How can I restore my hearing after getting hit in the ear?

Question

Hello doctor,

Two months ago, I was hit in the ear during a fight. The blow was not strong enough to cause obvious serious damage, but it was strong enough to cause noticeable pain and a feeling of congestion. The impact affected both the ear canal and the area behind the outer ear (auricle).

Within a day or two, the pain decreased, and my hearing slightly returned, but the feeling of congestion and muffled sound remained, subjectively about 70 percent of normal. Most of the pain has resolved, but a slight aching sensation deep in the ear canal still occurs occasionally. Sometimes it is more noticeable, sometimes less.

In the first couple of days after the blow, there was slight swelling, which was assumed to be the cause, as there was no visible damage. There was no bleeding or fracture, but a small crack in the ear cartilage appeared, which could only be felt by touch and was painful when pressed.

Now, two months later, the pain sometimes radiates deep within the ear. My ear feels muffled, as if it were filled with cotton. There is also a strange sensation of a vacuum deep inside the ear, which is difficult to describe but makes hearing uncomfortable.

These changes are especially noticeable with buzzing and humming sounds, such as from a blender or vibrations. These noises now sound distorted or incomplete, as if part of the sound is missing. Overall, my hearing has become less clear and somewhat muffled, but I have not noticed any other major distortions.

During the first month after the blow, I occasionally experienced sensitivity to sudden, sharp sounds, such as mouse clicks. My hearing was still muffled, but these sounds felt piercing and sometimes caused slight pain. Over time, this has improved somewhat.

Additionally, several times in the past two months, I experienced brief, sharp, loud noises in that ear, similar to ringing or squeaking, which disappeared after a few seconds. These did not occur before the injury.

Within 24 hours of the incident, I visited an ENT specialist. A routine examination, including checking the eardrum, showed no visible problems. I was advised to wait for any swelling to resolve. While the swelling seems to have gone down, the main issues with hearing and the unusual sensations remain.

My questions are:

What could have happened to my ear?
What can be done to restore my hearing?
And what is the likely prognosis for recovery?

I would greatly appreciate detailed advice.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

From the description and normal otoscopy, the most likely issues are:

Eustachian tube dysfunction.
Middle‑ear muscle (tensor tympani) irritation or hyperacusis, causing discomfort and distortion for certain buzzing or humming sounds.

Depending on findings, typical measures include: For eustachian tube dysfunction:

Treat any contributing rhinitis or sinus disease (topical nasal steroid, saline irrigation, allergy management, reflux control as needed).
Regular pressure‑equalization maneuvers (gentle Valsalva, Toynbee, frequent swallowing, or yawning) as long as they do not increase pain.
Short course of decongestant or antihistamine only if clearly indicated and medically safe; evidence is modest, so these are usually adjuncts.
If symptoms and negative pressure persist for months and are clearly middle‑ear in origin, options like balloon eustachian tuboplasty or tympanostomy tubes may be considered in selected patients.

For middle‑ear muscle hyperactivity or sound sensitivity:

Avoid continuous overprotection with earplugs in normal environments, as this can worsen central gain and hyperacusis; instead, use protection only in clearly loud settings.
Hyperacusis or tinnitus‑oriented sound therapy or CBT (cognitive behavioral therapy)‑based programs.
Address associated anxiety or stress, which can amplify muscle tension and perception of symptoms.
Avoid further acoustic or barotrauma (loud venues, diving, forceful nose‑blowing).

If a sudden marked drop in hearing, persistent spinning vertigo, facial weakness, or continuous unilateral tinnitus, urgent ENT (ear, nose, and throat) or audiology review is needed.

Prognosis and recovery:

Eustachian tube dysfunction: Many cases following an acute trigger gradually improve over weeks to months as inflammation resolves and pressure ventilation normalizes, especially with appropriate nasal or ET (eustachian tube) treatment.
Middle‑ear muscle hypersensitivity: Symptoms such as brief sharp pains, piercing clicks, or mild hyperacusis often lessen over time with avoidance of further trauma and sensible sound exposure, though they may take several months and can intermittently fluctuate. If detailed testing shows normal thresholds but difficulties with complex sounds, the long‑term prognosis is more variable; symptoms can stabilize and become less intrusive, but complete reversal is not guaranteed; however, current evidence suggests that at least some synaptic changes after noise or trauma can partially recover.

I suggest you undergo a few investigations, such as:

Pure‑tone audiogram.
Tympanometry and acoustic reflexes.
Speech audiometry.
Otoacoustic emissions.
Repeat otoscopy plus nasal endoscopy.

Please follow up with the reports.

I hope this helps. If you would like to discuss further or need more guidance, feel free to ask. I am always happy to help.

Thank you.