Ear & Balance

Blocked ears during or after a flu? It may be due to a Eustachian Tube Dysfunction (ETD)!

February 1, 2020
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Dr Gan saw Mr A, who had a sudden onset of ear blockage (both sides) while recovering from a common cold. He has been wearing hearing aids for a few years for age-related hearing loss. However, he was worried when his hearing level deteriorated further during his cold. He did not have any ear pain or fluid coming out of his ears.


On examination, there was fluid noted behind his right and left eardrums (Figures 1a-c). There were no palpable neck lumps. A nasoendoscopy (scope through the nose) was performed. It showed signs of a recent cold with thick mucous and swollen mucous membranes (lining of the nose)(Figures 2a-b). There was no mass blocking the opening of the Eustachian tube at the postnasal space (PNS or “back of the nose”). A hearing test showed mixed hearing loss and a “stiff” ear drum, suggesting fluid buildup behind the ear drum.



Figure 1a – Fluid behind left eardrum (dark yellowish tinge seen)



Thermal fluid heater

Figure 1b – Fluid behind right eardrum (dark yellow tinge and bulge seen on eardrum)



Figure 1c – Picture of a normal left ear canal and eardrum




Figure 2a – Endoscopic view of the back of the nose showing the left eustachian tube opening (indicated by blue arrow)



Figure 2b – Endoscopic view of the back of the nose showing the right eustachian tube opening (blue arrow) and thick mucous (blue asterisks)



As Mr A’s nasal symptoms were only 5 days and he was feeling better, it was likely that he was suffering from a viral cold (which does not need oral antibitoics). However, in view of the fluid behind the ear drum, he was given a course of oral antibiotics to fasten the resolution of the fluid. Typically, most fluid behind the ear drum resolves on its own (absorbed by body or drained through the Eustachian tube) between 1 to  3 months. Mr A was also advised to perform maneuvers to open the Eustachian tube regularly which may fasten the resolution of the collection of fluid. These include Valsalva maneuver (blowing out against a closed mouth and nose to “pop” your ear), chewing on a gum and swallowing. Mr A was also given medications to reduce inflammation and congestion in his nose. On review in the clinic 6 weeks later, Mr A’s hearing is back to his usual level. A clinical examination and hearing test showed complete resolution of the fluid behind his ear drums.


Mr A’s ear condition is known as Otitis Media with Effusion (“Fluid behind the eardrum” aka “glue ear”). This is a as a result of his cold which resulted in inflammation of the lining of the nose. The middle ear (the space behind the ear drum) is connected to the back of the nose by the Eustachian tube (Figures 3a-b). The Eustachian tube opens and closes during changes in environmental pressure (E.g. when one goes up the elevator, during air flight or diving) to equalize the pressure in the middle ear with that of the outside environment. However, when one has problems with the nose (E.g. sinusitis, allergic rhinitis or cold/flu), the tube may not be functioning properly, resulting in negative pressure in the middle ear and subsequent buildup of fluid behind the eardrum. A Eustachian Tube that fails to open or close to equilize the middle ear pressure is known as Eustachian Tube Dysfunction (ETD). It is always good to have a scope to screen the back part of the nose (PNS or postnasal space) as one of the early presentation of cancer of the nose is fluid behind the eardrum due to blockage of the Eustachian tube. Fortunately for Mr A, he did not have nose cancer!



Figure 3a – The Eustachian Tube connects the middle ear to the back of the nose



Eustachian tube

Figure 3b – Eustachian Tube opening in the nasal cavity

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.


    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award


    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

    Why Choose Dr Gan Eng Cern


    Reliable & Reputable ENT Expert

    Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.


    Friendly & Helpful Clinic Staff

    Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.


    Advanced ENT Equipment & Fully Equipped Facility

    Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.


    Financial Options

    There are various financial options available for you to ensure that you are able to receive the most optimal treatment and care. Our ENT clinic staff will be able to assist you with your medical insurance claims and work with your chosen healthcare organization to minimize the hassle and paperwork required. In some cases, you may be able to utilise the funds in your Medisave account to defray part of the costs of your treatment. As our clinic is accredited by the Medisave board, we are able to process your claims from your Medisave for certain clinic procedures.

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