Muffled hearing can sound and feel like cotton balls in your ear. You may have a sensation that’s similar to the pressure you feel while flying on an airplane. And while there isn’t complete hearing loss, you may strain to hear others clearly.

Muffled hearing occurs when sound waves have trouble passing through the inner ear. Different factors can contribute to a clogged ear. Some cases are minor and resolve quickly, but others require medical attention to protect your hearing.

Muffled hearing isn’t only characterized by a sensation of cotton in the ears. You may have other symptoms as well. These include:

Muffled hearing in one ear can be a symptom of many conditions. Common causes include:

Earwax buildup

Earwax prevents dirt and debris from entering the ear canal, and it also acts as a lubricant for ears. Sometimes, however, it can build up and become impacted in one or both ears. An earwax blockage can be minor, but a severe buildup can lead to muffled hearing.

Other symptoms of an earwax buildup include an earache, extreme pressure, and ringing in the ear.

Presbycusis

This refers to gradual age-related hearing loss of high-pitched sounds. A person with this type of muffled hearing may have difficulty hearing a phone ring. Hearing loss can range from mild to severe.

Other symptoms include trouble hearing when there’s background noise, ringing in the ear, and difficulty hearing a woman’s voice.

Middle ear infection

These bacterial or viral infections occur when fluid accumulates in the middle ear due to swelling or inflammation in the eustachian tube. This tube helps the ears drain fluid from the middle ear.

Some middle ear infections are mild and clear on their own. But others can lead to impaired hearing if left untreated. Middle ear infections can cause ear pain and ear drainage. Signs of an ear infection in children also include pulling at the ear, crying more than usual, fever, and loss of appetite.

Sinus infection (sinusitis)

A sinus infection is when cavities around the nasal passage become inflamed and swollen. Sinus drainage due to an infection can trigger ear congestion and muffled hearing. Other symptoms include a headache, coughing, bad breath, fever, and fatigue. Mild cases of sinusitis don’t need a doctor.

Common cold

A common cold can also cause muffled hearing due to congestion blocking the Eustachian tube. Colds are usually harmless, with a clogged ear improving once congestion does. Other symptoms of a common cold include a runny nose, coughing, body aches, a low-grade fever, and sore throat.

Hay fever

Symptoms of hay fever (allergic rhinitis) can mimic those of a cold and sinus infection. Allergies can also cause ear congestion, triggering mild muffled hearing. Additional symptoms of hay fever include watery, itchy eyes, sneezing, coughing, postnasal drip, and fatigue.

Airplane ear

Airplane ear occurs when there’s an imbalance of the air pressure in the middle ear, and the air pressure in the surrounding environment. This can happen in an airplane, an elevator, or while driving up a tall mountain.

You may have ear pain, vertigo, and bleeding from the ear with airplane ear. This condition isn’t usually serious, but it can lead to chronic ringing in the ear or hearing loss.

Noise damage

Noise-induced hearing loss (acoustic trauma) occurs when there’s damage to the auditory nerve. Hearing loss may be mild or severe, as well as temporary or permanent. Damage can occur after one-time exposure to loud noise, or after repeated exposure.

Tinnitus

Tinnitus (ringing, buzzing, humming, or clicking sound in the ear) can also cause muffled hearing. These sounds can be temporary or permanent, and occurs when sensory hair cells in the inner ear become damaged.

This can happen with age or due to prolonged exposure to loud noise. Sometimes, the cause of tinnitus is unknown. Tinnitus can be barely noticeable, or loud enough to interfere with concentration or sleep.

Ear blockage

Earwax isn’t the only cause of an ear blockage. A foreign object in the ear canal can also cause muffled hearing. This might include water, an insect, or any small object, which is more common for young children.

A foreign object in the ear is serious and requires medical attention to avoid injury to the ear. These types of blockages can cause pain, a feeling of fullness in the ears, and hearing loss.

Certain medications

Some medications can have a harmful effect on nerve cells in the inner ear. These include:

Hearing loss ranges from mild to severe. Other symptoms of medicine-induced hearing loss include vertigo, tinnitus, and fullness in the ear.

Eardrum perforation

Also known as a ruptured eardrum, an eardrum perforation is another cause of muffled hearing. This is when a hole or tear forms in the tissue separating the middle ear from the ear canal.

