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Have eustachian tube dysfunction. Treated with medicine. Stated ear pain. Cause and cure?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2554 Questions

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Posted on Mon, 7 Jan 2013 in Ear, Nose and Throat Problems
Question: I have been suffering from what my doctor and ENT has called steroids, water pills (they made me sick), and anti-histamine nasal sprays. I also did acupuncture for 2 weeks (6 visits) and nothing had helped. What I am experiencing is primarily ear aches almost every day, pain behind my ear, but the worst is I get an echo in my right ear with loud sounds, sensitivity to loud mid-range frequencies, and an odd feeling of hearing air pass through my ears if I open my jaw. Basically if I open my jaw and breath through my nose I hear air and it my ears get plugged. As soon as I swallow it will relieve the pressure that resulted from breathing in. Some days it is bad, some days not so much. It started in my right ear, and now my left ear is doing the same thing. I did a CT scan and everything looked normal. I also notice a "stickiness" if my ears are plugged and I swallow but have not had any fluid, or infections in my ear or nose. My ENT suggested there is fluid in my middle ear.

I am currently trying a device called the "EarPopper" which says to use for 7-11 weeks and so far it has been about 3 with no improvement. My ENT suggested to get tubes in my ears but I am an audio engineer and I cannot risk even the 1% chance of losing my hearing. I am also 24 years old so I am not interested in doing the extreme and getting surgery. This has been occurring for almost 9 months now and it drives me insane and greatly affects my work a long with costing me a lot of money and stress.

I am basically looking for alternate advice and where to go next since nothing so far has helped (Though I was continue to use the EarPopper/politzerization device). I would hate to "miss" something and having spent a lot of money with no improvements. I simply need advice from someone who can think out side of the box because I am disappointed that my ENT could not really offer any further solution. Thanks so much.
doctor
Answered by Dr. Sumit Bhatti 10 hours later
Hi,

Thank you for your query.

1. Have you recently undergone a PTA (Pure Tone Audiogram) and an Impedance Audiogram (I/A)? If yes, then what were the results? If not, kindly arrange to get these done and let me know the results.

2. Is there an eardrum retraction? Do you have any history of nasal problems, sinusitis, headache or tinnitus (sounds in the ear) ? Have you recently gained or lost weight?

3. The Eustachian tube is normally in a collapsed state and open during swallowing, yawning an so on. This explains why the pressure builds up while breathing with the jaw held open.

4. The pressure, pain, echoes, discomfort to loud sounds and hearing air flowing through the ears is due to Eustachian Tube Dysfunction (ETD).

5. A significant ETD should be picked up on an Impedance Audiogram.

6. Myringotomy and grommet insertion is not an extreme surgery and is routinely performed, even in children. The surgery is done not to drain any fluid but to promote adequate ventilation of the middle ear, overcoming any ETD. The principle of this surgery is that the improved ventilation helps the middle ear and ET recover.

7. You may start with regular steam inhalation through the nose and mouth. To suggest any further medication I will require your test results.

8. There are newer options such as nasal endoscopy to check the inner ends of the ET, laser surgery on the ET Cushion, Balloon dilatation of the ET and so on. Most of these are experimental and the carotid arteries are closely related to the ET. If an established procedure such as a myringotomy and grommet insertion is being avoided due to your profession as an audio engineer, then these procedures are much more complicated.

Awaiting your reply,

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti 11 hours later
Thank you very much for your information.

I have not done a PTA or IA, I will consult with my ENT to arrange to get this done. However, I am curious as to what exactly these tests will tell us that we do not already know? It seems odd to me that my ENT has not mentioned this or suggested this so it seems there may be a reason he has left it out.

I do not know if there is ear drum retraction. I have not had any major sinus issues and have occasionally experienced tinnitus but it is very rare. I haven't experienced much headaches as to more soreness behind my ears and jaw.

The myringotomy surgery worries me because through my research I've read that not all adults recover or it takes long to recover. There seems to be rare occasions where hearing is loss occurs. If audio was not my profession I may be more apt to doing this, but I am young and it still worries me that there is a small risk of hearing loss or permanent ear drum damage. Speaking with others online about ETD, it seemed to be split in half, it completely helped some, but it made it worse for others. Of course my view is skewed and the numbers are not accurate, but I have to be careful either way.

Why is a myringotomy favored over other more "complicated" procedures? Are there any dangers or risk of hearing loss there? My ENT never told me about these procedures but I have heard of balloon dilatation, I'm curious as to why I SHOULDN'T do the other procedures if they might accomplish similar results?

Thanks very much again, your help is appreciated.
doctor
Answered by Dr. Sumit Bhatti 4 hours later
Hi,

Thank you for writing back.

1. Impedance Audiometry (I/A) or Tympanometry is a simple objective test that uses a probe inserted tightly into the external ear canal to measure the changes in the middle ear pressure when the pressure is increased in the external ear canal. Ideally any increase in the middle ear should be rapidly equalized through the eustachian tube if it is functioning properly. Hence Eustachian Tube Dysfunction can be recorded. The presence of fluid or negative pressure in the ears may be recorded.

2. Another important information from the Impedance Audiometry is the state of the Acoustic reflex. Normally in response to loud sound, the tiny muscles attached to the middle dear ossicles contract and stiffen the ear drum, muffling the sounds and thereby protecting the inner ear from acoustic trauma. Since you have the echoing and sensitivity to loud sounds, this test is important. So even if your ENT Specialists say that ETD is a clinical diagnosis, this second reason should convince them.

3. A PTA (Pure Tone Audiogram) is a subjective test that shows hearing the hearing levles at different frequencies and may reveal any hearing loss that is due to ETD or is interfering with the acoustic reflex.

4. Ear drum retraction helps determine the severity of the ETD. It is good to know that you do not have any major sinus issues. Tinnitus is experienced by even normal people at some point in their lives. This is common. Soreness behind the ears and jaw may be due to chronic ETD or Temporo-Mandibular Joint (TMJ) issues. Have you had any dental work done?

5. During nasal endoscopy the inner end of the ET is visualized with an angled endoscope. After ruling out any obstruction, the patent is made to move the palate by swallowing and by repeating the alphabet 'k' several times. This shows the functioning of the inner end of the ET. The ET is also an enigma as an anatomically patent ET may not be physiologically functional.

6. Myringotomy and grommet insertion may work only if the ETD is due to a block. If your ETD is due to a muscular spasm or myoclonus, it will not respond to this procedure. You seem to be able to block your ETs at will by holding your jaw open and also manage to equalize the middle ear pressure by swallowing. I would recommend that get an I/A done. If it is normal, induce this block and repeat the Impedance Audiogram two more times before and after swallowing. So you should have at least three reports in your hand.

7. Hence a clear understanding as to the exact cause for your ETD is vital to the success of the treatment. Get a dental opinion from a dentist who specializes in treating TMJ Disorders.

8. We can discuss the newer options after the test results.

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

Regards.

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