— Ellie, New York Popping in the ears is often caused by a dysfunction of the eustachian tubes (the tiny channel connecting your inner ear to the back of your nasal passage/throat). These tubes should open slightly as needed to allow the pressure between the ear and the nose/throat to equalize. If they aren’t working well because the tissue around or near them is swollen or irritated, the pressure difference between the ear and the nose/throat will build until the tube is suddenly forced open, causing a popping sensation. Popping in the ears, without other symptoms, would be an unusual way for allergies to show up in a 19-year-old. I would ask your son about other symptoms: itchy eyes, runny, itchy nose, sneezing, nasal congestion, mucus draining down the back of his throat. It may be that the ear popping bothers him so much that he barely notices the other symptoms. Also, it seems to me that teenage boys I see in the office with their mothers often deny that they have any symptoms while their mothers are sitting next to them, rolling their eyes and nodding yes to every question. In other words, you may notice things that your son does not. Do you think he sounds congested much of the time, clears his throat a lot, or snores when he didn’t before? If you or he think that any of these other things are present, then an allergy evaluation with skin testing for inhaled allergies (pollen, animal danders, dust mites, etc.) would be appropriate. Also, it might be worth asking the ENTs who evaluated him if they saw any signs of allergy. Sometimes they do but simply neglect to mention it to the patient because they are more focused on problems that can be corrected surgically. People can also have symptoms of allergy but not have allergies — as can be seen with a condition called nonallergic rhinitis. In this condition, things like cigarette smoke, traffic fumes, and changes in temperature and humidity trigger inflammation in the nose and respiratory tract. In theory, nonallergic causes of chronic inflammation of the throat and back of the nasal passages can also include drug use or exposure to volatile chemicals. As best you are able, make sure he is not smoking, snorting, or inhaling anything that could be causing his symptoms. Additionally, look into whether he is exposed to any solvents or volatile organic compounds at work or during hobbies. Finally, temporal mandibular joint syndrome is a problem in which the joint where the skull meets the jaw bone becomes swollen and dysfunctional. Sometimes, people with this condition experience clicking as they move the jaw. Check that your son is not describing this as popping in the ears. Q2. Every morning when I wake up, my sinuses get clogged, and I start sneezing. I am trying to figure out what to take. What can I do for these allergies? Is there anything else that I can be doing besides having to take over-the-counter medication every day? Go to an allergist immediately and get skin tested to environmental allergens. Within 20 minutes you will know what triggers your allergy symptoms. If dust is the culprit, simple environmental modifications such as impermeable cotton mattress and pillow covers will reduce your dust exposure and the symptoms of dust allergy that result. The allergist might also suggest an antihistamine, leukotriene modifier and nasal spray to help treat your symptoms. Allergy shots – also called immunotherapy – are also extremely effective. Q3. I have a serious sinus problem, which puts fluid in my left ear. I have used every drug prescribed by my doctor, and nothing has helped. I cannot be tested for allergies because of the interaction with my blood pressure pills. I have suffered like this for over a year. Please tell me what else I can do. I would say that you and your provider should turn your attention to what is causing the serious sinus problem that you have, since you are not getting relief from symptomatic treatments. There are very few sinus conditions that cannot be treated, though many cannot be completely cured. It may be that your ear will only improve once the problems with your sinuses have been addressed. If you have not done so already, I would talk to your primary provider about a referral to an otolaryngologist (an ear, nose, and throat doctor), an allergist, or both. An otolaryngologist should examine you if you have had persistent fluid in one ear for over a year. A CT scan or MRI of the sinuses would also be in order. You may have sinus polyps, chronic infection, or something localized that is keeping your eustachian tube (the tiny channel connecting your inner ear to the back of your throat) on that side from functioning properly. In addition, there may be a way to perform allergy testing despite your blood pressure medication. If you are taking beta-blockers, then these can often be gradually stopped (don’t do this without a provider’s input), or changed to a different type of medication temporarily, to allow for skin testing. There are also blood tests to detect allergies that are not affected by medications. If blood tests do not show anything, then you should still try to have skin testing done because skin testing is generally better at detecting allergies. However, if the blood tests are positive, then you have some useful information to work with. Sinus problems are often difficult to sort out, and many patients see several specialists before they get a definite answer. I would start the process with the above steps. Q4. I have been waking up with very bad pain/pressure on my eyelids, where you would put eye shadow. It seems that if I sleep longer than six and a half hours, I can actually feel the pain come on. I take Benadryl for sinus/allergy headaches, and it does help after several hours. These headaches are debilitating to the point that I can’t move my head and I sometimes feel nauseous. I just had my eyes checked, and the doctor said they are very healthy, so I wonder if this is just a typical allergy symptom. What do you think? Do you have any suggestions for relief? — D., Connecticut Pain in the eyelid area upon awakening is not a typical allergy symptom. The combination of pain that increases with normal movement of the head and nausea sounds more like a migraine headache to me. Some people’s migraines are triggered by sleeping in (these people tend to get more headaches on days off compared with workdays). Other symptoms of migraine are sensitivity to light, some type of temporary change in vision, morning onset, and improvement with caffeine, although migraine symptoms can be very different from person to person. Some people have all the typical symptoms; others have just one or two. The symptoms of eye allergies (to pollen, cats, dust, and so on) are itchy, watery, irritated eyes. Pain is uncommon but sometimes occurs if the eyelids become very swollen. However, pain in isolation is not an allergy symptom. Allergies can also make your eyes feel gritty, as if bits of dust are trapped in them. I would talk to your primary care provider about your symptoms. These clinicians usually have considerable experience with migraines and their treatment. I hope this helps you get started. Q5. How do I prevent sinus infections? I understand they are caused by allergies. Is that right? Most sinus infections result from bacteria setting up shop in inflamed sinuses. If one has untreated allergies, this can lead to inflammation of the sinuses with bacterial “superinfection.” So if you have allergies, you should be diligent about keeping your sinuses free of inflammation by irrigating with saline solution, followed by treatment with inhaled nasal steroids and antihistamines. In cases of moderate asthma, treatment should include allergy shots. Learn more in the Everyday Health Allergy Center.