A ruptured eardrum isn’t usually an emergency and heals on its own. Other symptoms include ear pain, bloody drainage from the ear, ringing in the ear, vertigo, and nausea.

Tumor

Muffled hearing may also be a sign of a tumor. An acoustic neuroma is a benign growth that forms on the main nerve that leads from the inner ear to the brain. Other signs include loss of balance, vertigo, facial numbness, and ringing in the ear.

A lump on the neck can be a sign of nasopharyngeal cancer. This type of cancer develops in the upper part of the throat and can cause muffled hearing, ringing in the ear, and ear pain.

Meniere’s disease

This disease of the inner ear causes a variety of symptoms, including muffled hearing, tinnitus, vertigo, and pain in the ear.

The cause of Meniere’s disease is unknown, but it may be associated with abnormal fluid in the inner ear. There’s no cure for this condition, but symptoms may improve or disappear with time.

Brain injury or head trauma

A serious brain injury or head trauma can damage bones in the middle ear or nerves in the inner ear. This can happen after a fall or blow to the head. Other symptoms of a head injury include headaches, dizziness, and loss of consciousness.

Muffled hearing doesn’t always occur by itself. It can appear with other symptoms, too. It’s important to describe all symptoms to a doctor to help identify the underlying cause.

Muffled hearing and ringing in one ear

Along with muffled hearing, you may have tendinitis or ringing in one ear. Common causes of this combination of symptoms include:

  • medication
  • age-related hearing loss
  • perforated eardrum
  • earwax buildup
  • airplane ear
  • noise damage
  • tumor

Muffled hearing in both ears

Some conditions can cause muffled hearing in one or both ears. For example:

  • airplane ear
  • age-related hearing loss
  • noise damage
  • medication

Muffled hearing in one ear after a cold

Even though some people have muffled hearing while sick with the common cold, it can also develop after a cold. This can happen when a cold progresses to a sinus infection or a middle ear infection. In this case, drainage or congestion from these secondary infections causes clogged ears.

Common treatment options for muffled hearing include:

Remove a blockage

When a blockage causes muffled hearing, removing the obstruction may reverse hearing loss.

With earwax, your doctor may recommend an at-home earwax removal kit to soften and flush out the wax, or remove the wax in-office using a special instrument.

For a foreign object, your doctor may use a small vacuum device or small forceps to clear the blockage. You may need surgery to remove an object when there’s a risk of injuring the eardrum.

Antibiotics

When a sinus infection or middle ear infection causes ear congestion and muffled hearing, your doctor may prescribe an antibiotic to clear the infection.

Decongestant

A decongestant can open your Eustachian tube by constricting blood vessels and reducing swelling. This medication is also useful for airplane ear. Take a decongestant as directed before flying to equalize the pressure in your ears. You can also open your Eustachian tube by yawning, sneezing, or chewing gum.

Surgery

A tear or hole from a perforated eardrum will likely heal on its own. If it doesn’t heal, a doctor can use an eardrum patch to seal the hole, or perform surgery to repair the hole if a patch doesn’t work.

Surgery is also an option for tumors that affect the inner ear. For a benign tumor, a doctor may monitor the growth and only recommend surgery if the tumor increases in size.

If you have a malignant growth, your doctor may suggest radiation therapy or chemotherapy before surgical removal.

Hearing aids

Sometimes, muffled hearing doesn’t improve. This can happen with Meniere’s disease, age-related hearing loss, noise-induced hearing loss, and hearing loss due to head trauma or medication.

If your doctor determines that hearing loss is permanent, a hearing aid may improve your hearing ability. These sound-amplifying devices can be worn in your ear or behind your ear.

Because loud sounds can cause permanent damage to your eardrums, it’s important that you take steps to protect your ears. Damage can occur after a one-time exposure to extremely loud noise or occur gradually from repeated exposure.

To protect your ears from damage:

  • move away from loud noises, if possible
  • wear earplugs or other ear protection in loud environments (at work, concerts, working in the yard)
  • get your hearing checked if you suspect hearing loss
  • protect the ears of your children
  • don’t stand or sit too close to loudspeakers
  • turn down the volume when listening to music with headphones

Muffled hearing might be caused by something as simple as congestion from the common cold or hay fever, in which case, hearing may gradually improve on its own. But sometimes, muffled hearing is due to a serious condition like a tumor or head injury.

See a doctor for any sudden hearing loss or for muffled hearing that doesn’t improve with self-care.