Friday, December 23, 2005

Ear pain

Edited a bit for length, etc.

Q: [I have] been experiencing symptoms of a clogged ear, hearing difficulties, and jaw pain that was diagnosed as fluid in my Eustachian Tube by my doctor. All symptoms occurred on my left side. The symptoms were diagnosed as allergies but no allergy treatment worked.

Last April the problem progressed to similar but more painful symptoms in my left jaw, cheek, and ear. My new problems were no longer accompanied by hearing difficulties which caused my ENT to automatically conclude that my pain was not Eustacian Tube related. He ordered a CAT scan of the sinuses which was negative, and now believes that my problems are caused by either headaches or atypical facial pain.

I have become desperate to relieve the pain, and have begun to treat myself by holding my nose and blowing air into my Eustacian Tubes which pop and crackle when I do so. It tends to relieve the pain for a few hours. Am I harming myself by doing this? Also, what type of examination should I request at the doctor's office to totally rule out Eustacian Tube Dysfunction? The pain has become a regular part of my life now, and still resembles the pain I felt when my Eustacian tubes were full. Do you have any idea what could possibly be wrong?

A: I trust you've read the disclaimer?

First, let me answer your questions.

Are you harming yourself by auto-insufflating (that's what it's called)? Probably not, but I remember doing this after getting off an airplane, and next thing I knew I was sitting on the airport's bathroom floor, the toilets and latrines spinning around my head . . . Point is, I can't do this safely, but apparently, you can. I don't recommend people do this, because if any doctor had told ME to do this, I'd cut him a new one.

What test do you need to rule out Eustachian tube dysfunction? A tympanogram. It's quick, easy, painless (usually), and I'd be surprised and more than a little disturbed if you haven't had one already.

For a full run-down on the differential diagnosis of ear pain, see this page. To the list on that page, I would add migraine, atypical facial pain, giant cell arteritis, trigeminal neuralgia . . . and there are undoubtedly other conditions slipping my mind at the moment.

The main point: ear pain is a thorny, complex problem, and the only hope we have of figuring these out is to (A) take a thorough history, (B) examine the patient, sometimes with additional tests such as tympanometry, fiberoptic laryngoscopy, or binocular microscopy, and (C) be prepared to re-evaluate the patient if our initial diagnosis doesn't pan out.

Have I managed to figure out all of my ear pain patients? Not by a long shot. This is a toughie. Good luck to you.



At 3:55 PM, Anonymous Anonymous said...

I've endured (not lived peacefully with) ETD for over 13 years now. I find that avoiding sudden temperature changes (hot summer day into cool movie theater) helps. Also, in winter, keep both the ears and neck well insulated against extreme cold!

In answer to one question for the patient wondering if ventillation tubes would harm her ears: Take the advice of your ENT here. I've had four sets of tubes in the last four years. If you are careful about getting water into your ears and not probing that Q-tip too far into the ear canal, you and your "tubes" can have a very amicable relationship.

Tubes not only equalize pressure in the ear, they allow built-up fluid to drain properly, thereby avoiding clogged ears and ear pain. Another advantage of tubes is that your ear drops can now flow completely thru the ear and out into your throat...delivering medication to wherever that pesky infection is hiding. Ear drops were not an option for me until I had my first set of tubes. This is also a good way to avoid oral antibiotics...ugh!

The longer you have this problem, the more you might notice your ears becoming sensitive to barometric changes. My ears let me know the minute the barometric pressure drops below 29.94. My ENT calls me a "living barometer."

I've been told my ETD will never be's just a matter of finding the best methods of coping with it!

At 4:01 PM, Anonymous Anonymous said...

forget bit!

At 10:11 PM, Blogger Douglas Hoffman said...

Thanks, anon. When it comes to adults, tubes aren't for everyone. I honestly don't understand it, but some adults take well to tubes, and some hate them. It's an odd thing.

It's certainly true that some folks have ETD for life -- they simply have lousy Eustachian tubes. We try to identify underlying problems (allergy, sinusitis, etc.) but some patients don't have any problem other than dysfunctional ETs.

At 5:48 PM, Anonymous Anonymous said...

so, we're just supposed to use your comments section to submit our noses etc?

Here's what I'd like to know:

I am a woman with powerful sneezes. But sometimes my nose intends to sneeze but the process somehow goes awry; when no sneeze is forthcoming, the inside of my nose hurts.

Am I a physiological freak? What would be causing the pain? Could it be "blue balls"? (only misplaced and misgendered)

curious, not concerned

At 11:19 PM, Blogger Douglas Hoffman said...

I'm basing my answer on personal experience (since you won't find "nasal blue balls" in any medical textbook ;o) . . .

There's a blood pressure spike with sneezing. I suspect that in a suppressed sneeze, that spike might be even more drastic. The effect is a bit like getting punched in the nose.

