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Mastoid process pain, MRI showed clear fluid, enlarged blood vessel in ear, high sensoreal hearing loss. Worried

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ENT Specialist
Practicing since : 1991
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Hello 44 year old female before hysterectomy had a mild upper respiratory infection that cleared up but then severe pain underneath ear then tinnitus and developed into ear fullness and severe pain in cerebellum severe numbness that surrounded my left side face and went to my right side both ears have tinnitus..I have severe pain on the mastoid..MRI was normal except clear fluid in right mastoid process and mild clear fluid in enlarged blood vessel in the right ear..Audiogram shows High Sensoreal Hearing loss..however I dont have vertigo and I dont have dizziness. when I shake my head the sound moves..the ENT said I have inflammatory sinus disease..with a cyst polyp and massive swelling in the ethmoid and schemoid sinuses..could this be causing the ear issue...The ENT has said he cant do nothing for me and neither could the sinus doctor..both have said its permanent and I have to live with it..Im constantly cold and hot..I had a hysterectomy last september with two blood transfusions..The blood work came back with no diseases two things did pop up but they said it was a very long time ago and probably dont have it now is nerve or CSpine issues ENT and Sinus doctors are stumped..any ideas? he suggested chronic labryinthititis but I dont have vertigo..with it and I am concerned I have the wrong diagnoses..I have had swelling in brain for close to a year now..I get fatiqued easy and have real short of breath climbing stairs..I am worried this is something pretty bad as well as numbness that goes in a halo effect around my fact and ears..especially right above my ears..I get intermitten on right and mostly on left..could i have had something bad happen and it not show up on tests? Thank you if you can help please let me know Thank you. Lynn
Posted Sat, 21 Jul 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 9 hours later

Thank you for your query.

1. Decreased hearing also makes one more aware of tinnitus. With hearing loss, amplification may help mask the tinnitus. You should also get middle ear pressure checked with a Tympanogram (Impedance Audiometry).

2. Abnormal MRI signals in the para nasal sinuses and mastoids mean that you have chronic mastoiditis secondary to eustachain tube dysfunction due to chronic sinusitis. Do you have symptoms of allergy? (Sneezing, watery nasal discharge and obstruction). A trial of medication is necessary. Balloon Sinusplasty is a new procedure which can be useful for you if medical treatment fails to reduce your sinusitis.

3. Incidental findings on CT and MRI Scans must be reviewed in the light of clinical signs and symptoms. If you have no symptoms pointing to ear or sinus disease, there is no treatment needed. Simple medication (under the supervision of your doctor) will reverse or control the changes. The same applies to the treatment of the tinnitus. As long as these changes are asymptomatic, they should be left alone.

4. You may get her hearing checked by a PTA (Pure Tone Audiogram) and middle ear fluid or pressures by a Tympanogram (Impedance Audiogram). If these are normal, treatment is not necessary.

5. It will be interesting to review your MRI and CT images for some findings such as the enlarged blood vessel. You may share them here, if they are available.

6. I am assuming that:
a. You do not have true pulsatile tinnitus synchronous with your heartbeat and that there are no additional sounds.
b. You ear drums are normal and your PTA (Pure Tone Audiogram) and Impedance Audiogram (Tympanometry) is normal (no middle ear problems).
c. You have some hormonal imbalance after your hysterectomy, especially if the ovaries were removed. That would explain the hot and cold flushes.
d. Your blood pressure is within normal limits.

7. I would rule out the following conditions:
a. Atherosclerosis (turbulent blood flow). Get a Lipid Profile done.
b. A persistent Stapedial Artery.
c. High Jugular bulb.
d. Benign Intracranial Hypertension.
e. Sigmoid Sinus Dehiscence or diverticulum.
f. Hyperthyroidism.
g. Electrolyte disturbances such as Calcium, Vit. D , Vit B12 as you have symptoms of fatigue and breathlessness.
Cervical spondylosis is ruled out. Labyrinthitis is not possible without vertigo. I must emphasize that in a vast majority of patients of tinnitus, the cause is never found. However there are further treatment options. Tinnitus is not XXXXXXX in 99% people. Everybody hears Tinnitus at some point in their lives.

8. Common tinnitus therapy includes ginkgo biloba, multivitamins and antioxidants. Trans-tympanic steroids and Caroverine Injection (Tinnex) or capsules are effective in some patients.

9. I must emphasize that there is no cause for worry.

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

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