Expert: Harriet B Jacobster, Au.D. - 2/16/2009

Question
QUESTION: experienced fullness in right ear, occasional pain,draining periodically from right ear down throat during the day, especially first thing in morning when getting up. Noted that, when trying to sleep at night, terrible hissing keeping me awake most of night.  When trying to sleep, couldn't lay on affected side for more than a few minutes before hissing and pressure became worse, and felt some nausea.  Laying on unaffected side seemed to help. Had a case of viral gastritis when this began, so tried treating it with hot water bottle to ear with some relief-would notice increased drainage down throat for some time after.  Once gastritis cleared, noted feeling area of hardness or firmness in ear, and water bottle no longer producing results.  Started taking pseudophed; took for about a week, when one day had sudden, large drainage of fluid down throat, hissing stopped. Relief only lasted 1.5 hours, then started again with symptoms.  Friend recommended restricting salt and caffeine.  Went one entire day without either; about 1800, experienced gentle popping sensation in ear, followed by large release of fluid down throat and relief of symptoms.  Lasted about 3 hours, then it all started again.  Seen by doctor in Urgent Care-dx of inner ear infection. Am currently about 3/4 of way through treatment with amoxocillin.  Seemed at first that symptoms were gradually improving-pressure relieving, hissing decreasing so could sleep at night.  Yesterday, however, hissing increased again and didn't sleep. Conditions seem to be variable-somedays seems to be related to caffeine and salt intake; other days, it doesn't seem to be a factor in the equation.  Have been dealing with this since Christmas now, and am wondering if this will ever end.  How should I proceed from here?  (ie-hearing test done, results normal)

ANSWER: Hi Sharon,
You need to be evaluated by an ear specialist - ENT - immediately. What hearing tests were done?  Who did them?  There are many conditions that can still manifest with hearing within normal limits and only a skilled audiologist can administer the proper tests.  A general physician from Urgent care does not have the necessary tests or equipment available to diagnose an inner ear infection - unless you meant middle ear infection. Even so, you need to be evaluated by an ear specialist.

Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology

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

QUESTION: Saw an ENT doc at the University of Minnesota before I gave up in desperation and went to the Urgent Care.  His office did the hearing test before I saw him the same day. According to him (I'm not making this up) I have a silent case of GERD which is causing stomach acid to leak into my eustachian tubes while I'm sleeping-even though have no GI symptoms whatsoever! Went to a GI doc at Hennepin County Medical Center, who laughed herself sick over this one-said that it is technically possible, but I would have severe gastric reflux to the point of "literally gagging on gastric reflux" before any such fluid in the eustachian tubes could remotely occur, and even then such a condition is rarely heard of.  Went to the Urgent Care because I was fed to the teeth with "experts" who clearly had no idea of what was going on, and the Urgent Care doc was the only person I've seen during the course of this problem (have also been seen by an NP, a PA, an ER doc, and talked to a triage nurse 4 times) who seemed to have some realistic glimmering of what the problem might be and how to treat it.  Any suggestions on who I should see now, or where to go with this?

Answer
Hi Sharon,
Based on your symptoms, this is a matter for an ear specialist.  If you were not happy with the one you saw, then I suggest you see another. