Expert: Harriet B Jacobster, Au.D. - 1/23/2009

Question
Hi-
I have been suffering from fullness in my left ear, and pressure just below the ear, that builds and sometimes goes to the back of my neck, since August of 08. I also hear clicking and popping when I swallow or yawn or turn my neck, and  my left ear always feels clogged or built up with fluid.(worse at night) In addition to that, I had one bad spell of vertigo, and was weak for a day or two, back in August when I first noticed the fullness. It went away but occasionally I experience balance problems, and dizziness and vision focus problems. I have seen an ENT dr. and a balance specialist. I had the audiogram, and ENG, and a MRI, and a Tympanometric test, and some other tests there, and they suggested labyrinthitis. One Dr. said Meneires Disease. I was given balance rehabilatation exercises for 8 weeks, and they helped, but I still experience off balance problems, mainly during my menstrual cycle. At one point she gave me a diuretic, and Nasonex, to get fluid down in the body, and to help the inner ear areas become less inflamed, no change after 4 months on those.(off those meds now) I also have TMJ on my left side, same side as the troubled ear. (not painful, just a pop when I open wide) I experience tinnitus in both ears, 2 or 3 times a week. Sometimes I have neck aches, that last a day or two, go away and come back. Since all of that, the specialist thinks it will just take time for the inner ear to calm down, and that things will go back to normal. I can live with the balance issues, but the constant popping and clicking and fullness is driving me crazy, and I have never had anything wrong with me this long before. It feels like I have had something in my ear, that I want out, since August, and it is nerve recking. I have been trying the netty pot, in case my sinuses need attention, I am not sure, and I started Antioxidants, to try and boost my immune system, and see if that helps. My regular Dr. thinks it could be my Eustachian tubes, and he thinks my next move would be to have that checked, but the specialists said the Tympanometric test she gave ruled that out. It feels a little better when I hold my nose and blow air, and pops my ears, but they don't always pop. I just want this gone.Is there some way to look into the Eustachian tubes and see what the heck is going on in there or what? If you have any thoughts, please pass them on or send me to someone who can help. My medical bills seem to be for nothing. I am still the way I was when I started seeking medical help back in August, and no resolution to show for it.
Sincerely,
Seriously frustrated from VA

Answer
Hi Catherine,
You left out one important bit of history - your age.  A clicking sound is symptomatic of something known as palatal myoclonus (PM). Myoclonus is a rhythmic contraction of one of the muscles that leads to the middle ear.  It can be caused by Eustachian tube dysfunction or by something else entirely.  Standard tympanometry will not reveal myoclonus; the audiologist needs to perform a special test for that.  In younger people, PM may indicate an underlying neurological problem as can balance disorders.
I would suggest you return to the ENT and have him check you for myoclonus.  Treatment is usually muscle relaxants. If you haven't seen a neurologist, that may also be something to think about.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiolog