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Suggest Treatment For Pulsatile Tinnitus Despite Taking Oral Steroids

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Posted on Thu, 15 Sep 2016
Question: Finished course of medications for ear infection that occurred 7 weeks ago. Ceftin and oral steroids. Sudafed for ETD. Had aural fullness but that seems to be almost Still experiencing rumbling in the ears along with pulsatile tinnitus which is sometimes pretty loud. Will this go away at some point? I started back on Sudafed.
doctor
Answered by Dr. Sumit Bhatti (6 hours later)
Brief Answer:
PTA, I / A.

Detailed Answer:
Hi,

Thank you for your query.

1. Get a PTA ( Pure Tone Audiometry ) and I / A ( Impedance Audiometry / Tympanometry ) done. Tinnitus matching can also be estimated.

2. Depending upon the results of these tests, medication and surgical. Intervention can be decided.

3. Thr Tinnitus seems to be due to ETD. It should settle down once the ETD is decreased.

4. Rebound congestion with the use of decongestants can lead to tinnitus.

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

Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sumit Bhatti (56 minutes later)
I have had both Audiometry tests done. And the results were within normal limits. Initially I did have some diminished hearing, but that has returned the last few weeks. The ENT I saw does not see anything visual that would indicate infection, but could be in another area of the head.

I am taking the Sudafed orally for a few days on and off a few days to help with the ETD, which has improved. I take no more than 4 pills a day and not in the evening.

The pulsatile tinnitus started when the infection started. I am concerned that perhaps the infection may be vascular related now. I frequently get a headache under the mastoid process along with the tinnitus, and it is hard to tell which is causing which. Pulsatile causing the headaches or visa versa. My BP is within normal limits. I am thinking about seeing a neuro if this does not clear up within the next few weeks. Hard to sleep with the pounding in my ear.

Thanks in advance
doctor
Answered by Dr. Sumit Bhatti (10 hours later)
Brief Answer:
Rule out early Meniere's Disease. Neck colour doppler and MRA.

Detailed Answer:
Hi,

Thank you for writing back.

1. If you have fluctuating hearing loss in addition to the tinnitus, rule out early Meniere's Disease. A salt restricted diet and a test does of diamox (acetazolamide) can be taken under the supervision of a doctor.

2. For investigating the pulsatile tinnitus, get a Neck vessel colour doppler study and an MRA (MR Angiogram) done.

3. The pounding headache may also be a sign of residual infection. Continue medication from a local physician.

4. If all the above are normal, this will be a migraine associated tinnitus or a drug induced tinnitus (due to rebound effects of pseudoephedrine).

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

Regards.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Sumit Bhatti (5 hours later)
Ruled out Meniere's - I do low salt diet anyway. - Had a trial of diuretic. No vertigo or dizziness with this. I have an appt with Neurologist who may do the Doppler and MRA. given everything else that was ruled out.

I had an MRI in late May which was normal. PCP just gave me a script for Tramadol to take as needed for headache to see if possible migraine related . She did not hear anything unusual with the carotid artery blood flow. But I understand blood flow has to be really bad to hear anything with a stethoscope.

Thanks for you answer as causes are ruled out.
doctor
Answered by Dr. Sumit Bhatti (21 hours later)
Brief Answer:
Further investigation is required.

Detailed Answer:
Hi,

Thank you for writing back.

1. This will require a Neck Color Doppler study and an MR Angiogram.

2. There are certain conditions that also have to be ruled out:
a. Anemia (low hemoglobin which leads to increased blood flow)
b. Thyroid disorders
c. Patulous Eustachian tube
d. Benign Intracranial Hypertension (get an eye examination done)
e. Myclonus of the ear muscles.
f. Cervical spondylosis.

TMJD (Temporo-Mandibular Joint Disorders) and GERD (Gatro-Esophageal Reflux Disease) are associated with tinnitus and hence must be treated.

3. If all these are normal, try to stop the pseudoephedrine and check. Anti-migraine medication may help.

4. In a way, it is good to hear that many tests are normal. This rules out any serious problem. Most medications for tinnitus are given to improve blood flow to the inner ear. This may worsen your pulsatile tinnitus. Hence a trial of medication will have to wait until all your tests are done. You may share your previous reports here.

I must emphasize that in a vast majority of cases, the exact cause of Tinnitus remains unknown. Tinnitus cannot be cured, though it may disappear on its's own or be controlled by treatment.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti (2 hours later)
The list of items under 2 have been ruled out. I did get an eye exam. Beginning stage of cataracts otherwise healthy. Blood tests all came back normal and no sign of infection. My ET feels like it is working. I can "pop" my ears. The aural fullness is just about gone. I did stop the pseudoephedrine a few days ago.

I started seeing a chiropractor a few weeks back and x-rays indicated a small deviation of c1. He also detected substantial muscle tightness of the cranial muscles at the base of the skull. Particularly on the side of the ear issues. So he has been treating me for that. Not sure if this has been effective yet since I have been 4 times. He is w





orking on the TMJ just in case, although he did not detect that this was a problem.

This all happened when I had an ear infection on July 4 - which was treated. I did not have this PT or aural fullness before in this ear.

My PCP told me after the infection cleared it could take up to 3 months for what I am experiencing to resolve. At the end of all this differential diagnosis, I suppose it is possible that the infection caused nerve damage to the ear which may be permanent ( I pray not).

I will be sharing all my current findings with the Neurologist at my apt in less than two weeks. I do not want to continue taking drugs for the headache if that is possible. I am trying to control pain with ice and heat pacs. I am trying not to take too much Tylenol no more than 4 pills a days, and some days I can get by with two.

If it turns out that everything is normal. My next step is to concentrate on habituation therapy and TRT.

I just want to make sure that nothing serious is causing this.

During all this I have been using sound therapy to help me sleep. This distraction does help.

I apologize for the long response. It helps to share this with someone who does not think this is not my imagination.
doctor
Answered by Dr. Sumit Bhatti (16 hours later)
Brief Answer:
This should settle down.

Detailed Answer:
Hi,

Thank you for writing back.

1. This does seem to be a temporary phase after an ear infection or drug related.

2. Neck physiotherapy will help.

3. TRT and sound therapy is useful.

4. This should settle down. Let me know if this persists. You can follow up directly at bit.ly/Dr-Sumit-Bhatti

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

Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2685 Questions

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Suggest Treatment For Pulsatile Tinnitus Despite Taking Oral Steroids

Brief Answer: PTA, I / A. Detailed Answer: Hi, Thank you for your query. 1. Get a PTA ( Pure Tone Audiometry ) and I / A ( Impedance Audiometry / Tympanometry ) done. Tinnitus matching can also be estimated. 2. Depending upon the results of these tests, medication and surgical. Intervention can be decided. 3. Thr Tinnitus seems to be due to ETD. It should settle down once the ETD is decreased. 4. Rebound congestion with the use of decongestants can lead to tinnitus. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.