What can I do to relieve ear congestion and pressure?

Management of Ear Pressure and Congestion

For ear congestion and pressure, conservative non-medication approaches are recommended first, as decongestants and antihistamines have limited effectiveness and may cause adverse effects.

Non-Medication Approaches (First-Line)

• Nasal saline irrigation: Use daily to clear nasal passages and reduce congestion 1
• Nasal balloon auto-inflation: Perform 3-4 times daily to help equalize pressure in the middle ear 1
• Valsalva maneuver: Practice several times daily by pinching your nose, closing your mouth, and gently trying to blow air through your nose 1
• Swallowing or yawning: These actions help open the eustachian tube and equalize pressure, especially during air travel 1

Risk Factor Modification

• Avoid smoke exposure: Keep away from secondhand smoke, which can worsen ear congestion 1
• Reduce pacifier use: If applicable, limit daytime pacifier use in children older than 12 months 1
• Maintain hydration: Staying well-hydrated helps thin mucus secretions

Medication Options (If Conservative Measures Fail)

• Topical decongestants: May provide very short-term improvements in middle ear function 1, 2

  • Caution: Should not be used for more than 3 days due to risk of rebound congestion (rhinitis medicamentosa) 3
  • Evidence limitation: Studies show limited effectiveness for eustachian tube function 4, 5

• Oral decongestants (e.g., pseudoephedrine): Can temporarily relieve sinus congestion and pressure 6

  • Caution: May cause insomnia, irritability, palpitations, and rarely elevated blood pressure 3
  • Note: Phenylephrine has poor oral bioavailability and limited effectiveness as a decongestant 7

• Intranasal corticosteroids: Consider only if ear pressure is associated with allergic rhinitis 1

When to Seek Medical Attention

• If symptoms persist beyond 2-3 weeks
• If experiencing severe pain, fever, hearing loss, or drainage from the ear
• If symptoms significantly affect quality of life or daily activities

Special Considerations

• For children: A study showed that phenylephrine nasal drops did not improve abnormal middle ear pressures during common colds 8
• For frequent recurrences: Regular follow-up with an otolaryngologist may be needed to evaluate for underlying conditions 1
• For severe cases: Medical evaluation may be necessary to rule out otitis media with effusion or other conditions requiring specific treatment 3

Ineffective Treatments to Avoid

• Antihistamines: Not effective for nasal congestion unless allergies are present 3
• Antibiotics: Not effective unless there is a diagnosed bacterial infection 1
• Alternative therapies: Including chiropractic treatments, special diets, or herbal remedies have not been proven effective 1

Remember that ear pressure and congestion often resolve spontaneously with time and conservative measures. If symptoms persist or worsen despite these approaches, consult a healthcare provider for further evaluation.