Ear Popping During Exercise: Causes and Treatment
Ear popping during exercise is most commonly caused by Eustachian tube dysfunction, which can manifest as either obstructive or patulous Eustachian tube issues, or in some cases may be related to exercise-induced laryngeal dysfunction (EILD). 1
Primary Causes of Ear Popping During Exercise
Eustachian Tube Dysfunction
- Obstructive Eustachian Tube Dysfunction: Occurs when the tube fails to open properly, causing pressure differences between the middle ear and atmosphere 1
- Patulous Eustachian Tube (PET): Abnormally patent Eustachian tube that remains open inappropriately, often associated with weight loss, pregnancy, or without identifiable cause 2
- Exercise-Related Pressure Changes: Rapid breathing during exercise can create pressure differentials that affect the Eustachian tube function 1
Exercise-Induced Laryngeal Dysfunction (EILD)
- May present with ear symptoms due to pressure changes in the upper airway during exercise 1
- More common in young adult female elite athletes and middle school to high school-aged athletes 1
- Can involve vocal cord dysfunction, exercise-induced laryngeal prolapse, or exercise-induced laryngomalacia 1
Diagnostic Approach
Key Symptoms to Evaluate
- Timing of symptoms: Whether popping occurs during or after exercise (helps differentiate EILD from other causes) 1
- Associated symptoms: Presence of inspiratory stridor, throat tightness, or dyspnea 1
- Duration: How long symptoms persist after stopping exercise 1
Diagnostic Tests
- Otoscopic examination: To evaluate tympanic membrane position and mobility 1
- Tympanometry: To assess middle ear pressure and Eustachian tube function 1
- Nasopharyngoscopy: To visualize the Eustachian tube opening and rule out obstructive causes 3
- Continuous laryngoscopy during exercise (CLE): Gold standard for diagnosing EILD if suspected 4
Treatment Recommendations
For Obstructive Eustachian Tube Dysfunction
- Valsalva maneuver: Teach proper technique to equalize ear pressure (pinch nose, close mouth, and gently blow) 3
- Nasal saline irrigation: To reduce nasal congestion that may affect Eustachian tube function 3
- Nasal corticosteroids: If allergic rhinitis or nasal inflammation is contributing to dysfunction 1
- Balloon dilation of the Eustachian tube: For persistent cases not responding to conservative measures 5
For Patulous Eustachian Tube
- Hydration: Maintain adequate fluid intake before and during exercise 2
- Position changes: Slight head-down position may temporarily relieve symptoms 2
- Nasal saline sprays: To moisturize the nasopharyngeal end of the Eustachian tube 2
- Surgical interventions: For severe cases, options include mass loading of the tympanic membrane or silicone plug insertion 2
For Exercise-Induced Laryngeal Dysfunction
- Laryngeal control therapy: Breathing techniques and vocal exercises to control laryngeal function during exercise 4
- Speech therapy: Focused on proper breathing techniques during exertion 1
- Treatment of contributing factors: Address any underlying GERD if present 1
- Surgical intervention: Endoscopic supraglottoplasty for severe cases not responding to conservative management 4
Prevention Strategies
- Proper warm-up: Gradual increase in exercise intensity may reduce risk of symptoms 1
- Hydration: Maintain adequate fluid intake before, during, and after exercise 1
- Avoid irritants: Minimize exposure to environmental irritants that may affect airway function 1
- Breathing techniques: Practice proper breathing patterns during exercise 4
- Face masks: In cold weather, may help humidify inhaled air and prevent symptoms 1
Special Considerations
- Rule out exercise-induced bronchoconstriction: Similar symptoms but different management approach 1
- Cardiac evaluation: Consider if symptoms are accompanied by chest pain or palpitations 1
- Gastrointestinal factors: GERD may contribute to both Eustachian tube dysfunction and EILD 1