First, know that anxiety never "always" causes anything. Everyone has a different experience physically. So no, anxiety doesn't always cause pressure in the ears. Allergies often do, though, and it's allergy season. Inner ear problems do. Even wax build-up does. I've been on this site a long time and I've never heard anyone mention pressure in the ears as a symptom that concerns them. Mostly, we're concerned about feeling afraid and avoiding things because of it. The physical sensations build up over time, as our thinking becomes more and more filled with anxious thoughts and stress from them. Feeling what you do when you stand up sounds more like a blood sugar problem than an anxiety problem, but remember, anything that happens in your life, even having an alcoholic drink, can cause a feeling so similar to what you feel when you're anxious that it can trigger anxiety because that's what you expect to feel. Also keep in mind, the ER isn't the place to go for this stuff -- they don't do thorough exams, they're in way too much of a hurry and have much sicker patients than you, and are often very quick to attribute it to anxiety and give you a drug to get you out of there. You should be seeing your regular physician for a thorough check-up, looking for everything, such as blood sugar, nutritional deficiencies, thyroid problems, etc. that can have symptoms that are a lot like what an anxiety attack feels like. Until you eliminate the possibility of something physical, even something as easy to fix as low iron or Vitamin D3, attributing it to anxiety is bad doctoring. And the world is full of bad doctors. Just as it's full of bad plumbers. Use your instinct -- if you feel it's anxiety, well, get into therapy if you haven't already. If you feel it's not anxiety, and at least from what you've said I'm thinking it might be something else in this case, keep after your doctor. Good luck.