Hearing loss can be caused by many factors, including - as just noted - an infection or fluid buildup in the middle ear. This infection can also cause tinnitus, a constant ringing in the ear. A cholesteatoma, a benign tumor that develops from a pressure gradient, can form, causing the eardrum to suck in on itself. This destroys the eardrum,
leading to hearing loss. The cholesteatoma can erode the bones in the middle ear, which also causes hearing loss. A cholesteatoma needs immediate surgical management. The middle ear is connected to the outside world through the eustachian tube. When an eustachian tube becomes swollen or blocked, the middle ear can no longer equalize pressure with the outside world. When this happens, you may experience the sensation of being under water (dull hearing), dizziness, vertigo, or a feeling of imbalance. The dizziness can range from feeling a little off balance to feeling as the room were spinning.
In addition, chronic ear pressure can lead to ear infections. For instance, bacteria from the sinuses can spread to the ear and result in an acute ear infection and muffled hearing. If the infection worsens, the ear can start to drain as it makes a hole in the eardrum. This discharge through the eardrum is usually a foul-smelling pus. When the infection is acute, you can experience severe pain. If the eardrum is stretched severely or too quickly, you may also experience ear pain from acute bleeding into the eardrum.
Sometimes the eustachian tube becomes enlarged. This can occur after significant weight loss or after an upper respiratory tract infection. When this occurs, air will pass too easily from the back of the nose to the middle ear, and you might experience the sensation of stuffiness in the head, and the chance of an infection spreading from the sinuses to the middle ear increases. You might also hear an internal grinding noise when you chew. Although this is an annoying symptom, it is usually not permanent. You may even start to hear yourself when you speak. This symptom is called echolalia, and usually resolves on its own.