By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine


Question: I had a cold a couple of weeks ago. My right ear has been plugged up ever since, so I went to the doctor. He said I had a middle ear infection and put me on a 10-day course of antibiotics. It’s been seven days, and the ear is still plugged up. What else should be done? Will I need surgery?

Answer: It is not uncommon for people to get middle ear infections following a cold. A quick anatomy lesson will help you to understand what is going on and what you can do to fully recover.

The middle ear lies just beyond the eardrum. It contains three small bones, which move when sound waves vibrate the eardrum. Their movement transmits eardrum vibrations to your brain, which interprets the variety of sounds that you hear.

The middle ear connects to the back of the throat by the eustachian tube, which allows fluid to drain and equalizes air pressure in the middle ear. To “equalize air pressure,” the eustachian tube, which is normally closed, opens momentarily, letting in a small amount of air. When it opens, you hear a small pop. You may have experienced this while yawning or swallowing, especially when in an airplane or driving in the mountains.

A head cold can cause inflammation of the eustachian tube, since it connects to your throat near the intersection of your nasal passage. When the eustachian tube becomes inflamed, it can swell, blocking the passage of fluid and air. This leads to a build up of fluid in the middle ear. As a result, you may experience reduced hearing, since the eardrum cannot wiggle as freely through fluid, so the vibrations sent to the small ear bones and the brain become muffled as well. When this happens, bacteria in the trapped fluid can infect your middle ear. This is what your doctor means when he says you have an “ear infection.”

When your ear becomes infected, a full course of antibiotics is needed to kill the bacteria causing the infection. Decongestants can also help by decreasing the fluid in the middle ear. Chewing gum can help promote drainage from the middle ear. Also, avoid cigarette smoke, and do not take airplane trips when your ear is plugged up.

Sometimes it is necessary to also treat the inflamed eustachian tubes. Ibuprofen can help, because of its anti-inflammatory effect, but do not exceed the suggested dosage printed on the bottle. Certain steroid medications, which are also anti-inflammatory, may also help open the eustachian tube.

Finally, if all of these things don’t work, ventilation tubes can be placed through a surgical procedure to drain the middle ear and allow air to re-enter. Although this is typically a safe procedure, your doctor should avoid surgery whenever possible. Normally, ventilation tubes are not used unless ear fluid is present for more than four months, there is fluid in both ears, or infections are recurrent and/or do not respond to multiple antibiotics.

For now, start with the decongestants and chewing gum. Then, be sure to let your doctor know if you finish your antibiotics and the pressure remains.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at