Acid Reflux & Ears (GERD & LPR): Concern of Damage?

Can acid reflux affect the ears? Yes. It is most common with extraesophageal variations of reflux such as laryngopharyngeal reflux (LPR) and nasopharyngeal reflux (NPR).

Severe GERD (gastroesophageal reflux disease) may also cause intermittent ear-related symptoms as well.

That said, standard GERD does NOT typically reach extraesophageal regions and is less likely to cause significant ear-related symptoms (relative to LPR & NPR).

Disclaimer: Never assume that ear-related symptoms are a byproduct of acid reflux. Consult an otolaryngologist (ENT) for immediate evaluation to rule out more pressing/serious conditions that could be affecting your ears.

How acid reflux affects the ears

Many things can cause severe acid reflux, but it usually occurs as a result of esophageal sphincter dysfunction (UES & LES) – and possibly hiatal hernia (wherein food can get trapped).

Regardless of the root cause of one’s reflux, stomach content ends up “refluxing” above the esophagus into the throat, sinuses, and ears.

Related: Acid Reflux & Eyes (Pain & Burning)

Types of refluxed stomach contents

  • Hydrochloric acid
  • Pepsinogens (e.g. pepsin)
  • Gastrin (e.g. G-34, G17, G-71, G-6)
  • Bile salts (conjugated & unconjugated)
  • Trypsin (digestive enzyme)
  • Food particulates
  • Bacteria (e.g. H. Pylori)
  • Other digestive enzymes

Signs & Symptoms of Ear Reflux

Listed below are various signs and symptoms of ear-related reflux.

As I mentioned, it is important to NOT assume that your ear-related symptoms are from reflux until other conditions have been ruled out via appropriate audio-vestibular examination & neuroimaging (CT/MRI).

Ear pain

The pain may be intermittent or constant depending on how significantly your ears are affected by reflux – and the type of reflux that is occurring.

Eustachian tube dysfunction

There is significant evidence to suggest that acid reflux conditions (e.g. LPR & NPR) are associated with eustachian tube dysfunction.

  • Blocked eustachian tubes: This is typically due to catarrh (wherein fluid creates a blockage and causes inflammation).
  • Ear popping sounds: Some people notice their ears “popping” frequently for seemingly no reason. This is a sign that the eustachian tube is not functioning normally.
  • Ear crackling sounds: Some people may hear a crackling sound in their ears when the eustachian tubes are malfunctioning.

Dizziness

As a result of fluid and blockage in the eustachian tubes (possibly the inner ear), some people report dizziness.

The dizziness may be most significant after eating (when reflux occurs and less severe while fasted).

Disequilibrium (balance problems)

As a result of the eustachian tubes and inner ear being affected by reflux and corresponding inflammation – a person may feel “off-kilter” or as though they have a difficult time with balance.

Ear infection

Otitis media with effusion (OME) is associated with laryngopharyngeal reflux.

Many people report they got their first ear infection as a result of LPR/NPR.

Fluid in ear

Some people may end up with fluid in the middle or inner ear as a result of reflux. This could be a sign of infection.

Hearing loss

Many people end up experiencing hearing loss due to blocked eustachian tubes, inflammation, and/or refluxed contents entering the ears.

For a majority, the hearing loss will be transient (such that normal hearing returns once reflux is properly managed) – but in some cases it could be irreversible.

Tinnitus (ringing in ears)

Many people with LPR/NPR experience tinnitus or ringing in the ears.

This is typically a high pitched tone that is constant and annoying. It may be caused by inflammation within the inner ear.

Though this is typically reversible (treating the reflux reduces the ringing) – a few individuals have reported that it became permanent.

Vertigo

This is the sensation that you or the environment around you is moving or spinning.

Reflux vertigo differs from BPPV in that reflux vertigo tends to last for longer durations – and may emerge after eating.

Research of Ear Manifestations of Reflux

Included below are studies/papers discussing the potential ear (i.e. otic) manifestations of reflux conditions (e.g. GERD, LPR/NPR).

