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Medically reviewed guide · Last updated: 1 August 2026 · Reading time: approx. 8 min
Pressure in Your Ear: Eustachian Tube, a Cold or Your Jaw?
At a glance
“Like cotton wool in the ear” or “like being under water”is usually not a problem of the ear itself but a ventilation problem: the Eustachian tube (tuba auditiva) no longer equalises the pressure between the middle ear and the throat properly. The medical term for this is Eustachian tube dysfunction.
The most common trigger is a swollen lining— from a cold, a blocked nose, sinusitis or an allergy. The pressure sits in the ear, but the cause is in the nose.
After a flight or a dive, sudden pressure points towards barotrauma; in everyday life a plug of earwax is another common and harmless explanation.
Not every feeling of pressure comes from the eartension in the jaw joint can show itself as ear pressure even though the ENT findings are normal.
Decongestant nasal spray helps in the short term — and becomes a problem with continued use.A few days is the limit; after that a rebound effect looms, with a nose that stays blocked for good.
Get checked straight away if you havesudden hearing loss together with ear pressure, severe earache with a high fever, violent spinning vertigo, pus-like or bloody discharge, or one-sided ear pressure lasting weeks in an adult without a cold.
The most common causes compared
Cause
How the pressure feels
Typical accompanying signs
First step
Cold, blocked nose
Dull, alternating between both sides, clicks when you swallow
Blocked nose, scratchy throat, cough
Clear the nose, wait it out, limit how long you use nasal spray
Allergy (allergic rhinitis)
Recurring, seasonal or on contact with the trigger
Sneezing fits, itchy eyes, clear secretions
Avoid the trigger, discuss an antihistamine
Air travel or diving (barotrauma)
Sudden, often painful, during descent or when going down
Briefly worse hearing, rarely ringing in the ears
Practise equalising the pressure; see an ENT doctor if the pain persists
Plug of earwax
One-sided, dull, your own voice sounds hollow
No cold, no fever, often after showering
Removal at a practice — do not poke around yourself
Jaw joint and chewing muscles
Dull pressure, variable, increases when you chew
Clicking in the jaw joint, teeth grinding, tense neck
Assessment by a dentist or an orthodontist
Middle ear effusion
Persistently dull over weeks, often after a cold
Muffled hearing, in children noticeably asking again
ENT check if it does not settle
Table scrolls to the right
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The middle ear behind the eardrum is an air-filled space with exactly one connection to the outside: the Eustachian tube, a narrow passage to the nasopharynx that opens briefly when you swallow or yawn and evens out the pressure as it does so. If that stops working, negative pressure builds up, the eardrum is pulled inwards and vibrates less well. That is exactly what you notice as pressure, as cotton wool or as “hearing as if you were under water” — sometimes with a quiet clicking or with ringing in the ears. If the negative pressure persists, the lining draws fluid in after it: that is how an effusion forms.
Colds and a blocked nose: the most common explanation
During an infection the lining swells everywhere, including around the opening of the Eustachian tube in the nasopharynx. The ventilation passage narrows and pressure equalisation stalls. That is why ear pressure occurs so reliably together with a blocked nose — and why it usually helps more to clear the nose than to treat the ear. The feeling of pressure often lasts longer than the cold itself; one to two weeks is not unusual. The guide Cold, flu or COVID sets out the typical courses.
The sinuses: when the pressure comes from above
Sinusitis, or inflammation of the sinuses, keeps the lining swollen for weeks on end. Typically the pressure increases when you bend forward, along with thick mucus and tenderness on tapping over the forehead or the cheeks. The ear pressure is an accompanying symptom.
Allergy: the recurring pressure without an infection
In allergic rhinitis the lining swells for the same reason as in a cold — just without a fever. The pattern is what gives it away: the pressure comes back seasonally or after contact with an animal, accompanied by sneezing fits, clear secretions and itchy eyes.
Flying and diving: barotrauma
During descent and when diving down, the outside pressure rises faster than the Eustachian tube can keep up with. If it is already narrowed by a cold, equalisation fails — and barotrauma develops, with a stabbing pain and suddenly muffled hearing. This usually settles within a few days. If pain, reduced hearing or dizziness persist after a dive, that needs examining promptly: when diving, the inner ear can be affected as well — a different category from aeroplane ear.
Earwax: the simple cause nobody thinks of
A plug in the ear canal produces the same symptoms as a tube problem: dull pressure, muffled hearing, your own voice sounding hollow. The two can be told apart by the context — a plug appears without a cold, often on one side and after showering. Do not try to help things along with cotton buds; removal at a practice takes a few minutes.
The jaw joint and the chewing muscles
The jaw joint sits immediately in front of the ear canal. Tension in the chewing muscles and a malfunction of the joint — known medically as temporomandibular disorder, or TMD for short — can therefore produce a dull pressure even though the ear itself is unremarkable. The clues are clicking when you chew, tense cheek muscles in the morning and teeth grinding. This is the classic constellation behind the sentence “The ENT doctor said everything was fine, but the pressure is still there” — and then an assessment by a dentist is worthwhile, often alongside physiotherapy.
Middle ear effusion and middle ear infection
If the negative pressure persists, fluid collects behind the eardrum — a middle ear effusion. It often does not hurt, but it muffles hearing noticeably and can drag on for weeks. If germs are added to the picture, a middle ear infection develops, with throbbing earache and a fever. In children the effusion matters particularly, because it falls in the period when they are learning to speak.
Self-tests: first clues at home
These observations do not replace a diagnosis, but they will help you narrow down the direction — ventilation, ear canal or jaw.
The swallowing test: swallow deliberately or have a proper yawn. If your ear clicks and the pressure briefly eases, that points to a ventilation problem of the Eustachian tube. If nothing happens at all, a plug or an effusion is the more likely candidate.
The nose test: is one side of your nose blocked at the same time, and does the ear pressure change when your nose is briefly clear? Then the building site is in the nose.
The jaw test: place your fingertips in front of your ears and slowly open and close your mouth. If it clicks, or if the ear pressure increases when you chew, the jaw joint belongs in your thinking.
The time course: note down how long the pressure has been there and what changes it — a cold, a flight, stress. With one-sided pressure over weeks, this is the most important point.
Take care with the Valsalva manoeuvre. The well-known trick — pinch your nose shut, close your mouth and gently press air into your nose — can support pressure equalisation, but it needs to be done gently: pressing hard can strain the eardrum and, during an infection, push germs into the middle ear. Swallowing, yawning and chewing gum are milder and usually just as effective. If you have a pus-producing infection or suspect an injury to the eardrum, leave it alone.
Warning signs: when not to wait
Sudden hearing loss together with the feeling of pressure
Severe earache with a high fever
Violent spinning vertigo, unsteadiness on your feet or vomiting
Pus-like or bloody discharge from the ear
Redness, swelling or tenderness behind the ear
Ear pressure after a dive that does not settle within a few days
One-sided ear pressure over several weeks in adults — without a cold, without an allergy
Ear pressure together with newly appeared facial paralysis
One-sided pressure over weeks belongs with an ENT doctor Persistent, one-sided ear pressure in adults that occurs without a cold and stays for weeks should be assessed by an ENT doctor. Usually a harmless explanation turns up. But there is one rare and important exception: a growth in the nasopharynx can block the Eustachian tube on one side and produces exactly this picture. No reason to panic — but the reason why a look into the nasopharynx is part of the routine. If sudden hearing loss, violent spinning vertigo, a high fever with very severe earache or facial paralysis are added, that needs examining the same day.
The treatment pathway: step by step
The nose first, then the ear. As long as the lining of the nose is swollen, the Eustachian tube stays narrow. Nasal rinses with a salt solution, drinking enough and moist room air are the basis — unspectacular, but with few side effects.
Practise equalising the pressure. Swallowing, yawning, chewing gum. A gentle Valsalva manoeuvre only if there is no acute infection.
Decongestant nasal spray — strictly limited in time. It makes the Eustachian tube passable in the short term, but it is explicitly a short-term measure.
Treat the cause. Tackle an allergy, sinusitis or a jaw joint problem specifically.
ENT assessment. If the pressure does not give way after two to three weeks, stays on one side or your hearing gets worse. The eardrum, its mobility and your hearing threshold are examined, and the nasopharynx if needed.
Further measures. For a stubborn effusion, balloon dilation of the Eustachian tube or a grommet are options — the treating practice decides that based on the findings and the course.
What to bring to your appointment How long has the pressure been there, one side or both, what makes it better, which sprays and tablets have you used and for how long? The last point is often forgotten and is usually the decisive one. More on this in the guide Preparing for your doctor's visit.
The medication angle: what helps, what harms, what is unnecessary
Decongestant nasal sprays: the vicious circle
Active ingredients such as xylometazoline narrow the blood vessels in the lining of the nose: the nose clears, the Eustachian tube becomes passable, the pressure eases — often within minutes. It is exactly this reliable effect that tempts you to carry on.
A few days is the limit — not a few weeks Decongestant nasal sprays are intended for short-term use, as a rule for no longer than a few days at a stretch. After that the lining responds with rebound swelling — your nose is blocked more than before, you spray more often, and the ear pressure comes back. What was a help turns into a dependence on the bottle. How to get out of that again is described in the guide Nasal spray dependence. If you have been spraying daily for more than a week, raise it rather than carrying on treating yourself.
Antihistamines, if an allergy is behind it
If there is an allergic cause behind it, treating the allergy is the direct route. Active ingredients such as cetirizine and loratadine damp down the allergic reaction; loratadine usually causes less drowsiness. Neither replaces identifying the trigger — and for ear pressure caused purely by an infection they achieve little.
Steroid nasal spray for chronic tube problems
For persistent swelling of the lining — with an allergy or chronic sinusitis, for example — a corticosteroid nasal spray with an active ingredient such as mometasone is often used. It works over days to weeks, but it is not habit-forming. Placed honestly in context: for pure Eustachian tube dysfunction without an allergic background the evidence is limited. The practice makes that decision.
Antibiotics: usually unnecessary for ear pressure alone
Ear pressure on its own is not a reason for an antibiotic. Eustachian tube dysfunction and a middle ear effusion are not bacterial infections — an antibiotic shortens nothing here, but it does bring side effects and contributes to resistance. Most uncomplicated middle ear infections also clear up without one. If one is prescribed, it belongs taken in full — see the guide Taking antibiotics correctly.
What else can be down to your medication
Some blood pressure medicines and other active ingredients can cause a blocked nose as a side effect and indirectly encourage ear pressure that way; hormonal changes also make the lining of the nose swell. Starting or switching a medication shortly before the symptoms appeared is therefore worth a note — see the guide Medication side effects. Never stop prescribed medicines on your own; with over-the-counter sprays the opposite applies: the earlier you stop, the easier it is.
How many days have you actually been spraying?
Nasal spray, tablets and symptoms in one record instead of in your head.
Nasal rinsing as a routine during infections — a salt solution keeps the lining moist and flushes secretions out. The most sensible ongoing measure if you are prone to tube problems.
Prepare for flights and dives — if you have a cold, make sure your nose is clear in good time, and swallow regularly or chew gum on the approach; do not sleep through it, because you barely swallow while asleep. With a heavy cold, do not dive at all.
Treat allergies instead of sitting them out — if you have the seasonal swelling under control, you have the recurring ear pressure under control too.
Nasal spray with an end date — write the day on the bottle when you open it, or set yourself a reminder for day three. The simplest prevention against dependence.
Take the strain off your jaw, go easy on the lining — for teeth grinding, a splint and stress relief help; smoke and dry heated air prolong every phase of swelling.
Day three is the limit — brite reminds you
Short-term medicines with an end date instead of ongoing use out of habit.
Usually there is a ventilation problem behind it: the Eustachian tube no longer equalises the pressure between the middle ear and the throat properly, negative pressure builds up in the middle ear and the eardrum vibrates less well. This is typically triggered by a swollen lining during a cold, sinusitis or an allergy. A plug of earwax produces exactly the same feeling.
Decongestant sprays are intended for short-term use, as a rule for no longer than a few days at a stretch. After that the lining can respond with rebound swelling: your nose becomes blocked more than before, you spray more often and you end up in a vicious circle. If you have been spraying daily for more than a week, raise it with a doctor or at a pharmacy.
As a rule, no. Ear pressure on its own caused by Eustachian tube dysfunction or a middle ear effusion is not a bacterial infection, and an antibiotic brings no benefit here, only side effects. Many uncomplicated middle ear infections also clear up without an antibiotic. The treating practice makes that decision based on the findings and the course.
Yes. The jaw joint sits directly in front of the ear canal, and tension in the chewing muscles can show itself as dull ear pressure. Typical clues are clicking when you chew, tense cheek muscles in the morning and teeth grinding. If the ENT findings are normal but the pressure remains, an assessment by a dentist is worthwhile.
One to two weeks after an infection is not unusual, because the lining stays swollen for longer than the cold itself lasts. If the pressure goes on for more than two to three weeks, becomes one-sided or your hearing gets noticeably worse, that needs examining by an ENT doctor — a middle ear effusion may be behind it.
Usually a harmless explanation turns up, such as an effusion or a plug of earwax. But because a growth in the nasopharynx can block the Eustachian tube on one side, persistent one-sided ear pressure in adults without a cold belongs assessed by an ENT doctor. That is no reason to panic, but it is the reason for a look into the nasopharynx instead of further nasal spray prescriptions.
Gesundheitsinformation.de (IQWiG): middle ear infection, middle ear effusion and the common cold — German source. Accessed 2026.
gesund.bund.de: earache, Eustachian tube ventilation problems and decongestant nasal sprays — German source. Accessed 2026.
MSD Manual, Consumer Version: Eustachian tube dysfunction, barotrauma of the ear and middle ear effusion. Accessed 2026.
Guidelines of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC) in the AWMF register: rhinosinusitis and otitis media — German source. Accessed 2026.
Summaries of product characteristics for the active ingredients mentioned (xylometazoline, cetirizine, loratadine, mometasone). Accessed 2026.
This article is for general information and does not replace medical advice, diagnosis or treatment. The self-tests described are a rough guide and not a diagnosis. Use decongestant nasal sprays only for short periods and do not stop prescribed medicines on your own. If you have sudden hearing loss, violent spinning vertigo, a high fever with severe earache, pus-like or bloody discharge, or one-sided ear pressure lasting weeks, please contact a doctor or the emergency services.
