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Have Had A Constant Popping In Ear While Swallowing. Is It Due To Food Allergy? Any Ideas?
Question: I have had a constant popping in my ear for many years now when I swallow, ever since I caught a very bad cold in elementary school (now college graduate). I remember sneezing and it seemed to lodge up my middle ear and plugged them up. This combined with my usual overactive sinuses and allergies has created a permanent "ear popping" when I swallow, similar to how your ears pop during altitude change. I don't smoke and no combination of allergy medicines, prescribed or otherwise, seem to ever alleviate these symptoms. I believe my issue to be Otitis media or "glue ear". What are some treatments that I can do to resolve this issue? It is extremely loud and annoying.. I've gotten wax removed before and it didn't fix my problems. I've heard that 2 olive oil drops at night daily in the ear might help. And then there are surgical procedures, like getting a myringotomy and getting trympanostomy tubes or grommets, correct? I am also aware of eustachian tube balloon dialation. And one doctor I had said this might be caused by a food allergy? Any other ideas would be helpful! Thanks!
XXXXXXX
XXXXXXX
Hi,
Thank you for your query.
1. The simplest way forward is to get a PTA (Pure Tone Audiogram) and Tympanogram (Impedance Audiogram) done. Treatment can then proceed accordingly. A plain CT PNS (Para Nasal Sinuses) will definitely help understand your problem. If that is not possible, at least get a Cone Beam CT or an X-ray PNS, Water's view.
3. Regular steam inhalation is one of the best and simplest ways to keep the Eustachian Tubes healthy and functioning. If steam inhalation makes you uncomfortable, then your septal deviation and nasal obstruction is significant. A course of antibiotics, anti-inflammatory, anti-allergics, decongestants, mucolytics and steam inhalation should be done under medical supervision. I would recommend a steroid nasal spray such as Nasonex (mometasone), fluticasone or ciclesonide.
4. You may wait for a fortnight before you proceed to see if spontaneous recovery takes place. Kindly share the test results here. If they are normal, no treatment is necessary. If they are abnormal, I will be able to recommend further treatment. If you wait very long, the trapped fluid may thicken to a glue like consistency and not be able to drain into the nose.
5. A Myringotomy with a grommet insertion may be necessary for immediate relief. However this procedure only bypasses the Eustachian Tube dysfunction for some time and does not treat the cause which is why both medical and surgical therapy is required.
6. The Balloon dilatation procedure of the Eustachian tube (ET) is still in it's infancy. An anatomically patent ET may not still not work physiologically. Also the inner end is cartilage and outer end is very hard bone. The main carotid artery canal may also be dehiscent. It may be tried if all else fails. Olive oil drops will cause no harm if your ear drum is intact. You may do a food intolerance test.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Thank you for your query.
1. The simplest way forward is to get a PTA (Pure Tone Audiogram) and Tympanogram (Impedance Audiogram) done. Treatment can then proceed accordingly. A plain CT PNS (Para Nasal Sinuses) will definitely help understand your problem. If that is not possible, at least get a Cone Beam CT or an X-ray PNS, Water's view.
3. Regular steam inhalation is one of the best and simplest ways to keep the Eustachian Tubes healthy and functioning. If steam inhalation makes you uncomfortable, then your septal deviation and nasal obstruction is significant. A course of antibiotics, anti-inflammatory, anti-allergics, decongestants, mucolytics and steam inhalation should be done under medical supervision. I would recommend a steroid nasal spray such as Nasonex (mometasone), fluticasone or ciclesonide.
4. You may wait for a fortnight before you proceed to see if spontaneous recovery takes place. Kindly share the test results here. If they are normal, no treatment is necessary. If they are abnormal, I will be able to recommend further treatment. If you wait very long, the trapped fluid may thicken to a glue like consistency and not be able to drain into the nose.
5. A Myringotomy with a grommet insertion may be necessary for immediate relief. However this procedure only bypasses the Eustachian Tube dysfunction for some time and does not treat the cause which is why both medical and surgical therapy is required.
6. The Balloon dilatation procedure of the Eustachian tube (ET) is still in it's infancy. An anatomically patent ET may not still not work physiologically. Also the inner end is cartilage and outer end is very hard bone. The main carotid artery canal may also be dehiscent. It may be tried if all else fails. Olive oil drops will cause no harm if your ear drum is intact. You may do a food intolerance test.
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
Hi, Doctor Bhatti. :) I am very impressed with your knowledgeable and timely reply!
Feel free to take your time with the next response if need be; it is extensive; sorry!
1. What if my hearing is not impaired, as revealed by the test? This was the case when I was younger and had some ear tests done shortly after the onset of these symptom.
I also had a CT scan performed recently, which my doctor diagnosed as "minor inflation of the sinus region" or some close variant. I have no idea of the class of CT scan performed, so I will request some documentation about the results.
2. Missing #2? :P
3a. How can I inhale more steam in a nonobtrusive way in my daily life? Any particular inhaler device? In my experience, room humidifiers do not help me in any way.
3b. How could I convince my doctor to prescribe me with the correct medication? I've always felt that my symptoms have been misdiagnosed for just for allergic reactions. And I have always only been prescribed allergy medication. I used to use a breathalyzer for "allergy-triggered" asthma which helped, but now I don't have those issues and exercise (I run) daily. I have been prescribed Fluticasone multiple times as different rebrands with different chemical R groups, and it appears to have no effect alone or combined with Allegra (Fexofenadine), Singulair (montelukast sodium), or Claritin (Loratadine). I've also been on a prescription of Astepro 0.15 (Azelastine HCl). I feel like the correct allergy medication(s) would be only a part of my total treatment..
Over-the-counter Phenylephrine XXXXXXX decongestant seems to help alleviate my symptoms if taken in the morning. But I try not to abuse this OTC, and reserve it for use before airflights, because the pressure caused by altitude change in airplanes can sometimes be EXCRUCIATING if my sinus congestion has built up heavily or if I additionally sick like I am now (caught a cold).. Loratadine helps alleviate symptoms if I am experiencing an "allergy attack" during a day--usually constant sneezing.
And how did you know I had a nasal deviation? I failed to mention that in my original post, but I do have a nasal septum deviation pushing into my left nostril that impairs the distribution of my nasal inhalation to a degree. And if I plug my right nostril with my finger to and attempt to breath in with my left, I cannot. Would I be correct in thinking that that is somehow correlated with my symptoms?
4. I will get results but I am afraid the trapped fluid is already in a glue like consistency already, since this has been an issue for many years now. Would the medication have no effect at this point?
5. Good advice, I will take it into consideration. Under what circumstance(s) would you find it necessary to perform a Myringotomy? Thank you!
6. Thank you. Dilation might be a XXXXXXX endeavor. Any ideas about food/diet/allergy factors in my condition?
Also, I get regular drainage down my throat from the Eustachian area.
What sign would you say this is all a condition of?
The support is outstanding, thank you once again!
XXXXXXX
Feel free to take your time with the next response if need be; it is extensive; sorry!
1. What if my hearing is not impaired, as revealed by the test? This was the case when I was younger and had some ear tests done shortly after the onset of these symptom.
I also had a CT scan performed recently, which my doctor diagnosed as "minor inflation of the sinus region" or some close variant. I have no idea of the class of CT scan performed, so I will request some documentation about the results.
2. Missing #2? :P
3a. How can I inhale more steam in a nonobtrusive way in my daily life? Any particular inhaler device? In my experience, room humidifiers do not help me in any way.
3b. How could I convince my doctor to prescribe me with the correct medication? I've always felt that my symptoms have been misdiagnosed for just for allergic reactions. And I have always only been prescribed allergy medication. I used to use a breathalyzer for "allergy-triggered" asthma which helped, but now I don't have those issues and exercise (I run) daily. I have been prescribed Fluticasone multiple times as different rebrands with different chemical R groups, and it appears to have no effect alone or combined with Allegra (Fexofenadine), Singulair (montelukast sodium), or Claritin (Loratadine). I've also been on a prescription of Astepro 0.15 (Azelastine HCl). I feel like the correct allergy medication(s) would be only a part of my total treatment..
Over-the-counter Phenylephrine XXXXXXX decongestant seems to help alleviate my symptoms if taken in the morning. But I try not to abuse this OTC, and reserve it for use before airflights, because the pressure caused by altitude change in airplanes can sometimes be EXCRUCIATING if my sinus congestion has built up heavily or if I additionally sick like I am now (caught a cold).. Loratadine helps alleviate symptoms if I am experiencing an "allergy attack" during a day--usually constant sneezing.
And how did you know I had a nasal deviation? I failed to mention that in my original post, but I do have a nasal septum deviation pushing into my left nostril that impairs the distribution of my nasal inhalation to a degree. And if I plug my right nostril with my finger to and attempt to breath in with my left, I cannot. Would I be correct in thinking that that is somehow correlated with my symptoms?
4. I will get results but I am afraid the trapped fluid is already in a glue like consistency already, since this has been an issue for many years now. Would the medication have no effect at this point?
5. Good advice, I will take it into consideration. Under what circumstance(s) would you find it necessary to perform a Myringotomy? Thank you!
6. Thank you. Dilation might be a XXXXXXX endeavor. Any ideas about food/diet/allergy factors in my condition?
Also, I get regular drainage down my throat from the Eustachian area.
What sign would you say this is all a condition of?
The support is outstanding, thank you once again!
XXXXXXX
Hi,
Thank you for writing back.
1. If all the above mentioned ear tests are within normal limits, you do not need a Myringotomy and Grommet. This can also mean that your Eustachian tube dysfunction is mild and occurs only when you have a cold,allergy or sinusitis. Then you experience barotrauma during flights. At other times it pops open and relieves the fluid or negative pressure built up in the middle ear (behind the ear drum).
Try and share the CT Scan images (and not the report) for an accurate assessment.
2. The missing part concerned an entity known as vasomotor or intrinsic rhinitis and a Post Nasal Drip (PND) which may be a part of your un-diagnosed problem.
3. An electrical steamer similar to those used in salons is the best way to take steam regularly, at least 10-15 minutes at a time. Do not expose yourself to cold air for at least 15 min. thereafter.
I do find it a little confusing as to why you exhibit allergic symptoms like sneezing and yet not respond to highly effective combinations of anti-allergic medication like loratidine fexofenadine, montelukast, fluticasone and azelastine and at times your allergy responds to loratidine.
Get your nasal mucosa (lining) examined again. The color of the nasal mucosa is normally a healthy pink. A bluish or purplish red color is seen in allergy. A XXXXXXX XXXXXXX color is seen in acute colds or vasomotor rhinitis (in the absence of a cold). A pale whitish color denotes long standing allergy (which responds well to nasal steroids).
Fluticasone is relatively mild nasal steroid spray. Try an older and stronger one such as Rhinocort Aqua (Budesonide). In anti-allergics, try levocetrizine and rupatidine (though they may cause sleepiness). There is no doubt that a combination of an anti-histamine, an anti-leukotriene and a nasal steroid spray works better than either taken alone.
A nasal deviation is what causes all the subsequent changes in the lateral (side) walls f the nose and the nasal mucosa (lining). Your CT scan images will show this clearly.
4. If there are glue or adhesions in your ear, medical treatment may not work alone.
5. A Myringotomy with a grommet insertion may be necessary if your Tympanogram shows a B or C type of graph as against a normal A type.
6. The Balloon Sinuplasty may be a more established and a more appropriate procedure if your CT Scan shows blocked sinuses. A Septoplasty, radio-frequency or co-ablation assisted nasal turbinate reduction or a FESS (Functional Endoscopic Sinus Surgery) are other alternatives your CT may suggest.
Food Intolerance as against Food Allergy has a different mechanism. You will have to consult an allergist for this.
A Post Nasal Drip (PND) is due to mucus draining from sinusitis into the throat.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Thank you for writing back.
1. If all the above mentioned ear tests are within normal limits, you do not need a Myringotomy and Grommet. This can also mean that your Eustachian tube dysfunction is mild and occurs only when you have a cold,allergy or sinusitis. Then you experience barotrauma during flights. At other times it pops open and relieves the fluid or negative pressure built up in the middle ear (behind the ear drum).
Try and share the CT Scan images (and not the report) for an accurate assessment.
2. The missing part concerned an entity known as vasomotor or intrinsic rhinitis and a Post Nasal Drip (PND) which may be a part of your un-diagnosed problem.
3. An electrical steamer similar to those used in salons is the best way to take steam regularly, at least 10-15 minutes at a time. Do not expose yourself to cold air for at least 15 min. thereafter.
I do find it a little confusing as to why you exhibit allergic symptoms like sneezing and yet not respond to highly effective combinations of anti-allergic medication like loratidine fexofenadine, montelukast, fluticasone and azelastine and at times your allergy responds to loratidine.
Get your nasal mucosa (lining) examined again. The color of the nasal mucosa is normally a healthy pink. A bluish or purplish red color is seen in allergy. A XXXXXXX XXXXXXX color is seen in acute colds or vasomotor rhinitis (in the absence of a cold). A pale whitish color denotes long standing allergy (which responds well to nasal steroids).
Fluticasone is relatively mild nasal steroid spray. Try an older and stronger one such as Rhinocort Aqua (Budesonide). In anti-allergics, try levocetrizine and rupatidine (though they may cause sleepiness). There is no doubt that a combination of an anti-histamine, an anti-leukotriene and a nasal steroid spray works better than either taken alone.
A nasal deviation is what causes all the subsequent changes in the lateral (side) walls f the nose and the nasal mucosa (lining). Your CT scan images will show this clearly.
4. If there are glue or adhesions in your ear, medical treatment may not work alone.
5. A Myringotomy with a grommet insertion may be necessary if your Tympanogram shows a B or C type of graph as against a normal A type.
6. The Balloon Sinuplasty may be a more established and a more appropriate procedure if your CT Scan shows blocked sinuses. A Septoplasty, radio-frequency or co-ablation assisted nasal turbinate reduction or a FESS (Functional Endoscopic Sinus Surgery) are other alternatives your CT may suggest.
Food Intolerance as against Food Allergy has a different mechanism. You will have to consult an allergist for this.
A Post Nasal Drip (PND) is due to mucus draining from sinusitis into the throat.
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
1. Thanks. I will come back with the CT scans and post them. I believe I should be able to obtain digital copies from the imaging center I hope, as I did spend a lot of money getting them done. I am still concerned, however, about me passing the hearing tests after I take them and my problem going misdiagnosed again, even though I clearly experiencing the symptoms of some sort of blockage in my Eustachian area.. I will request the specific tests that you mentioned. Thank you.
2. I feel like I am ALWAYS experiencing PND, year-round, as a result of this condition. Of course, during the allergy season or if I have a cold, the amount of PND is worse. But, as I write, I can voluntarily flex my Eustachian muscle where it meets at the top-back of my throat and swallow, and a small amount of mucousy discharge comes out and goes down my throat each time. It's quite possible that I might be exhibiting the effects of vasomotor rhinitis, although I have never been able to isolate any of the non-allergic triggers that are impacting my symptoms. Looks like azelastine and olopatadine together are effective treatments. I have never tried olopatadine. And maybe instead I have intrinsic rhinitis, influenced by my deviated septum.. Or a combination of all 3 (allergic, vasomotor, intrinsic)? haha
3. Good recommendation on the steamer; I will look for one. I don't believe I have ever used medical montelukast, maybe I should try. I will also request information on levocetrizine and rupatidine anti-allergenic for my situation, as I don't believe I've ever tried those either. I will request another examination of my mucosa and ask about the Rhinocort Aqua (Budesonide) steroid. Excellent, thank you.