Just a guess, but I honestly can't think of another explanation.

At 7:38 PM, Anonymous Anonymous said...

I've looked at a lot of info on your site and haven't fully seen my problem addressed.
My ear is "plugged," and it hurts at times to talk or sing because it sounds so loud. (I miss being able to sing comfortably.) I have constant pain in my upper jaw. I've had 2 MRIs a CT of my ear and sinuses (neg.), and 2 hearing tests and the MD at the HOUSE Inst. said I have otosclerosis. I read about it online and I don't have tinnitus or hearing loss. I've wondered if I have ET dysfunction. This has been going on for almost a year and nothing has helped. Have you ever heard of my symptoms?
It sounds like I'm asking for a diagnosis but I guess I just need some moral support or a clever response doc!

At 9:01 AM, Anonymous Anonymous said...

Back in December I had four powerful sneezes in a row. I was turned around so as not to sneeze in my gf's face. Two symptoms followed this event.
1) My ribs were sore for a week
2) My right ear felt like it was plugged up, just like in an airplane.
Problem number one went away fairly quickly, problem number two still persists.
My Dr. said it was most likely a collapsed Eustachian Tube and suggested I use the Nasonex to help with recurring sinusitis and tracheitis, help with the ET and also recommended I equalize my ear (by holding hte nose and gently blowing) to relive the pressure.
Well I stopped taking the Nasonex three days ago as I don't think it's doing any good and I believe it's negatively affecting my asthma, which is is not bad by any means - the asthma that is.
I still equalize my ears 20 or so times a day and constantly "click" my right ear. It no longer clicks by itself when I swallow so I have to do this manually. I belive repeatedly doing this (100x day I'm sure) is causing the headaches I get in my right temple, right eye and extending all the way back to the base of my skull - the constant jaw movement and the constant eq'ing of my ear.
I'm going to see an audiologist for a hearing assesment and tympanography next week. I hope I have the chance to describe all these things to them.
Do you think it's possible that since that sneeze I've got something blocked in my ET that's not coming out? I have a blcked tear duct which prevents my right eye from draining - it's been there for 15 years. I'm wondering if now my ET is blocked as well.
If so will a tympanography show this?
The one other symptom I forgot to mention is that the submandibular gland right at the base of the right side of my jaw is often tender and almost always more prominent in size than the right one.
I've had a thyroid uptake, ultrasound of the jaw, X-Ray of the sinus, panascan x-ray at the dentist of the entire jaw area, scope of the larynx - all these things have come back negative.
It really drives me nuts to feel like I'm not hearing properly out of my right ear, even though I can make sounds beside both ears like the clicking of mny finger and it sounds the same on both sides. I also can hear music in stereo properly without having to turn one side up.

At 2:27 PM, Anonymous Anonymous said...

I have lived with clogged ears, pain in my ears, ringing and clicking and wooshing noises for many years. I have become off balance at time and sometime experience dizziness. I originally thought it was my sinuses, then I thought it was allergies. I also have TMJ, so I thought maybe grinding my teeth was irritating the nerves and giving me the pain and clogged feeling. I've gone to many ENT's. My audiograms show high frequency hearing loss in one ear and low frequency hearing loss in the other which the doctor says is quite unusual. This recent ENT (#5) diagnosed me with Meneire's Disease. (Google Meneire's disease for more info.) From what I understand it is fluid in the inner part of the ear, that cannot be treated with antibiotics. I have been placed on a low salt diet and have been prescribed diuretics. I've been told to stay away from caffeine, and alcohol. I was given a special Meneire's diet. This helped for a short time but I still have clogged ears and ringing that changes in severity. For awhile, lipoflavanoid helped with the ringing. I do notice that the weather and barometric pressure will worsen my condition. I've been told there's no cure, just to manage my diet. I also have hypothyroidism and although I take medication I still experience symptoms. I believe the hypothyroidism may contribute to some of the Meneire symptoms. Now I just have to find an endocrinologist that listens!

At 10:34 AM, Anonymous Informative Blog said...

I've checked out a couple ear-related pages from this blog today, and they have both been very informative.

I've recently just suffered right ear trouble the last few weeks and am not sure what is going on...

It started just before the onset of a sinus/head cold. After a week or so, the illness was gone, but now, upon waking, it feels like there is water in my right ear. It usually goes away, but still flares up from time to time. Now, it is worse than ever, but it has still only been on & off for about 3 weeks.
Do things like this usually clear up on their own, without further treatment?

At 1:43 PM, Anonymous Anonymous said...

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At 1:17 AM, Blogger komal said...

Hearing loss is one from the ear ringing causes. Around the age of 60 years old, some people may have hearing loss and this cause tinnitus. Head injury, brain injury, ear injury, and nerves or ear linking injury can cause ear ringing. Construction equipment, rock concert, loud music can cause ear ringing but only when it does not over a long period of time.


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