Expert: Harriet B Jacobster, Au.D. - 9/6/2008

Question
QUESTION: I was diagnosed with ETD. I was given a six pack of steroids (methylprednisolone) for ear fullness. After weeks of no improvement, I went to audiologist who said my hearing was okay. I then went to an ENT who gave prescribed a nasal spray. This helped some after two weeks, but the feeling was still present. I returned. He told me that we could drain the ear and place a tube, or he would give me steroids and antibiotics. He told me that there was a less than 1% chance of side effects occurring with the tube placement. Long story short, he drained my ear and placed a tube(not a lot of fluid, but some) after the tube placeement there was no immediate relief. Actually the feeling got about eight times worse and I felt as if I couldn't hear as well either. I called him and he called in antibiotics and steroids. I started those. No help. It was so miserable I went to the ER. He said the tube looked fine and sent me home with pain meds. But the pain is little to none. This full feeling is miserable. I returned to him a few days later and he removed the tube. He said that he had consulted with his fellow physicians and they said that this was rare and hardly ever happened but because I was older maybe I just wasn't able to handle a new foreign object in my ear. I am 28. That was reasonable. Now I am status post a few days post the removal and it does not seem to be getting better. And now, I am having a slight popping and fullness in my LEFT ear and I can't get any more miserable and frightened than I am. Am I going to lose my hearing? Will this get better? And if it can (and I pray it can) how long will it take? Also, in my right ear (where it all began), vibrations seems to be louder and I feel like I am talking from inside my head. Did this procedure do this? What is the next step? Also, how does a doc know if an infection is viral vs bacterial when they prescribe these antibiotics? I appreciate any help you can give me. Also, sometimes I feel better when I am on the phone on the affected right ear, or when I tie a scarf around it. And I know it takes time for things to get better after a procedure, but it should be at least getting a little better right?

Rachael

ANSWER: Hi Rachael,
My suggestion is very simple: you need to consult another ear specialist.  It is not unusual to place a tube in an adult.  However, if there was no fluid, then there was very likely no infection.  But, did you also have a sinus infection or similar at the same time?  Personally, I have never heard of an adult not being able to tolerate a tube. Did the ENT at any time mention taking an MRI?  There are several causes for ETD, some are not so common.  There is always the possibility that there is something else going on besides the ETD that is causing your symptoms. With more information and more tests, I am sure the ENT will be able to answer your quetsions.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology

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

QUESTION: Thanks Dr Jacobster. I did got to another ENT, two actually. I am really having a hard time tolerating this. The first told me that I had a small spot on my right tonsil that may be causing "referred pressure", and the second did a CT of the sinuses which did show some sinusitis, but on the left side. My symptoms have subsided some, I think a lot of it had to do with inflammation and swelling after tube placement? Reasonable? But I still feel as if I am talking "inside my head" or underwater, and vibrations seem really loud. There is still a small hole, per the MD's, in the right ear, but I was told it was very small, almost 95% healed. Could this be causing these symptoms? Also, what other causes of ETD could an MRI show? And would you recommend that? And what other things could be going on besides ETD? Also, I still feel like there is something "draining inside my ears". More fluid? Or another referred feeling? Is it possible that I will have to live with these symptoms for the rest of my life, or of recurrence. Thanks for any help or insight you can give me. You've been great.

Answer
Hi Rachael,
I do not recall anybody having inflammation and swelling after myringotomy, but I suppose it can happen.  There can be blood encrusted around the tube or the tube itself can become blocked.  I also have not hearing of a very small perforation causing the symptoms you describe, although, again, I suppose it can happen. ETD is usually due to allergies or sinusitis; however, lesser causes include obesity which can also predispose a patient to Eustachian tube dysfunction because of excess fatty deposits around the passageway of the Eustachian tube. Rarely, Eustachian tube blockage may be the sign of a more serious problem such as nasal polyps, a cleft palate, or a skull base tumor. These would show up on an MRI. If the problem persists and shows no sign of resolving, I would recommend an MRI.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology