If you could provided me with any advice or information about thefollowing situation, I would greatly appreciate it.
I am a 27 year old male who is good health except for the following: I have been experiencing pain and fullness in my ears, along with a popping in my ears when I swallow, for over six months. These symptoms are also accompanied by a sense of dizziness (loss of balance), and recently headaches and a low grade fewer (around 99.6F). Performing the maneuver where one pinches the nose and blows produces a gurgling sound as if fluid or something is moving around. There is no indication that there is any fluid in the middle ear, by either direct examination or through audiological testing. My hearing is normal Endoscopic examination is normal. CT scans & MRI scans indicate normal ear structure, but have revealed minor sinus irritation and a small nasal polyp. Historically, I do not suffer from sinusitus or allergies. I'm being told that it appears that my eustachian tube is blocked, which makes sense to me. A myringotomy and removal of my adenoids (which were enlarged) have provided no relief. An ENG test was normal except for induced caloric nystagmus being dysrhythmic. All blood test are normal.
I seem to be running out possible treatment therapies, yet my condition persists and, saddly, worsens. While I continue to work with a great ENT doctor in New York City, I still seek advice and knowledge from any source.
Are there any procedures for clearing or opening the Eustachian tube directly? (Decongestants and steroids did not help.) Can this sensation of gurgling be from mucus or tissue? Have you ever dealt with a case like this?
I'm reaching the end of my rope, I fear. Any information will be seriously valued.
Thank You.
Answer --------------------
The symptoms described are consistent with a eustachian tube inflammation possibly related to nasal or sinus disease. The evaluation you have described certainly appears to have been comprehensive and thorough, however I might suggest a formal allergy evaluation despite your notation of having no known history of allergies.
The eustachian tube and its mucosal lining may be a target organ for allergic reactivity. Conditions affecting the eustachian tube may result in chronic symptoms that are not amenable to short term curative therapies. You describe having had many treatments commonly employed in the management of bothersome eustachian tube symptoms, with the possible exception of allergy intervention. Based on what you have described, the only suggestions I might make are to consider formal allergy evaluation and remain on topical nasal steroid such as Nasacort, Rhinocort, Beconase, Vancenase, Flonase, etc.; possibly in combination with the use of systemic decongestants such as pseudoephedrine if they are tolerated. While there are no direct surgical procedures that are effective in treating chronic eustachian tube dysfunction, an indirect surgical treatment is the placement of a tympanostomy tube in the ear drum to maintain a constant air pressure equilibrium in the middle ear. A "T-tube" is a tympanostomy tube designed for long term placement and can sometimes remain in place for many years.
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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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