Association Between LPR & Media Otitis: A Systematic Review (2021)

Lechien et al.: The association between LPR & OM is still unclear. Future clinical and experimental studies are needed to fully elucidate the relationship. (R)

  • Researchers conducted a systematic review by analyzing articles published between 1980 and 2020 that studied the relationship between LPR & OM.
  • 26 clinical & 3 experimental articles met inclusion criteria – encompassing 1,624 children & 144 adults with chronic otitis media with effusion or recurrent otitis media.
  • The prevalence of LPR & GERD in OM patients were 28.7% (LPR range: 8-100%) and 40.7% (GERD range: 18-64%).
  • There was significant heterogeneity between studies regarding definitions of “reflux” and “otitis media” – as well as exclusion criteria, methods, and measurements of pepsin/pepsinogen within the middle ear.
  • Future studies should examine the relationship between LPR & OM in adults – and determine whether the reflux events are acid, weakly acid, alkaline, or mixed.

Association of GERD with Increased Risk of Chronic Otitis Media with Effusion in Adults (2021)

Yeo et al.: From long-term follow-up, the prevalence of chronic OME in adults was 1.84-fold greater in GERD patients compared to non-GERD patients over an 11-year period. (R)

  • This was a retrospective propensity score-matched cohort study performed using data from the Korea National Health Insurance Service.
  • A total of 17,660 individuals were included in the study population – of which 3532 were diagnosed with GERD (relative to 14,128 without GERD).
  • Researchers state that when a patient is diagnosed with otitis media with effusion (OME) – doctors should consider the cause may be GERD.
  • Patients with allergic rhinitis, asthma, or chronic rhinosinusitis showed higher risk of developing chronic OME than those without these conditions.

Lei et al. (2018): LPR was an important pathogenic factor in adult otitis media (OM) patients – and these patients have no symptoms of GERD. (R)

  • ELISA (enzyme-linked immunosorbent assay) was used to measure pepsin A concentration in middle ear fluid.
  • Patients with LPR were significantly more likely to have pepsin A in middle ear fluid – and at high concentrations.
  • LPR was the most common condition in patients with pepsin A in middle ear fluid (8 of 18 patients or ~44.44%).
  • Patients with pepsin A in middle ear fluid had significantly higher BMI (body mass index) than those without pepsin A detected.
  • None of the healthy controls in this study had pepsin A detected in middle ear fluid.
  • In sum, adult patients with otitis media caused by pepsin A are most likely to have LPR – but GERD is also possible (albeit much less common).
  • Researchers speculate that obesity may be an indirect cause of secretory otitis media in adults. That said, obesity can contribute to the pathogenesis of LPR via numerous mechanisms wherein otitis media occurs as a downstream effect.

Lin et al. (2017): “GERD symptoms are associated with higher risk of hearing loss in women, but use of PPIs and H2-RAs are not independently associated with the risk.” (R)

  • Patients aged 41-58 with normal hearing before onset of GERD symptoms and medication use.
  • The primary outcome was self-reported hearing loss – potential confounds were adjusted for by Cox proportional hazards regression.
  • Higher frequency of GERD symptoms was associated with higher risk of hearing loss.
  • Hearing loss was not confirmed with pure-tone audiometry but was confirmed with predictably reliable questioning.
  • Exposure of the inner ear to gastric contents via diffusion or active transport of gastric contents through the round window membrane may damage the inner ear and cause sensorineural hearing loss.
  • Increased permeability of the round window membrane may make the inner ear more susceptible to damage as well.
  • Does this mean only women lose hearing? No. The study involved exclusively women – so nothing was concluded about men.

Abtahi et al. (2016): There’s a significant association in children between GERD and otitis media (OM), acute otitis media (AOM), and chronic serous otitis media (CSOM) – relative to healthy controls. (R)

  • Researchers compared 50 children with OM vs. 50 healthy children (without OM).
  • Prevalence of GERD in children with OM was 58% vs. 22% in healthy controls.
  • Rate of AOM was 61.1% in children with GERD vs. 22% in healthy controls – and rate of CSOM was 72.7% in children with GERD vs. 22% in healthy controls.
  • Looking for GERD in children with OM may improve treatment outcomes.

Clinical Presentation of GERD in Children with Chronic Otitis Media with Effusion (OME) (2013)

Yuksel et al.: “GERD should be considered in the patients with OME or other upper respiratory tract infections.” (R)

  • GERD may be related to eustachian tube dysfunction and otitis media.
  • Reflux of gastric contents in the nasopharynx can cause inflammation of the nasopharynx and eustachian tube.
  • Gastric contents can arrive into the middle ear due to the angle of eustachian tubes and lay the groundwork for bacterial infections.
  • Studies show that intermittent application of gastric contents to middle ear mucosa leads to eustachian tube dysfunction and mucociliary clearance dysfunction.
  • After myringotomy, pepsinogen/pepsin concentrations can reach 1000-fold greater than those in serum.
  • Most patients end up misdiagnosed before GERD is discovered.

