SEVERE EAR PAIN WITH CPAP

[pavelow360]

So, I have been doing cpap therapy for about 17 months and always use the machine. I also fly for work very often and use it while flying. Maybe 3 or 4 months ago, I started getting pains in my ears at random times. Mostly one or the other, usually not at the same time. I had episodes of clicking sounds in one or both ears and the pain in my ears is more constant in the last few weeks. When suggesting the issue was cpap related to an audiologist who tested my hearing, he dismissed it and said something to the effect of "if there was hearing loss due to cpap usage, there would be lawsuits" and also said "other things can give ear pain" but no suggestion to help at all. He knew my occupation and only dismissed the change in my hearing was due to that. I have spent 25 years exposed to loud noise at work and have religiously used hearing protection and have never had hearing issues like this until now. I do not doubt that some hearing loss is due to getting older and exposure to loud noise over time but I know for sure this pain and hearing loss now is due to the CPAP machine. I have read people having this issue because they had their machines set too high. My prescribed settings are a minimum of 8 and a maximum of 10. I have never went any higher than 10 and only recently with this issue have experimented with lowering the maximum setting to 9 with and EPR now set to 3. I have tried getting a tap device made but it doesn't seem to work at all for me as I am considered severe OSA. I know I need this machine to help with my OSA but I do not want to lose my hearing and the pain is killing me. I am stuck between a rock and a hard place here. I do not know if anyone can suggest a solution or what, I just needed to post this. Thanks if you read it all

[Hydrangea]

Hi! I have experienced what your experiencing! You're not alone.

With some experimentation, I found a few things that have helped eliminate my ear pain and almost completely eliminate the clicking when I swallow throughout the day:
- EPR of 1.
- Keep the spread of min/max pressures small.
- Don't yawn or swallow while the machine is turned on. (Pull the mask off your face if you need to yawn or swallow while trying to fall asleep.)

For me, a higher EPR means a constant raising and lowering of pressure, which irritates my ear drums(?). When I minimize the EPR as much as possible, it HUGELY helps me!

So sorry your audiologist blew you off. I'm finding that most doctors (including my former sleep "doctor") don't know much about CPAP therapy, nor the side effects. In a social situation, I met an ENT dr, so I asked him about the ear pain and clicking (this was before I figured out a solution); his suggestion was surgery... although he admitted he'd never heard of ear pain from xPAP.

[sonicboom]

This is what I found:

https://www.sleepapnea.org/treat/cpap-th...-with-pap/

"Although treating sleep apnea usually eliminates morning headache, some patients get headaches on PAP. Others find that their ears develop pressure or pain in them. Most of this relates to underlying sinus congestion caused by allergies or PAP itself. The experience is similar to that experienced traveling in an airplane when you have a cold. The congestion can block the ear canals and changes in air pressure can cause pain when air gets trapped. It is best not use PAP when you have a cold or sinus infection to avoid these problems. Sometimes the congestion remains in the ears and sinuses after the acute symptoms of the cold are gone. If you develop headache or ear pain on PAP, speak with you sleep specialist. In the interim you may try decongestants or antihistamines, but check with your doctor before you take these medications."

You may also find this case quite illuminating and instructive. "We describe the detailed clinical course and outcome for a patient with otic barotrauma as a result of excessive self-titration of CPAP therapy in an in-home setting. We also discuss the pathophysiology of otic barotrauma and present a review of current literature on the topic."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896658/

[Sleep2Snore]

Interesting study and a lot of people have ear problems, but it is a case of what is worst.
A bit deaf or feeling like death warmed up?

[pavelow360]

Hi!  I have experienced what your experiencing!  You're not alone.

With some experimentation, I found a few things that have helped eliminate my ear pain and almost completely eliminate the clicking when I swallow throughout the day:
- EPR of 1.
- Keep the spread of min/max pressures small.
- Don't yawn or swallow while the machine is turned on.  (Pull the mask off your face if you need to yawn or swallow while trying to fall asleep.)

For me, a higher EPR means a constant raising and lowering of pressure, which irritates my ear drums(?).  When I minimize the EPR as much as possible, it HUGELY helps me!

So sorry your audiologist blew you off. I'm finding that most doctors (including my former sleep "doctor") don't know much about CPAP therapy, nor the side effects.  In a social situation, I met an ENT dr, so I asked him about the ear pain and clicking (this was before I figured out a solution); his suggestion was surgery... although he admitted he'd never heard of ear pain from xPAP.

hello Hydrangea, 

Thank you for responding and for your suggestions. I gave it a try and boy is it hard to not swallow, you feel like you are salivating and have the urge to swallow a lot. I just hit the button on top to stop the machine, then swallow if I had to.

[Hydrangea]

It's hard when you're thinking about not swallowing.

For me, I've learned to swallow after an exhale but before starting an inhale. Most of the time that doesn't bug my ears.

[holden4th]

The role of your eustachian tubes in regulating ear pressure should not be underestimated. The motion of swallowing allows your eustachian tubes to regulate the pressure in your middle ear thereby normalising the shape of your eardrum. The clicking suggests that one of your tubes may be blocked and I'm saying this because I've had that sensation. I also think that PAP therapy might be a factor for me but can't be completely sure.

There are a variety of ways to clear your eustachian tubes from the valsalvar manoeuvre to using a dedicated device such as the Otovent. If you have a build up of fluid in your middle ear then it needs to be rectified.

A visit to an ENT specialist might help.

[pavelow360]

Revisiting this issue because it has not gone away. I've worked on no swallowing or yawning but it doesn't change anything. I've been able to see an ENT that understands this phenomena and he suggested two possible aids. One, estrogen ear drops and / or two , poking a hole in my ear drum to help aleve any pressure build up. I have received the ear drops but haven't used them as I am scared of any side effects this may cause. This is an estrogen that is injected into woman. The doctor just diluted a bottle of estrogen in saline solution.  I want help but I am scared of side effects. The Dr. says this would help to keep my eustachian tubes closed better. He said he has had mixed results. Has anyone heard of or had experience with either of these two methods?

[Hydrangea]

I've not heard of either of those.

My ear issues have *completely resolved* since shutting off the exhale support. Keeping the pressure the same for both inhale and exhale has eliminated the ear pain, clicks, and pops.

[mesenteria]

There's another often overlooked cause of the clicks 'n pops, and that would be hardened ear wax making occasional contact with the tympanic membrane.