I have a blockage behind both ears that seems to run the length of my
eustacian tubes.
As a child I had 6 sets of ear tubes through my first 15 years
I had my right eardrum replaced at age 17 due to a permanent perferation
from scar tissue.
I have seasonal allergies, occasional sinus infections and am allergic to
dust, mold , pollens and chlorine.
This blockage in my middle ear is different this time because it wont go away depite the use of amoxicillin and other over the counter antihistimines and decogestants.There is no pain involved, but I keep bringing up bright green or white mucus.
I do not want another set of tubes at age 27.What should I do? This blockage has lasted almost two weeks.
thanks for any advice
Answer --------------------
As I understand it the primary symptom is ear pressure or congestion that is associated with either nasal or post-nasal discharge. There is an underlying history of both seasonal and perennial allergies with occasional acute sinus infections. The current symptoms have been present for 2 weeks and have failed to respond to a single course of amoxicillin combined with antihistamine and decongestant.
Ear pressure or congestion typically accompanies most sinus or nasal conditions including viral cold syndromes, sinusitis, and allergic rhinitis. Frequently the ear pressure is due to simple eustachian tube inflammation resulting in air-pressure differentials between the air inside the ear and the outside air. If the pressure imbalance is severe, or if the infection is particularly virulent, fluid or pus may actually fill the middle ear. When the latter occurs, the symptoms usually include ear pain rather than just congestion, as well as hearing loss.
A prior history of chronic ear problems may suggest a predisposition towards ear symptoms. However, it is not uncommon, even in the absence of a previous history of ear problems, to have ear congestion following or concurrent with an upper respiratory ailment. Furthermore, it is not uncommon to experience such ear congestion for several weeks following resolution of many or all of other upper respiratory symptoms. This is because eustachian dysfunction can linger and is occasionally difficult to clear up promptly with medication.
It is important for a physician to determine whether or not there is fluid in the middle ear. If you have had previous surgery, it may be difficult to tell this simply by looking in the ear because of the possiblity of dulling of the ear drum or the presence of scar tissue. In this case, hearing tests and a test known as a tympanogram may be necessary.
If actual fluid is in the ear, and particularly, if there is still evidence of redness of the ear drum suggesting incomplete resolution of infection, then an "extended spectrum" antibiotic such as Augmentin, cephalosporins, or new macrolide antibiotics (Bactrim, Zithromax) might be recommended. In the absence of fluid, eustachian dysfunction typically is difficult to clear with decongestant medication. I have found that topical nasal steroids frequently are very helpful - such medications include Beconase, Vancenase, Nasacort, Rhinocort, Flonase. Also, "autoinflation" of the ears is frequently helpful. This is accomplished by plugging one's nose and gently forcing air into the part of the throat above your palate until one feels the ears "pop".
Occasionally, eustachian tube dysfunction or middle ear fluid fails to clear up despite these measures. If the condition fails to resolve after 4-8 weeks, then insertion of ventilating tubes into the ear drums might be recommended.
It is important to address all concomittant upper respiratory conditions concurrent with management of the ear symptoms - that is the presence of sinus infection or active allergy all must be dealt with in order to successfully eliminate the ear problem.
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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.
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