when it supposed to? Then the pressure difference persists and you will continue to feel being pressured in your ears and muffled. When the eustachian tube does not do what it supposed to do, it is called eustachian tube dysfunction.
When the Tube Stay Open (PETD)
Most of the time, ETD means Eustachian tube (ET) does not open. What if it stays open? That is what we call patulous eustachian tube dysfunction (PETD). Famous Japanese singer Mika Nakashima suffered from this condition. What would happen if you have a patulous eustachian tube dysfunction (PETD)?
Basically you have a tube that sound can flow in from the nasal cavity. What kind of sounds? Whatever that can resonate in your nose. Your breathing, your voice, sometimes jaw movements can be heard. Well, to be specific, those sounds will be resonated at the frequency range whose the wavelength shares same value as the volume of your nasal cavity. So, it will be much amplified at those frequencies, thus you will likely notice and hear those sounds more, especially when they are amplified such as raising your voice or singing.
PETD became more prevalent nowadays. Guess what has happened recently (I mean 2025-2026 for those who read this after that time frame). Wegovy, the weight loss medication. There could be inflammation or fat tissue that were blocking Eustachian tube. These could be resolved with weight loss management, and thus leaving Eustachian tube open. In general, this process occurs gradually and the muscles in the tube have adequate time to adjust. However, if the change occurs rapidly, muscles won’t have enough time to adjust. Thus, the tube stays open. Will it close? Maybe or maybe not. But there are interventions, so you don’t need to be concerned if it will be a permanent thing.
Well, this became much more chaotic than I started initially. At least this is a start of this series. This series is going to be like this. Me writing about various ear related topics. I might become more structural later, but we’ll see. Hope this was helpful to those who have some questions regarding your symptoms. If you want to update some information, please share.
***I won’t reply to any individualized consultations. That is why we have a medical system in US. I will also delete hostile comments because this my blog. Correction of the information above (with manners and gentleness) is always welcomed.