Sone et al. (2013): Reflux is likely present in a significant number of adult patients with otitis media (OM) – and may contribute to eustachian tube dysfunction in those patients. (R)

Miura et al. (2012): “The prevalence of GERD in children with chronic otitis media with effusion or recurrent acute otitis media may be higher than the overall prevalence for children.” (R)

  • Researchers conducted a systematic review (242 studies examined & 15 met inclusion criteria) – encompassing children with otitis media.
  • Presence of pepsinogen/pepsin in the middle ear could be related to physiologic reflux.
  • A cause-effect relationship between pepsinogen/pepsin in the middle ear and otitis media is unclear.
  • Antireflux therapy for otitis media cannot be endorsed based on existing research. (I’m assuming they mean in patients without confirmed GERD).

Yazdi et al. (2012): “Data show that the effect of GERD on the outcome of chronic otitis media surgery may be considerable. Treating chronic otitis media patients for GERD medically for 2 months before tympanoplasty improves the surgical outcomes.” (R)

  • In a RCT, 58 patients with chronic otitis media (COM) were evaluated for GERD and divided into 2 groups: (A) GERD positive and (B) GERD negative (control).
  • GERD positive patients were randomized to receive medical treatment for GERD vs. no treatment – prior to ear surgery.
  • Surgical outcomes were assessed at 3 and 6 months post-surgery in the 3 groups.
  • 20 of 24 patients (83.3%) who received GERD treatment before surgery recovered after surgery – whereas 44.4% (8 of 18) of non-treated GERD patients recovered.
  • Data from Yazdi et al. support a relationship between GERD and chronic otitis media.
  • There are obvious limitations here including the small sample size.
  • (One might also wonder whether a subset of the patients with GERD didn’t actually need surgery – and instead just needed to continue treating reflux?)

Al-Saab et al. (2008): “LPR plays an important role in the pathogenesis of OME as gastric reflux reaches the middle ear through the nasopharynx and eustachian tube to cause OME.”

  • Adenoid tissue of 25 patients with OME (otitis media with effusion) demonstrated significantly higher pepsinogen immunoreactivity when compared with the adenoid tissue of the control group (29 person) – specifically the epithelia and subepithelia.
  • The presence of pepsinogen was detected in 84% of middle ear effusions (MEEs) from the group with OME (at concentrations of 1.86 to 12.5-fold higher than that of serum).
  • Pepsinogen messenger RNA was not found in any of the adenoid tissues of the OME group.

O-Reilly et al. (2008): “Pepsin is detectable in the middle ear cleft of 20% of pediatric patients with otitis media (OM) undergoing tympanostomy tube placement – compared to 1.4% of controls.” (R)

  • Patients with pepsin in the middle ear cleft were more likely to have an effusion at the time of surgery than patients without pepsin in this region.
  • Clinical history of GERD, allergy, asthma, and post-tympanostomy otorrhea did NOT correlate with likelihood of extra-esophageal reflux disease reaching the middle ear cleft.

Sone et al. (2007): The presence of pepsinogen (PG) in middle-ear effusions (MEEs) supports the idea that GERD can be a causal factor. (R)

  • Researchers investigated the clinical relationship between GERD and otitis media with effusion (OME) in 60 adults wherein the causes of OME were unclear.
  • A GERD questionnaire was administered to patients and pepsinogen concentrations within middle ear effusions were measured.
  • The percentage of patients with high pepsinogen concentrations in middle ear effusions was significantly higher with questionnaire-positive GERD than those with questionnaire-negative GERD.
  • Concentrations of pepsinogen decrease in some patients after receiving PPIs (which also decreased GERD symptoms).
  • The conclusion: “Treatment for GERD should be considered in patients with ear complaints, especially those who have GERD-related symptoms.”

Crapko et al. (2007): Pepsin was detected in 60% of patients with otitis media with effusion (OME), confirming that extra-esophgeal reflux (EER) into the middle ear occurs in these children. (R)

  • A prospective, translational, cell biology research study was done on 32 samples of ear tissue removed during a tympanoplasty tube (TT) procedure – from children with otitis media with effusion (OME).
  • Pepsin protein was detected in 18 of 32 (56%) of samples analyzed and 12 of 20 (60%) patients had at least one positive sample for pepsin.
  • Pepsin concentrations ranged from 80-1000 ng/mL with the pH of the samples ranging from 6.0 to 7.6 – with a mean pH of 6.8.
  • Although the pepsin present would have minimal/zero activity at pH 6.0 to 7.6, researchers believe that pepsin remains stable below pH 8.0 and could be reactivated after a decrease in pH.
  • (This is somewhat alarming because it implies that pepsin may be extremely difficult to eradicate from extra-esophageal tissue as a result of its stability up to 7.6 pH and reactivation at low pH levels.)

Caruso & Passali (2006): “In children, ENT manifestations of GERD mainly affect the larynx, ears, nose, paranasal sinuses, and oral cavity.” (R)

  • Otitis media with effusion is among the main manifestations of GERD in children.
  • Repeated exposure of the ciliate respiratory epithelium to pH 4 or less blocks ciliary movement and mucous clearance.
  • Hydrochloric acid (HCL) and pepsin cause local inflammation, edema, and ulceration of the respiratory mucosa – leading to loss of eustachian tube ventilation function.
  • Tasker et al. (2002) were referenced in which ELISA (enzyme-linked immunosorbent assay) was used to analyze middle ear secretions via tympanocentesis in 54 children. They found pepsin and pepsinogen concentrations ~3-fold greater than in serum.

Megale et al. (2006): GERD can cause otolaryngologic symptoms in children and remission of these symptoms can be obtained with antireflux therapy. (R)

  • A retrospective study was done on 45 children (ages 3 months to 12 years) with GERD diagnosed by clinical examination and 24-hour single-channel pH-metry.
  • Recurrent acute middle ear infection occurred in ~35.56% of this sample.
  • The cure rate was 100% for the recurrent acute middle ear infection group (the highest of any group) with treatment of: antireflux drugs, allergy medications, and surgery.
  • Total treatment time was 1.8-fold longer for the remission of extraesophageal symptoms.
  • Exclusive antireflux treatment promoted full remission in 12.5% of patients with recurrent middle ear infection (not exactly a high-response rate – but this was a small sample).

Burton et al. (2005): “Possible mechanisms of GERD-mediated damage to extraesophageal structures include: (1) direct-contact damage of mucosal surfaces by acid-pepsin exposure and (2) a vagal reflex arc between the esophagus and upper aerodigestive tract (triggered by acid reflux).” (R)

  • High-dose PPI therapy for 9-12 weeks is recommended as the first-line treatment.
  • Operative therapy is recommended for patients with severe complications or who fail to adequately respond to treatment.
  • Complete lack of response to treatment should consider an alternative diagnosis.

White et al. (2002): “Nasopharyngeal exposure to simulated gastric juice causes eustachian tube dysfunction in rats. Specifically, middle ear pressure regulation and mucociliary clearance of middle ear contents was disabled. These results support recent reports in the literature linking nasopharyngeal reflux to eustachian tube dysfunction and secondary development of otitis media.” (R)

Tasker et al. (2002): In 45 of 54 children with “glue ear” – pepsin/pepsinogen was detected with ELISA and enzyme assays. Data indicate that reflux of gastric juice could cause glue ear in children. (R)

Tasker et al. (2002): “Pepsin in middle ear effusions is almost certainly due to reflux of gastric content, and there may be a role for antireflux therapy in the treatment of otitis media with effusion.” (R)

  • 59 of 65 effusion samples gave a positive result with the anti-pepsin antibody – which also detected pepsinogen.
  • Pepsin/pepsinogen levels ranged from 0.8 to 213.9 mcg/mL.
  • All effusions contained albumin & fibrinogen with respective ranges of 1.77-95.75 & 0.30-2.30 mg/mL.
  • Pepsin/pepsinogen levels in effusion samples were over 1000-fold that of serum samples – whereas albumin and fibrinogen levels were of the same magnitude.

