Came across this today --> Recently I was reading a CT scan of the temporal bone (ear and skull) on a a nice older man with pain and pressure in the ears when flying. He has not been diagnosed with an ear infection as an adult, but gets excessive pain and pressure that seems to linger for a few hours after his flights. It always affects the right ear.
The patient has been seen and treated for sinus complaints and allergy issues over the years, none of which were very severe. We can generally treat ear pain and pressure when flying with ear tubes, the problem though is the tubes obviously impact you daily and require special precautions around swimming or getting the ears wet — all in order to treat the 1 or 2 days a year that the patient may feel uncomfortable after flying in planes.
The patient was considering the new technology of balloon eustachian tube dilation, which holds promise to help the eustachian tubes work better.
As part of that planning, we performed imaging of the skull base and ear.
What we can see in this patient is that the right mastoid bone is underdeveloped relative to the left. The mastoid bone is the firm bone in the back edge of the temporal bone that during infancy typically develops into a hollow air-filled cavity communicating with the repair. This extra air-filled cavity basically as a little bit of air pressure reserve, allowing for sudden pressure changes in the ear to be distributed across more volume, perhaps 3 times as much volume as just the middle ear behind the eardrum.
Patients with chronic eustachian tube dysfunction in childhood will often have undeveloped mastoids. They will often complain of ear pressure, fullness in the ear, have ear infections, and even sometimes pulsatile tinnitus related to some other vascular developmental anomalies at the same time. Most of us think that eustachian tube blockage in infancy basically leads to the mastoid bone not developing those air pockets to allow for the air pressure buffering.
For these folks, maneuvers for eustachian tube clearance, nasal steroid sprays, and likely even balloon eustachian tube dilation procedures can be very very helpful and almost needed during high-pressure situations such as flying or scuba diving.