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Fullness in ear, audiogram normal, pain and pressure in ears, lightheadedness, CT scan showed opacification of mastoid air cells. Second opinion?

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Hello. I am a 27 y/o female having ear troubles for approximately 7 weeks. The trouble started after I got a cold at the beginning of January, when I woke up one morning feeling as though I had an ear infection in my left ear. I have had an ear infection in the past, so I was not alarmed. I went to my dr who told me that I didn't have an ear infection because my eardrum wasn't bulging. He told me that I had fluid in my ear and to take sudafed to remove the fluid. Over the next 48 hrs the sudafed seemed to work. Then the ear fullness came back. I saw my dr again who dx'd sinusitis and was put on several courses of antibiotics because the sinusitis wasn't responding. I saw an ENT who confirmed sinusitis and wanted to try a course of avelox and prednisone before giving up on antibiotic treatment. I did this treatment but got no real relief. I still had the fullness in my left ear which was starting to spread to my right. The ENT looked into my ears and said I was fine and there was no fluid. He administered a basic audiogram to calm my fears. The audiogram came back saying my hearing was normal. I was told there is nothing he can do except Rx flonase and astepro. I have taken both these sprays for over a month with no improvement in the ears. My current symptoms are:
-constant feeling of fullness in both ears ( feeling in a tunnel or underwater)
-occasional pain in the left ear
- intermittent pressure in both ears and in my head
- intermittent pressure on both ear drums
-feeling like I am not hearing as well as the audiogram suggested, sound I'd muffled in large open and loud spaces like malls
-popping/crackling of ear drums/ eustachian tubes upon swallowing, yawning, etc.
-occasional lightheadedness
-no fever
I have had a blood test to rule out infection. WBC count was normal.
Had 3 ct scans of my head, sinuses, and ears. The only significant finding in the report states: partial opacification of left mastoid air cells, correlates clinically with mild left mastoiditis. My ENT saw the actual images of these scans and did not find these findings significant I am assuming. He told me that my symptoms are all just anxiety, though i didn't have anxiety up until the point of this situation not being resolved. I was basically told not to come back. Where do I go from here? Another ENT for a second opinion?
Posted Mon, 7 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 4 hours later
Thank you for your query.

1. Check your investigations to see whether a Tympanogram (Impedence Audiometry) has been done.

2. middle ear leading to your symptoms. A Tympanogram, especially at the time of feeling of increased fullness in the ear will be useful. Has a nasal endoscopy been done to check the inner end of the Eustachian tube?

3. I would like to review your scan images, audiograms and detailed eardrum findings (clinical notes), if possible. Images of the eardrums may be obtained by an endoscope or video-oto-endoscope. If possible, please upload the reports using “Upload your reports” section on the right.
As I believe that more information can help a physician help a patient better, please answer the following questions:
•     Do you hear any sounds (Tinnitus) or have any dizziness?
•     Is your hearing fluctuating at times or is it distorted at times?
•     Do you hear 'double' (diplacusis)?
•     Do you have any family history of ear problems?
•     Did you have adenoid related problems in childhood?

5. Since medication has not helped, if there is a proven middle ear pressure differential or fluid, it can be relieved by a myringotomy and grommet insertion.

6. Sinusitis may cause Eustachian Tube Dysfunction. However sinusitis will show up on a computerised tomography scan of the Para Nasal Sinuses (CT PNS)

7. Anxiety will be a diagnosis of exclusion. The exact cause of Interstitial Cystitis is unknown. A similar or common cause may be responsible for both your conditions.

I hope I have answered your query. If you have any further questions I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Fullness in ear, audiogram normal, pain and pressure in ears, lightheadedness, CT scan showed opacification of mastoid air cells. Second opinion? 9 hours later
Dr. Bhatti,
I do have occasional tinnitus. It is very mild and goes away right away. I almost don't notice it.
I also have dizziness at times, though it isnt a spinning type dizziness, it is more of a severe lightheadedness that makes me want to sit down. I usually feel quite tired after the dizzy spells, which did not happen at first but are happening more often now.
I don't have any family history of ear problems that I am aware of. I am not sure if my hearing fluctuates or is distorted at times because my hearing seems for the most part ok, it's just when I go to large open and loud places that I feel like I am straining to hear, or the hearing is muffled. I haven't had any adenoids problems as a child.
In response to you questions about testing that may have been done on me, I have had only a basic audiogram to tell me that my hearing is normal. No tympanogram. The ENT I saw wanted to diagnose everything as anxiety related. I did have a nasal endoscopy done, but I am not sure if he looked at my eustachian tubes, he did mention a lot of swelling though, more than he had expected. Unfortunately all reports were kept in my file by my ENT so I cannot get them today. So should I be consulting with another ENT for a second opinion? I am at my wits end. Thanks.
Answered by Dr. Sumit Bhatti 42 minutes later

Thank you for writing back.

1. You should get a second ENT opinion for a Tympanogram. Depending upon whether it is normal, shows evidence of fluid or negative pressure, the treatment will vary. Unsteadiness occurs with negative middle ear pressure.

2. It would be of great help if you could access your file. Your CT images will confirm or rule out sinusitis and show whether the swelling seen on endoscopy in the nose and nasopharynx still persists.

3. Avelox (Moxifloxacin) has many side effects. Not long ago it was considered a wonder drug for sinusitis. Now, multiple side effects have surfaced. Get Liver Function Tests done. Severe light headedness that makes you want to sit down may be due to weakness.

4. It is good to hear that most of your answers are in the negative.

I hope I have answered your query. If you have any further questions I will be available to answer them.

Above answer was peer-reviewed by
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