Chronic middle ear disease & GERD: A Causal Relation? (2001)

Poelmans & Feenstra: “GERD may manifest itself as an extraesophageal manifestation, such as nasopharyngitis, leading to ear disease. Therapy-resistant chronic middle ear disease may be caused by GERD.” (R)

  • Many ENTs are NOT familiar with extraesophageal manifestations of GERD such as otitis media.
  • This was a case series in which 4 patients with GERD-related middle ear disease were examined.
  • One patient had “puzzling” and “therapy-resistant” unilateral chronic otitis media – so researchers analyzed 3 additional patients with similar signs and symptoms (a chronic ear problem plus GERD).
  • One patient with chronic ear problem and GERD experienced remission in both ear pain and GERD with: (1) PPI therapy (omeprazole); (2) raising the head of the bed 20-25 cm; (3) avoiding meals and drinks 3+ hours before sleep/rest; (4) other lifestyle/diet modifications.
  • It was noted that “GERD leads to nasopharyngitis and this to a chronic ear problem.”
  • All patients responded favorably to anti-GERD therapy – resulting in a curative effect on ear disease.

Note: There are likely other studies/papers that have documented or discussed links between reflux and ear (otic) symptoms. I included some studies just to demonstrate that there is a clear link and research supports it.

Treatment for Ear Reflux

To effectively treat ear reflux – it is important to treat both: (1) ear-related symptoms AND (2) reflux causes (such as to prevent further ear manifestations of reflux).

Ear-related symptoms

Managing ear-related symptoms with various interventions is recommended until the reflux is better controlled.

  • Corticosteroid nasal spray: Examples include Fluticasone (Flonase), Nasonex, Nasacort, Beconase, Rhinocort, etc. The key is administering these properly such that they reach the eustachian tubes and don’t drip down the back of the throat.
  • Saline spray: I like to use Arm & Hammer because it contains sodium bicarbonate (alkaline) and is purified. Some people may use a homemade spray with purified alkaline water plus baking soda (mixture).
  • Decongestants: Oxymetazoline, Phenylephrine, Pseudoephedrine.
  • Oral corticosteroids: In some cases, low-dose oral corticosteroids may be helpful here for reducing inflammation and ear pain.
  • Chew gum: I personally use Juicy Fruit because it contains Xylitol (fine for teeth) and is non-mint (mint can be bad for reflux).
  • Hydrate: Drink more water throughout the day (but not so much as to trigger reflux).
  • Anti-inflammatories: Reflux may cause inflammation within structures of the inner ear. Certain anti-inflammatories may help counteract this inflammation and reduce pain.
  • Allergy medication: Relatively useless if the cause is solely reflux. However, if you have comorbid allergies – these should help reduce symptoms.
  • Antihistamines: Some people may find antihistamines helpful for managing eustachian tube dysfunction resulting from reflux.
  • Antibiotics: If you end up with a bacterial infection as a downstream effect of reflux (e.g. reflux-induced inflammation & catarrh leads to bacterial colonization and infection). Most antibiotics tend to worsen reflux (with the exception of azithromycin – but this drug isn’t always appropriate for ear infections).
  • Ear cleaning: Proceed with caution here. Recommended to have an ENT clean your ears with a cannula if full of wax. Some may find relief from gently putting sterile water in the ears.

Note: Ensure that none of the interventions used will worsen your reflux. Certain medications may exacerbate both reflux AND ear-related symptoms of reflux so use with caution.

Reflux treatment

The key to reversing these symptoms permanently is to treat the actual reflux.

If you simply manage ear-related symptoms without treating the actual reflux – the symptoms may worsen or never go away.

This is why it’s critical to treat the reflux aggressively. Consult a medical doctor for optimal reflux treatment.

  • PPIs: Twice daily before breakfast/dinner (~30-60 minutes before).
  • H2 antagonists: For those who don’t use PPIs. (Sometimes combined with PPIs).
  • Alginates: After every meal (Gaviscon Advance oral suspension – Aniseed flavor is best).
  • Magaldrate: May help with non-acidic forms of reflux.
  • Fat loss: For those who are overweight/obese (20% of body fat loss recommended). (Read: Weight Loss for Reflux).
  • Low calorie, low acid diet: Helps with fat loss and reduces acidity.
  • Eat small meals: No bigger than the size of your fist.
  • Elevate head of bed 6+ inches: Work with gravity to prevent sleep reflux.
  • No food 4-5 hours before bed: Minimizes odds of nighttime reflux.
  • Loose fitting clothing: Reduces intraabdominal pressure.
  • Sleep on left side (exclusively): Right side and stomach cause reflux.
  • Zero caffeine, nicotine, alcohol, carbonation: All are terrible for reflux.
  • Surgery: If you’re unable to get relief after implementing every single reflux management strategy with near-perfect execution for 6-12 months – then surgery is recommended.

How to know if you’re dealing with ear reflux… (Logical Questions)

Included below are some questions to ask to determine whether you might be experiencing ear manifestations of reflux conditions.

That said, the only way to truly know whether your ear symptoms are from reflux is to rule out all other conditions (including allergies).

  1. Have you been diagnosed with a reflux condition? (e.g. GERD, LPR/NPR, etc.)
  2. Do you have an extraesophageal variant? (e.g. LPR/NPR) (Although GERD can have ear-related symptoms as well – they are more likely with LPR/NPR because of where the reflux is taking place).
  3. Do you experience burning in your upper throat, sinuses, and eyes? (These are signs that refluxate can reach your ears).
  4. Do you experience more significant ear pain after eating (e.g. within 1-2 hours)?
  5. Have doctors examined your ears and told you that they look fine (e.g. no infection)?
  6. Do you experience eustachian tube dysfunction? (Symptoms such as popping/crackling in your ears
  7. Does the ear pain “come and go” such that it’s painful, then goes away?
  8. Does the ear pain rotate between ears – and occasionally affect both ears simultaneously?
  9. Does corticosteroid nasal spray tend to improve the ear pain quickly?
  10. Is pepsin present in your saliva/tears? (Tests can be done)
  11. Has an ENT ruled out more common ear conditions?
  12. Do your symptoms improve when your reflux is under control?
  13. Do you experience a burning sensation between your ears?
  14. Do your ears occasionally feel blocked or muffled?
  15. Does the ear pain increase when swallowing?

If you answered “YES” to many of these questions – odds are that you’re dealing with reflux-induced otic (ear) symptoms.

For example, if you have confirmed LPR – and your ears burn/plug up immediately after eating, but improve or subside after your reflux is under control (e.g. with weight loss, PPIs, lifestyle changes) – then you probably were dealing with ear-related reflux.

Note: It is necessary to mention that a person could have a preexisting ear condition AND experience ear-related symptoms of reflux – and there could be symptom overlap or difficulty knowing which condition is culpable for the symptoms.

Can acid reflux damage the ears?

Maybe. It’s unknown as to whether acid reflux causes damage to the ears – and whether the damage is transient or permanent (irreversible).

That said, there may be some individual variation here depending on: (1) reflux severity; (2) amount of reflux reaching the ears; (3) chronicity & frequency of reflux; (4) specific type of reflux (compounds reaching the ear); and (5) preexisting ear conditions.

Various materials such as gastric acids, bile salts, pepsinogens, trypsin/digestive enzymes, and bacteria (e.g. H. Pylori) could end up in the eustachian tubes/ears and cause:

  • Inflammation
  • Proteolysis
  • Mucosal damage
  • pH changes
  • Oxidative stress

A combination of these effects could result in damage – and the damage may become irreversible if the effect is significant AND the reflux goes unmanaged for an extended duration (months/years).

Note: There are likely some biological feedback loops with regard to LPR and ear issues. Reversing these feedback loops (primarily via reflux therapy) should reverse the damage.

What should you do if you’re worried about ear damage from reflux?

Treat the reflux as aggressively as possible under the guidance of one or more of the following doctors: gastroenterologist (GI); otolaryngologist (ENT); allergist/immunologist.

In the event that reflux does NOT respond to conventional/aggressive treatment over a 6-12 month period – surgery should be pursued (e.g. Nissen fundoplication, LINX, Stretta).

Monitor audio-vestibular function under the care of an ENT and audiologist. ENTs are most knowledgeable regarding safe treatments to prevent/minimize reflux-related ear problems.

My personal experience with ear symptoms of acid reflux (LPR)

I was diagnosed with LPR and initially began experiencing globus sensation and eye-related symptoms.

However, the condition did NOT respond to PPIs right away and I didn’t know how serious the condition could get without proper dietary changes.

Anything acidic caused my inner ears/eustachian tubes to “burn.”

A few weeks after the burning emerged, I noticed that my left ear felt significant pain upon waking in the morning.

