Expert: Harriet B Jacobster, Au.D. - 6/19/2008

Question
I am having problems with my ears and no one(including the ENT) can figure it out.

I was injured in an explosion in Iraq 2 months ago. I didn't hit my head on anything, but the force of the explosion threw me forward and the sound waves litterally knocked the wind out of me. I wasn't knocked out (I don't think), but when I got up I was dazed..kind of out of it a few minutes. I went to the hospital and was told I suffered a concussion. I had tinnitus(ears ringing) and headaches for a week afterward.

Approx two weeks after the incident...very suddenly....both ears plugged up and I was getting horrendous headaches. Dr (general Physician) thought ear infection(s) and gave me antibiotics. They did not help and ear pain continued to get worse. At the time, my Dr was aware of the blast injury but didn't think the two were related.

After I got home to the US, I suffered significant pain for weeks while I was drugged on Tramadol and they tried everything (Flonase, Claritin, etc.) to drain my ears with no luck. I saw ENT and she said she has never seen as severe case of Eustacian Tube Dysfunction in an adult. I eventually got ear tubes last week after the pain became too much to bear--my eardrums began to perforate(sp?) under the pressure and I was at risk of bursting my eardrums.

The tubes helped...but I still am getting pressure behind the ears (even with the tubes). My ears are leaking, so I know the tubes are working...but I've noticed my hearing has gotten worse with the tubes. I thought they were supossed to improve hearing?

Have you ever heard of a concussion(mTBI) or very loud noise causing such ear problems? There is nothing on the internet that I can find about a concussion/eustachian link--but the pain and pressure are very real.

All I can find for causes on the internet are sinus problems...but I haven't had any allergies or ear infections for years (since I was a kid--20+ yrs). I haven't had any other symptoms of a cold/sinus probs...no runny nose or cough or anything. My Eustachian tubes are still blocked...I am getting zero drainage down my throat.

The military checked my hearing (audiologist) and concluded that "my hearing is normal". It doesn't feel that way is I am having a hard time understanding people when they talk--before the tubes...but worse afterwards for sure. It really is a downer for me...I used to speak out/conversate a lot but I don't know because I feel stupid. I can't my voice volume very well at all and always feel like I am shouting. Then when I lower my voice...I can't hear what I am saying so it is extremely hard to articulate.

So, I guess my question is...is there any research of a link between head injuries and Eustahian tube problems?

Thanks.

Nate

Answer
Hi Nate,
First of all, I am glad you returned home safely.  Next, before I answer your question, I need to know, was an MRI done on your head/ears?  It is not uncommon to have hearing problems after a traumatic injury such as yours.  Several things may actually be possible here.  You might have a small fracture near the ear and there may be a cerebral spinal fluid leak. Many times a CSF leak is mistaken for middle ear infection.  Or, you may have suffered a small hole in the inner ear known as a fistula.  Also, there are several nerves and muscles in the middle ear that control the Eustachian tube as well as the little bones in the middle ear.  Any one of these may have been damaged and be causing your symptoms.  If this is the case, the tubes may not be helpful. This condition is known as palatal myoclonus.  You need to either return to your ENT and/or audiologist and ask them to test for these conditions.  You might also want to consult a neurologist as well.  And, if you haven't had an MRI, you should insist on one.
Hope this helps.  Good luck
Harriet B. Jacobster, AuD
Board Certified in Audiology