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Does Fluid Pressure In The Middle Ear Cause Headaches?

Posted on Wed, 12 Feb 2014

Question: Dr XXXXXXX Thank you for writing. Tomorrow I have an appointment with my ENT. Several individuals in the health care field agree that I have blocked eustachian tubes. This is now the 8th week. All my blood work is normal including CBC and CMP Recently a hearing aid specialist demonstrated to me that there is no movement in the tympanium at all, the skin is dark with very little light reflex. When the left ear is covered, the tinnituass is not to be heard, hence there isnduction problem. There appears to be no evidence of pus or infection. I was given 10 days of augmenten, then 3 days of Azithromycin, then 5 days of 40 my prednisone. Then I acquired oral thrush and an over growth of candida. The latest symptom is severe cervical headaches at the base of the skull. I had never get headaches. usually 2 Ibuprofen helps with the pain. We do have extreme pressure changes here since we ware 6000 ft. high. Could the headache be due to the fluid pressure in the middle ear? Could the overgrowth of candida albicans cause such headaches. I do take Nystatin mouthwash 2 times daily. My PCP feels I may have multiple which is the cause of the pain in the maxillary sinuses. My nasal fluids are clear but I have a post nasal drip. I take loratadine 5mg bid, oxymetazoline XXXXXXX spray, bid, ginkgo, 1 tab qd, some of the other things you suggested in your last letter do not seem to be available in the US. I'm good at taking care of others, but trying to figure out what is happening to me is quite puzzling. Someone suggested getting ear tubes to help with the pressure. So my friend, can you help me work through this difficult list of symptoms. Dr. XXXXXXX

Answered by Dr. Abhishek Sharma (2 hours later)

Brief Answer: Take steroid nasal sprays Detailed Answer: Hello Dr XXXXXXX sir , First for the candida -- there could be pain in mouth or throat due to candida, I prescribe gargle to my patients and they have to make it --Take Lignocaine viscous 1 bottle add in it 4 tablets of Betnesol add nystatin mouthwash in it, then use 2 tea spoon full (tsf) of it for gargle 3 times a day half an hour before meals. Betadine gargle 2 tsf in 2tsf water for gargle 2 times a day. Secondly probably You have headache becuase of nasal and sinus disease. Continue with oxymetazoline spray for 10 days not more than that, and in addition add Mometasone spray for a month and normal saline spray for a month- 2 puff both nostril two times a day. Continue with tab.loratidine. The nasal steroid spray is harmless to the body as has very very minimal systemic absorption , it will act both for the nose and for the back of nose where the eustachian tube opens so that it will help in equalising the pressure. You can first try with the steroid spray and then if it doesnot help then you can go for ear tubes . General advice-- Chew chewing gums it will help a lot in opening the tubes and Go for walk daily Avoid acidity or heart burn (I prescribe domperidom tablet to prevent reflux to my patients) I hope this will help In any doubt please do reply

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Abhishek Sharma (9 hours later)

Dr. XXXXXXX Thank you for you quick response and good advice. As far as thrush is concerned I have had no pain only soreness and stickiness in my mouth, the thick coat of candida is gone. I use nystatin mouth wash I will follow your advice regarding steroids. Would you suggest I go through allergy testing to see what allergens I am reacting to? At the moment we are experiencing warm weather which is not natural for Southern New Mexico. I have been doing steam inhalations 2-3X's daily, I use eucalyptus oil. Are there any other substances that would be good for steam inhalations? Your suggestions and support are greatly appreciated. Dr. XXXXXXX , What is your experience on how long ETD can last? Today was one of the worse days with high pitch tinnitus and pressure in the ears. I try not to think about it but as you know it is very unsettling especially when I am seeing patients. I did steaming but it did not help. Should I take Lorezapam 0.5 mg? I'm sure today it has to do with the weather front moving in. Does ibuprofen help in this case with inflammation ? Dr. XXXXXXX Dr. XXXXXXX

Answered by Dr. Abhishek Sharma (12 hours later)

Brief Answer: ETD takes 2-3 weeks Detailed Answer: Hello sir, The steroids mentioned previously are for local action and have no systemic side effects so can be used safely. The betnesol tablet for gargles will decrease the inflammation faster and healing will be faster. Regarding nasal steroids, they will act for both nasal disease and Eustachian Tube Dysfunction also. Plain Steam inhalations will do.Other menthol drops etc will only give false feeling of opening the nose but will not help in ETD Do continue with Loratidine. ETD lasts for 2-3 weeks. If the current symptoms is troubling, you can take lorazepam briefly. Avoid taking it for long duration. I personally do not favour allergy testing . You can start with steroid nasal sprays which will take care of all allergy and will help in open up the nose and treat ETD. You can also take mucolytics like ambroxol and do chew chewing gums , its looks senseless but it does help. You might understand some of the medicines I suggested above are not over the counter. Most importantly ,i advice you to see your ENT specialist to get nasal endoscopy done and to evaluate the nasopharyngeal area for any mass etc, as any mass in this area can present with ETD which is refractory to medicines. If endoscopy is not available then do get done MRI scan especially for nasophayngeal area. I can understand its a annoying problem but it will go away. Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Abhishek Sharma (11 hours later)

Dr, XXXXXXX Finally I was able to get the attention of my ENT yesterday. She reexamined my ear and nasopharynx and retested the tympanium movement and said there was no fluids in the ET.s. She said my nasal chonchae were extremely inflamed and this was the causal factors of the ET,s being closed and also inflamed. She offered me a Kenalog injection, will do extensive skin tests for inhalant allergies and blood tests at the hospital lab for food sensitivities. If this does not give abatement of symptoms she wants to do surgery to remove some of the tissue blocking the left os of the ET. I expect that this will also include endoscopy( she loves to do surgery!). At this time I will get a second opinion and also request an MRI. The Kenalog injection is doing a good job producing lots of thick phlegm, I slept 8 hours yesterday, no ansheadache, and at the moment I have no tinnitus. But I approach all of this cautiously as again I notice more thrush this a.m. and will see if we have Betnesol tabs. Is Ambroxol similar to Guafenisen? Thanks again for the help and support and I will keep you posted Dr XXXXXXX

Answered by Dr. Abhishek Sharma (5 hours later)

Brief Answer: continue same medicines Detailed Answer: Hello, Its good that you got relief with steroid injection. You can ask your doctor for nasal sprays too. Guafenisen can also be used. Continue the medicines. If in doubt do reply Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Abhishek Sharma (4 hours later)

just two quick question's. I'm sure you have treated many patients with ETD, you mentioned that generally it takes between 2-3 weeks, but mine has lasted over 8 weeks, have you had some patients who have had ETD this long or even longer? I notice the tinnitus louder after I eat and the ears are sensitive to high pitch sounds i.e. telephone voices, slamming door etc. Is this due to a hearing deficit, I do have at high pitch deficit at 8K /90 dc. left ear and 8K /80 dc. right ear.? These are the only questions I have left. You have been more than patient with me and I thank you kindly for your help.I did ask a question regarding hearing loss (8K/80dc) if this could explain the annoying high pitch sound I hear with a door closing spoon dropping etc. Hyperacusis. ? Also, I know I am impatient with my condition but I wanted to know if you had patients who had ETD longer than 10 weeks?? Other than this I am taking your good advice taking the medications you suggested, some are not available in the US. No further questions, thank you for your listening and patience.

Answered by Dr. Abhishek Sharma (2 days later)

Brief Answer: sorry for being late Detailed Answer: Hello Sir, I am extremely sorry for being late, I was out of station. Yes, there have been few patients who have had ETD for long. What I have seen is that these patients have nasal disease, acid reflux disease, or a mass in nasopharynx region (ie a area behind the nose). After anatomical abnormality like cleft lip, palate, etc., I consider important to rule out those three reasons. That is why I suggested to get done nasal endoscopy once. Again I strongly suggest to get done nasal endoscopy after consulting your ENT specialist. High pitch deficit could be because of age related hearing loss. I am trying to suggest what ever best i could, but its out of my hands as you are so far , and even the variation in medicines etc, hope my suggestions have been fruitful for you. Regards

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Above answer was peer-reviewed by : Dr. Prasad