Expert: Harriet B Jacobster, Au.D. - 7/25/2008

Question
QUESTION: Hi Dr. Jacobster,

I am 49 years old and after suffering from non-alergenic sinusitus and bronchiectasis for as long as I can remember, a new and apparently related condition has emerged over the last 3 years.  This is pulsatile tinnitus.  After CT and MRI imaging, it was determined that I have fluid build up in my ears which is acting as a bridge for sound transfer between my ear drum and a nearby artery. One ENT MD temporarily removed the fluid by poking a hole in my eardrum and suctioning it out. Almost immediately, the noise returned and it took 2 weeks before the hole closed up.  He also suggested inserting drainage tubes, but I was too leary about any more holes being made in my eardrum. My fealing is that it would be best to treat the underlying cause, i.e. the mucus buildup in my sinuses, ears, and lungs.  Nasal sprays and puffers don't seem to work.  Apparently, I have no allergies as tests have indicated.  At this point I feel like I am spinning my wheels when trying to get help with this problem. Do you have any suggestions?  

Thank you

Stephen

ANSWER: Hi Stephen,
If indeed the cause of your tinnitus is fluid build-up, the I have to agree with the MD who wants to put in tubes.  Fluid build up is usually due to Eustachian Tube Dysfunction. There are many causes for ETD and allergies are primary.  However, without a properly functioning Eustachian tube, you will continue to have the fluid buildup.  The drainage tube take over the function of the ET.  If you consider the damage to your ears and other organs that fluid buildup can cause, you should not worry about having the tubes placed and the resulting "hole" in your eardrum.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology

---------- FOLLOW-UP ----------

QUESTION: Dr Jacobster,

Are there cilia in the Eustachian tube which facilitate the drainage of inner ear fluid?  If there are and the cilia are malfunctioning, can that lead to improper drainage?  Regarding the insertion of drainage tubes, I was told by another ENT specialist that there is no guarantee that the hole in the eardrum will close after the tubes are removed and he would rather not recommend this procedure.  His preference is to use Nasonex, saline sprays, etc. but unfortunately, they are having no effect on my sinus and ear congestion.  

Stephen

Answer
Hi Stephen,
Fluid drains by force of gravity. In an adult, the ET points slightly downward from the ear to the nose. As for the hole not healing after the insertion of tubes...yes, this is always a possibility. However, the consequences of chronic otitis media are far worse, for instance, deterioration of the middle ear bones, neoplastic growths, etc.  If the hole in the eardrum doesn't heal, it can be patched.  Since you are having no success with the nasal sprays, I suggest you seek the advice of another ENT.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology