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Throbbing in the ear, taken nasonex, diagnosed with barotrauma and asthma. Risk of hearing loss?

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ENT Specialist
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I was diagnosed with barotrauma of the ears after flying almost a year ago. I saw an EMT and he told me that the throbbing (pulsating) in my left ear would go away. Although my hearing did return after about a month, I still have the throbbing, and need to release the pressure in my ear quite frequently. Will this ever go away? Was there permanent damage? Am I at risk for later hearing loss? I am 47, 5'6" and weigh 155 lbs. I do have asthma, but am in excellent health. Although the throbbing has improved, I have had this problem for almost a year now. I have taken Nasonex, but still have the throbbing.
Posted Mon, 23 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 4 hours later

Thank you for your query.

1. Get a PTA (Pure Tone Audiogram) and an Impedance Audiogram (I/A) done. Post your results here along with the eardrum findings or images (obtained by a video-endoscope / otoscope), if possible.

2. If all of the above are within normal limits and if you do not have any vertigo or dizziness, then there is no permanent damage yet.

3. Have you had an uneventful flight over the past year? If so, then the chances of improvement are good.

4. I would recommend a change of nasal spray to a stronger steroid nasal spray such as budesonide (Rhinocort Aqua). In addition you should take a trial with an antihistamine and an anti-leukotriene for a fortnight. Please take regular steam inhalation for ten minutes at a time.

5. Do not fly when you have cold or congestion. Chewing gum may help at times. Further treatment depends upon your reports.

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

Above answer was peer-reviewed by
Follow-up: Throbbing in the ear, taken nasonex, diagnosed with barotrauma and asthma. Risk of hearing loss? 17 hours later
Dear Dr. Bhatti,

Thank you for your detailed answer. I will probably make an appt. to have the recommended tests. I did have some type of hearing test shorting after the diagnosis, and the doctor said that there was no nerve damage..(something to the effect of conductive vs. inductive?) If I choose to try to wait this problem out on my own, could I do irreversible damage? Could my problem become progressively worse? The doctor said that the hearing would return, and that the pulsing (throbbing) would stop. My hearing did return, and my general practitioner couldn't see anything wrong when looking at my (outer) ear, so why do I still have the throbbing/pulsing? What do you think is causing it? It has been almost a year.

I am a little bit afraid to have a specialist do anything invasive to my ear, because I am so worried that it might cause vertigo. (That is why I have been reluctant to see an EMT. ) I had vertigo years ago, but it went away after having it off and on for about two years. Do you think that I have any nerve damage? Thank you for your help answering my questions. I hope that I made sense. Sometimes I can't fall asleep because of the throbbing, and I don't understand why I still have it. The vertigo went away long before I got the barotrauma.
Answered by Dr. Sumit Bhatti 4 hours later

Thank you for writing back.

1. The recommended tests are non invasive. Very few general practitioners are able to distinguish the subtle changes in the eardrum, if any. Hence you must get at least one specialist opinion. You may always refuse any invasive treatment.

2. The conductive loss usually decreases after a few weeks after barotrauma. If you have waited for a year and you are still symptomatic, then there are chances of progressive and irreversible changes. The throbbing / pulsing may represent tinnitus or vertigo in the past. Your PTA(pure tone audiogram) can rule out nerve damage.

Wish you a speedy recovery.

Above answer was peer-reviewed by
Follow-up: Throbbing in the ear, taken nasonex, diagnosed with barotrauma and asthma. Risk of hearing loss? 14 hours later
Dear Doctor,

Thank you again. I wish that you were here, and that you were my doctor! Nevertheless, is there a cure for eustachian tube dysfunction or tinnitus? Is there anything that I can do.? Is it possible for the throbbing/pulsing/pressure to go away, or is there really nothing I can do if damage has already been done?
Answered by Dr. Sumit Bhatti 9 hours later

Thank you for follow up.

Start with the tests. If they are normal or nearly normal, medical treatment will gradually restore your mild Eustachian Tube dysfunction and help reduce the Tinnitus. Treatment works on the principle that once adequate ventilation is established (by either medical or surgical means, or both), the middle ear slowly heals and function returns to normal.

There are invasive procedures such as myringotomy and grommet insertion which are time tested remedies to severe Eustachian Tube dysfunction. There are other newer laser assisted procedures which may be done on the inner (nasal) end of the Eustachian Tube. Otherwise the Eustachian Tube is a XXXXXXX seated structure on which very little surgery is possible. There are still some missing links in the understanding of the function of this tube. For example, anatomical patency does not guarantee physiological function.

Tinnitus is a vast subject. If your throbbing/pulsing/pressure is due to Eustachian Tube dysfunction, it will reduce in intensity. There are many medical regimens available, however the treatment of your Tinnitus will follow the treatment of your Eustachian Tube dysfunction.

You have had symptoms for a year. I do not believe that you have a lot of permanent damage yet. I can advise you about specific medication that you may discuss with and take under the supervision of your physicians when you submit your test and examination results.

Wishing you good health.

Above answer was peer-reviewed by
Follow-up: Throbbing in the ear, taken nasonex, diagnosed with barotrauma and asthma. Risk of hearing loss? 12 hours later
Dear Dr. Bhatti,

You have been very helpful, and I appreciate all of the time you spent with me. I have an appointment to see a PA at an EMT's office in a few days. Hopefully it will go successfully for me. If I have tests done, will I still be able to communicate with you at a later date?

Thank you for everything!
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for writing back.

It is good to hear that you are due for evaluation soon.

Yes, if necessary, you will be able to communicate through the Ask a Specialist Section by directing your query to me.

Wishing you a good recovery,

Above answer was peer-reviewed by
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