I became very ill for a few days in the Spring of 1995 with symptoms of vertigo, vomiting, diahhrea, congestion, and tinnitus in the right ear. I was diagnosed at the time with labyrinthitis, resulting from a viral infection. I have improved considerably since that time and have not experienced any of the severe symptoms that occurred during this episode. However, I still periodically experience stuffiness, fullness in my right ear, and tinnitus. Nasacort (and currently Flonase) seemed to help, but I can never be totally sure because of the vagueness of the symptoms and other medications that I have been taking. I have read that infections of the throat, nose, and sinuses can affect eustachian tube function and produce tinnitus. I have noticed recently that increases in the tinnitus appear to correspond with the appearance of white spots on my tonsils. Is it possible that infected tonsils can produce tinnitus? Can there be a lingering, low grade infection from the earlier labyrinthitis (or from other sources) that is affecting the tinnitus? Any suggestions that you have will be sincerely appreciated.
Answer ------------------------
A sensation of pressure or fullness in the ear is a common symptom. The symptom can occasionally be extremely aggravating and yet there may be no visible abnormality on physical examination of the ears nor abnormalities on objective testing of the ear. The symptom of fullness or pressure in the ear is also frequently associated with some form of tinnitus or noise in the affected ear.
The fact that you experience some improvement with a nasal steroid suggests that you most likely have a residual eustachian tube dysfunction following an upper respiratory infection. In the most common situation, ear pressure and tinnitus is in fact related to actual pressure differential between the space behind the ear drum, known as the middle ear, and the external or ambient air pressure. The usual cause of this is inflammation, most commonly due to upper respiratory infections like the common cold. The inflammation is associated with swelling of the lining in the middle ear and eustachian tube impairing the normal pressure equalization. When eustachian tube dysfunction occurs, it is not uncommon for it to persist long after other symptoms of an acute upper respiratory infection have resolved. Isolated eustachian tube dysfunction may be associated with a normal appearing ear drum on examination. In most cases, however, a test known as a tympanogram, will reveal the eustachian tube problem.
When eustachian tube dysfunction persists, a common recommendation is oral decongestant medication. However, decongestants have a variable and inconsistent effect on this problem and may have undesirable side effects. More recently nasal steroid sprays have been used and in my experience are frequently helpful when combined with an exercise known as "autoinflation". This exercise is accomplished by pinching the nose and blowing in order to gently "pop" the ears. When done in a controlled fashion this manuever is safe and generally quite effective, but usually must be repeated frequently for a period of time. Antibiotics are generally not effective for isolated eustachian tube dysfunction in the absence of obvious infection.
Occasionally ear pressure and tinnitus can occur despite apparently normal eustachian tube dysfunction. An audiogram or hearing test should be performed to ensure that the symptom is not due to a loss of hearing that may not be easily recognizable to the patient. If a one-sided nerve hearing loss is found in the symptomatic ear, a more detailed and in-depth medical investigation is necessary to identify the cause and rule out more serious conditions. As an example, a form of Meniere's syndrome which is associated with high fluid pressure in the fluid-filled chambers of the inner ear, might account for such symptoms. This condition frequently responds to certain dietary modifications including avoidance of caffeine, combined with a medication known as a diuretic. A more uncommon possible cause for this constellation of symptoms is a benign tumor located on the inner ear nerve which is called an acoustic neuroma. The main point to take home here is that if ear pressure and tinnitus persist for an extended period of time as essentially isolated symptoms, and when they fail to respond to the usual measures a more in-depth investigation should be carried out, usually by an otolaryngologist.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review
previous Ear, Nose and Throat Clinic consultations