This may seem peculiar, but whenever the temperature changes quickly or when the weather is stormy, I get severe pain and pressure in my right ear. Sometimes I get nauseous. Sudafed helps, as well as large doses of ibuprofen. When I'm checked by a physician, there is no infection or anything wrong with my ear. Where exactly could this pain be coming from? I had surgery on my jaw 20 years ago -- could this be why? Can I take anything to prevent this?

Sue B.

What may seem peculiar to you is bread-and-butter to me. Don't blame your jaw. You have "eustachian-tube dysfunction" (ETD), a problem which, in its many manifestations, affects at least one-third of my patients.

The eustachian tube is a muscular tube that connects the middle ear (the air pocket behind the ear drum) with the throat. Are you old enough to remember the paper straws that some of the cheaper fast food joints used to dispense with their soft drinks? Do you remember how, half way through your soda, the straw would collapse and be useless? That's sort of what the eustachian tubes are like: a collapsed, flexible straw.

There are throat muscles attached to the eustachian tube. When someone feels the need to "pop her ears," she may swallow, yawn, jut out her jaw -- any number of maneuvers, all of which flex the throat muscles so as to forcefully open the eustachian tubes.

An important point is that the eustachian tubes are closed almost all of the time and open only occasionally. Their primary purpose is to ventilate the middle-ear space. There is no other way for air to reach the middle ear (unless you have a hole in your eardrum).

When the weather changes, the ambient air pressure changes. At times, this change may be rapid and dramatic. Since the middle-ear space is a closed pocket most of the time (except when the eustachian tubes "pop open"), the air pressure in the middle-ear space will be different than the ambient air pressure. This pressure difference is no laughing matter, as you well know. Physically, it is a force distributed over the walls of the middle ear, but to you, this pressure difference is experienced as PAIN.

Everyone has experienced this several times during their lives, while flying, driving through mountains or diving in deep water. You happen to be unusually sensitive to these pressure differences. You are not alone. I knew one person who was having difficulty deciding whether or not to buy her "dream house." The problem was that the house was atop a hill, perhaps 2,000 feet above sea level, and she developed ear pressure and pain whenever she left or came back to the house!

Sudafed (generic name pseudoephedrine) is a decongestant. It is occasionally helpful, but it is not without side effects. It can aggravate high blood pressure and cause insomnia or sleepiness. Even though Sudafed is a nonprescription drug, people should consult with a physician before using it with any great frequency. Ibuprofen (trade name Advil) helps because it is a pain reliever. I suspect that any pain reliever would give you some relief from your symptoms.

Is there any way to solve this problem? Unfortunately, some people are born with poorly functioning eustachian tubes. In others, the eustachian tubes have difficulty opening due to inflammation (swelling). The inflammation may have many possible explanations: the common cold, chronic sinusitis, nasal allergies, food allergies -- all have been implicated as possible causes of ETD. Some people think that even gastroesopha geal reflux disease (a condition in which stomach contents back up into the throat) can cause ETD! Obviously, if your doctor can diagnose and successfully treat the root cause of your ETD, your ear problems should improve greatly. An ear, nose and throat doctor (ENT) is the best specialist to enlist for this sort of detective work.