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Had a grommet removed. Didn't help ringing and fullness in ear. Eustachian tube not functioning properly?

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ENT Specialist
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I have just had a grommet removed 5 days ago from my left ear after it being in for 9 weeks, didnt really help the ringing and fullness that I have been experiencing in my ear for a few months after a sinus infection.
My ENT specialist thnks my eustachian tube in not funtioning properly ie not opening when it should, this makes sense, I have read that chewing chewing gum can help open the tube, will this inhibit the healing process of the hole in my left ear as I have been chewing gum regularly for the last two days and clicking my jaw and today the ear feels sore could this be a result of this or just that the hole is hesling and what else if anything should I avoid eg blowing nose hard until the hole heals up?
Posted Sat, 5 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 57 minutes later

Thank you for your query.

1. Ear Grommets are designed to extrude themselves slowly over a few months as the epithelium of the ear drum heaps under their rim. The myringotomy opening usually closes and heals. The principle of placing the grommets is not drainage of fluid, but ventilation by air which slowly heals the middle ear lining (mucosa). Therefore, the longer the grommet stays in place, the better the chances of recovery of Eustachian tube function.

2. Your ear is probably sore due to the early removal of the grommet. Removal of the grommet causes the myringotomy opening to remain as a small perforation for a few weeks. This should heal in a few weeks. You should get your otorhinolaryngologist (ENT Specialist) to check your ear again to rule out any infection or inflammation. This is also because the middle ear is wet with normal secretions that delay healing.

3. The Eustachian tube is normally in a collapsed state. It can be voluntarily opened by yawning, swallowing, chewing gum, or performing the valsalva manoeuvre. These actions will not delay the healing process unless you blow your nose too hard too often.

4. You should avoid blowing your nose too hard too often as it may delay healing by forcing the edges of the myringotomy opening apart. If you sneeze, do so with your mouth open to reduce the pressure transmitted to the ears.

5. If you could share your Pre-op Impedance Audiometry (I/A) and Pure Tone Audiometry(PTA) reports? Was there fluid detected during the procedure? At the age of 54, a single sided Eustachian tube dysfunction would also require a nasal endoscopy to rule out any obstruction on the inner (nasal) opening of the tube.

6. Failure of the grommet to relieve the symptoms may be due to many reasons such as adhesions and compartmentalization of the middle ear space. Have you ever had fluctuating hearing loss, dizziness or vertigo?

7. Tinnitus is a common complaint after ear grommet insertion. Sometimes it is so severe that the patients insist on removal of the grommets. As I believe that more information can help a physician help you better, I would request you to answer the following questions:
•     Has your ringing (tinnitus) reduced after removal of the grommet?
•     Was it there before the procedure? Tinnitus usually reduces after the opening closes.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

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Follow-up: Had a grommet removed. Didn't help ringing and fullness in ear. Eustachian tube not functioning properly? 1 hour later
The tinnitus was there before the procedure stangely it stopped a fair bit after the insertion but has returned now that the grommet has been taken out.

The insertion of the grommet caused I believe a greater build up of pressure and had effect like having my head in a barrel when I spoke or was hearing different noise sources.

My ENT specialist told me there was no fluid present during the insertion of the grommett nor when removing it.

I did have a nasal endoscopy and it didnt show anything of concern I have never had fluctauting hearing loss until the sinus infection but have never had dizziness or vertigo.
Answered by Dr. Sumit Bhatti 5 hours later

Thank you for writing back.

1. It is possible that your grommet was blocked with dried up secretions and ear debris after some time, leading to an increase in tinnitus again. This is often seen after grommet insertion.

2. Since your tinnitus was present before the procedure, and reduced for some time after the grommet insertion, before increasing again, there is definitely a link between changes in middle ear pressure and the severity of your tinnitus. This also causes fluctuating hearing loss.

3. This needs further evaluation and testing as outlined above.

4. It is good to hear that there was no fluid, your nasal endoscopy was normal and you do not have dizziness or vertigo.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them. Please accept my answer in case you have no follow up queries.

Wish you good health.

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