4. OK, well, then hopefully there are some (middle) ear cleaning procedures that can be done if I have glue or adhesions in my ear..
5. Good to know. I will make sure to get the CT scan and hearing test results.
6. Good information, thank you.
2. I feel like I am ALWAYS experiencing PND, year-round, as a result of this condition. Of course, during the allergy season or if I have a cold, the amount of PND is worse. But, as I write, I can voluntarily flex my Eustachian muscle where it meets at the top-back of my throat and swallow, and a small amount of mucousy discharge comes out and goes down my throat each time. It's quite possible that I might be exhibiting the effects of vasomotor rhinitis, although I have never been able to isolate any of the non-allergic triggers that are impacting my symptoms. Looks like azelastine and olopatadine together are effective treatments. I have never tried olopatadine. And maybe instead I have intrinsic rhinitis, influenced by my deviated septum.. Or a combination of all 3 (allergic, vasomotor, intrinsic)? haha
3. Good recommendation on the steamer; I will look for one. I don't believe I have ever used medical montelukast, maybe I should try. I will also request information on levocetrizine and rupatidine anti-allergenic for my situation, as I don't believe I've ever tried those either. I will request another examination of my mucosa and ask about the Rhinocort Aqua (Budesonide) steroid. Excellent, thank you.
4. OK, well, then hopefully there are some (middle) ear cleaning procedures that can be done if I have glue or adhesions in my ear..
5. Good to know. I will make sure to get the CT scan and hearing test results.
6. Good information, thank you.
Hi,
Thank you for writing back.
1. A Tympanogram (Impedance Audiometry) is an objective test. It will not fail to show middle ear which helps gas exchange and pressure in the middle ear, almost like a passive lung. Hence Eustachian Tube disorders are difficult to diagnose and treat. Tympanometry is a simple non-invasive test and you may repeat the tests at intervals.
2. Many people think of one disease at a time, while in reality there may be multiple disease processes progressing simultaneously.
3. Olopatadine is a relatively new molecule. Try Cetrizine or its derivatives instead.
4. The Myringotomy and Grommet insertion procedure is done to promote ventilation of the middle ear rather than to drain fluid or glue from the middle ear. Once ventilation improves, the middle ear mucosa and Eustachian Tube function slowly return to normal. For example, after a Eustachian Tube block, oxygen gets absorbed and the increase in carbon dioxide in the middle ear space causes more mucus secretion setting up a vicious cycle. Adhesions are more difficult to treat.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Thank you for writing back.
1. A Tympanogram (Impedance Audiometry) is an objective test. It will not fail to show middle ear which helps gas exchange and pressure in the middle ear, almost like a passive lung. Hence Eustachian Tube disorders are difficult to diagnose and treat. Tympanometry is a simple non-invasive test and you may repeat the tests at intervals.
2. Many people think of one disease at a time, while in reality there may be multiple disease processes progressing simultaneously.
3. Olopatadine is a relatively new molecule. Try Cetrizine or its derivatives instead.
4. The Myringotomy and Grommet insertion procedure is done to promote ventilation of the middle ear rather than to drain fluid or glue from the middle ear. Once ventilation improves, the middle ear mucosa and Eustachian Tube function slowly return to normal. For example, after a Eustachian Tube block, oxygen gets absorbed and the increase in carbon dioxide in the middle ear space causes more mucus secretion setting up a vicious cycle. Adhesions are more difficult to treat.
I hope that I have answered your queries. 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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