Heartburn and ear pain: causes and treatment

How does heartburn affect your ears?

Heartburn is an uncomfortable burning sensation just behind your breastbone. It’s caused by digestive acid moving into your esophagus, which is the tube between your throat and your stomach. Heartburn is typically experienced:

• After eating
• In the evening
• After lying down

If you have frequent heartburn that interferes with your lifestyle, you may have gastrointestinal reflux disease (GERD). Two extraesophageal variants of GERD are laryngopharyngeal reflux (LPR), also known as silent reflux, and nasopharyngeal reflux (NPR). These vary in sensation within your esophagus and other areas of the throat.

Here’s a breakdown:

• GERD: backflow of stomach acid that irritates your esophagus
• LPR: backflow of stomach acid that irritates your larynx (voice box) and pharynx (part of your throat above the esophagus and larynx, behind the mouth and nasal cavity)
• NPR: backflow of stomach acid that irritates your nasopharynx (upper part of the your throat behind your nose)

For some people, LPR and NPR can lead to ear pressure and ear pain, often in the form of eustachian tube obstruction (ETO).

Each of your ears has a eustachian tube. This is a canal connecting your middle ear to your nasopharynx to equalize the pressure in your middle ear to the air pressure outside your body.

Studies have suggested a connection between ETO and the variants of GERD. According to a 2015 study, LPR and ETO appear together in many cases. A 2014 study found that nasopharyngeal reflux may have a role in the development of ETO.

Eustachian tube obstruction symptoms

Your eustachian tube connects your middle ear and throat. ETO, also referred to as blocked eustachian tubes or eustachian tube dysfunction, is characterized by symptoms such as:

• Ear pain
• A feeling of fullness in your ears
• Hearing difficulties
• Ringing or popping noises in your ears
• Dizziness

LPR symptoms

Most LPR symptoms appear in your throat, such as:

• Feeling like there’s a lump in your throat or needing to clear your throat
• Sore throat
• Difficulty swallowing
• Hoarseness
• Persistent cough
• Postnasal drip
• Irritated larynx

While the majority of people with GERD experience heartburn, according to Stanford Medicine, only about 35% of those with LPR experience this symptom.

NPR symptoms

Symptoms of NPR include:

• Runny nose
• Stuffiness
• Postnasal drip
• Inflamed sinuses

Treating acid reflux

If your heartburn and ear pain have been diagnosed as symptoms of acid reflux, your doctor may recommend things like over-the-counter medications (OTC), prescriptions, surgery, or lifestyle changes.

OTC medications

For symptom relief, you doctor may suggest:

• Antacids, such as Tums, Rolaids, and Mylanta. These help neutralize stomach acid.
• H2-receptor blockers, such as famotidine (Pepcid AC), nizatidine (Axid AR), and cimetidine (Tagamet HB). These reduce stomach acid production.
• Proton pump inhibitors, such as omeprazole (Prilosec OTC) and lansoprazole (Prevacid 24 HR). These block acid production.

Prescription medications

If OTC medication doesn’t give you enough relief, you doctor may suggest:

• H2-receptor blockers, such as prescription-strength nizatidine and famotidine
• Proton pump inhibitors, such as prescription-strength omeprazole (Prilosec, Zegerid), dexlansoprazole (Dexilant), pantoprazole (Protonix), esomeprazole (Nexium), lansoprazole (Prevacid), and rabeprazole (Aciphex)
• Medication to help empty your stomach faster, such as metoclopramide (Reglan) and bethanechol (Urecholine)

Lifestyle changes

To lower your frequency of acid reflux, your doctor may suggest that you:

• Reach and maintain a healthy weight.
• Eat slowly and thoroughly chew your food.
• Don’t lie down until 3 hours after eating.
• Raise the head of your bed 6 to 9 inches.
• Avoid trigger foods, like alcohol, caffeine, onions, fried foods, garlic, and tomato.
• Stop smoking, if you currently do.

Takeaway

Heartburn and ear pain can both be symptoms of acid reflux. If you experience ear pain from acid reflux, it’s most likely 1 of 2 extraesophageal variants of GERD: LPR or NPR.

If you have a recurring earache or experience heartburn often, talk with your doctor.