Expert: Harriet B Jacobster, Au.D. - 9/14/2008

Question
Hello doctor Iam 36 years old, I have always had a bit of problem in travels and in elevators with my ears, I usually had the blocked feeling for several hours, but it never took more than a couple of hours to pop my ears by themselves. My problem started in November 2007, I was suffering from an upper respiratory infection for about 3 weeks with no resolution, as my wife was very upset because of me coughing at night, when I coughed I shut my mouth to avoid making noise, besides at work I used to blow big balloons, days later I had fever and pain in one ear and a blocked feeling, I went to a doctor (NOT AN ENT) who gave me cedax for 5 days and 1 shot of 500mg amikacin every 12 hours for 1 day only. I remember I felt worse the next day I took the 2 AMIKACIN SHOTS, my ear felt really plugged, super plugged and was hurting me really really badly, I felt too much pressure in my ear and I had to put cotton in my ear to feel a bit better, I could barely hear my own voice, 1 week later I went to AN ent, he applied something in my nose and it became decongested, he said I was still sick, that my TM´S were very retracted, and that the hearing loss I was suffering was due to the 2 amikacin shots I received 1 week before and that surely the auditory nerves had suffered irreversible damage. Long  story short: I visited several doctors, most of them said amikacin was not harmful because it was only two shots, I was on nasal steroids and salted solutions for several months, I felt much better in March 2008 but still not as I used to hear, I had several tests done, audiogram: right ear  is normal, but the left ear is normal in all frequencies except at 8khz where it is at 30 db, besides it is 10 db worse than the right ear in all other frequencies, I had the tuning fork test performed and hear the vibration much more in my left ear (the worst hearing ear), had pneumatic otoscopy and doctor said my eardrums moved fine, but more right ear than the left,  tympanogram reflects a type AS curve ,RIGHT EAR: Volume 1.02, compliance 0.41, pressure -18, gradient 0.23. LEFT EAR: volume 1.10, compliance 0.32, and pressure - 55, gradient 0.10. My ETF is RIGHT EAR: volume 1.03, pressure -18,-29,-30.  LEFT EAR : -43,-43,-49 and according to doctor normal reflexes. I was told I suffer from  severe ETD as swallowing or blowing with mouth closed has little to no effect in my ear pressure and was instructed to do Eustachian tube exercises like blowing balloons or open my mouth widely.
I have nasal septum deviation and was told that it could be the cause of my ETD and they said surgery is recommended.
Currently I hear much better than in November but not as I used to hear, I have to raise the treble in my stereo a lot more than I used to, some days I hear really muffled, the sounds are dull and my hearing varies day by day, I discovered that if I wear ear plugs for 1 hour or so my hearing improves and I hear clearer, I still feel the  ears plugged, much more my left ear, in the mornings the plugged feeling and my hearing is worse, I hear crackling noises and feel as if I had some fluid in my ears.
My questions are:
DO I have to continue the ET exercises even If I feel they are useless and in most cases after blowing balloons or blowing my nose I feel ear pain and my hearing gets worse? (My doctor says yes)
Do you agree that I have ETD or could it be otosclerosis.
Do you think surgery to correct my septum deviation could help me with my ETD?
Is it common to ETD to last for so long?
Dou you think I could get some help from those medical nasal balloons or this device, the ear popper, and if they are safe to use?
Please tell me what else I can do I don’t want my hearing to get worse, and I don’t want to do the auto inflation exercises as I feel I can damage my eardrums, besides I feel that my problems started because of Me blowing those big balloons. Do you think all that balloons blowing could have damaged my Eustachian tubes? And if so, ear tomography could help me to check my Eustachian tube integrity?


Answer
Dear Jorge,
You have a lot going on here, but I wish to focus in on an important point. You have an asymmetrical hearing loss at 8kHz.  That in itself is a red flag.  Everything else you describe could be attributed to ETD except for this.  ETD usually creates a conductive (mechanical) loss more so in the low frequencies; however, when we see a high frequency loss, we usually think sensorineural. It is possible that these two types of loss can occur simultaneously in the same ear.  In my opinion, I think you need a complete neuro-otological workup to see if there is any damage to the auditory nerve.  It is not unusual that ETD could last long, depending on the cause.  I believe a neuro-otologist, an ENT who specializes in the auditory nerve, would be able to get to the root of your problem.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology