| Grade | Symptoms | Otoscopic Finding | | :--- | :--- | :--- | | | None | Normal TM | | 1 | Mild fullness, slight muffling | TM retraction with hyperemia of malleus handle | | 2 | Moderate blockage, hearing loss <30dB, autophony (hearing own voice) | TM retraction with visible fluid line or air bubbles (serous effusion) | | 3 | Significant hearing loss, pain, tinnitus | Gross TM retraction + hemotympanum (dark blue/red behind TM) | | 4 | Sudden pain relief ± popping sound, bloody otorrhea | TM perforation (usually anteroinferior quadrant) |
Hold a warm (not hot) washcloth against the blocked ear for about 10–15 minutes. The heat can help reduce congestion and soothe any mild pain, making it easier for the tubes to clear. When to See a Doctor blocked ear after flight