After the ear pain began, I also experienced extreme dizziness, disequilibrium, vertigo (to the point that I did NOT feel comfortable standing up).

Initially I thought it might just be BPPV – but this vertigo was way more extreme and lasted for over a month without changing.

In fact, the vertigo was so extreme that I could NOT work the entire time and thought that I was going to fall over while showering.

(I’ve yet to read about anyone with this significant of vertigo resulting from LPR – but there is a correlation).

The dizziness, vertigo, disequilibrium were the WORST symptoms of my ear-related reflux.

The thing I noticed about the ear pain is that it would fluctuate in both intensity and perceived location – but it was certainly annoying.

The ear pain eventually affected both of my ears (left and right) and had me convinced that I might have an infection (e.g. bacterial rhinosinusitis spreading to the ears).

When my go-to ENT examined my ear canals and sinuses – there were no signs of infection but it was recommended that I do audio-vestibular examinations (I skipped this because no point – waste of thousands of dollars just to “test” function without knowing a cause.)

I conversed with 7 different otolaryngologists (yes – 7!) and I received vague/different suspected diagnoses from nearly all of them (e.g. sinusitis, possible H. Pylori, vestibular disorder, allergies, immune response, etc.).

After many back-and-forth consults with these doctors, several eventually came to the conclusion that I was probably dealing with “eustachian tube catarrh” or “catarrh of the eustachian tubes” – as a result of LPR.

(I agree with this diagnosis as I never had any ear/balance issues until the onset of LPR).

One internal medicine doctor thought I might have a bacterial ear infection and prescribed Augmentin (which didn’t seem to help but I tried it anyway).

Another doctor thought allergies – yet no allergy medications helped.

The only thing that made a significant difference in my symptoms was using Flonase (Fluticasone) 2-3 times per day or on an as-needed basis.

(I know, Flonase is NOT intended to be used more than once a day and problems can arise – but I skip entire days if the ear pain is gone. If there’s pain, I use Flonase and it helps reduce the pain pretty quickly when properly administered.)

Prior to this I had been using standard “saline” nasal sprays and they had zero significant effect.

I’ve made plenty of lifestyle changes (lost over 10 lbs.; eat smaller meals; low acid diet; bed head elevation) AND take PPIs twice daily plus alginates after every meal plus antacids plus magaldrate AND use saline rinses/corticosteroids, etc. – but none of this helped my symptoms.

Even chewing gum did NOT help with the ear pain. (Read: Chewing Gum for Acid Reflux).

I also tried an ultra-gentle Valsalva exercise to improve eustachian tube function but this didn’t do anything (this should be done with extreme caution – most people blow way too hard).

The most frustrating thing is that most ENTs were NOT familiar with LPR/NPR causing ear issues (yet there is plenty of literature suggesting that these conditions can cause ear issues).

I’m not going to act like I have this symptom fully under control when the reality is that I do NOT.

I still get ear pain fluctuating throughout the day (sometimes just one ear, other times both).

Thankfully the ear pain is somewhat mild/moderate – but it is very disconcerting.

When I read about people with LPR/NPR complaining about swallowing issues/globus – I think to myself these people are extremely lucky if they don’t experience ear-related symptoms involving ear pain, extreme vertigo/dizziness, and eustachian tube dysfunction (these are way scarier).

One thing that might help this symptom (in addition to corticosteroid nasal spray) is humidification (I’ve noticed my symptoms tend to improve slightly in higher humidity).

(I may update this article if I ever get this symptom under control… am hoping for complete elimination of all ear-related symptoms.)

I suspect that I may have been able to avoid ear-related symptoms if I would’ve been diagnosed sooner with LPR and began more aggressive treatment (my ENT prescribed Omeprazole 20 mg once daily and said this should fix it).

I had to consult other ENTs and self-educate (watching LPR presentations by MDs to learn what it takes to potentially get the condition under control.)

Have you experienced ear-related symptoms from reflux?

If the comments are open, feel free to mention your experience with ear-related symptoms resulting from reflux. Note whether you’ve been formally diagnosed with a reflux condition – and whether it’s GERD or LPR (or both).

Have you come up with any effective ways to reduce ear-related symptoms of reflux – or are you still trying to get these under control? (Share what worked for you below).

If you managed to get your reflux under control with proper treatment – did your ear symptoms improve in lockstep with the reflux improvement?

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