1. It is not possible to decide whether a sinus is blocked on nasal endoscopy alone. This is because sinuses are formed by bony walls and their openings are usually hidden from direct view. I suggest that you should ask for a plain CT PNS. It is the gold standard investigation for sinusitis
2. A PTA and an Impedance Audiogram will pick up any hearing loss
and any Eustachian Tube dysfunction
(which may also cause tinnitus).
3. The pressure generated due to a Valsalva maneuver
is many times the normal pressure usually found in the middle ear. That is why the ear crackles and squeaks and other abnormal sensations such as feeling of fluid movement or facial pain
occur. It may also hasten middle ear damage in the long run.
4. Surgery is always an option, however you should a have a two to four week trial with medication first. The CT will be your surgical road map. If it is within normal limits, there is no question of surgery.
5. Alcohol competes for many chemical and drug receptors in our body, leading to worsening of symptoms. This is a common complaint.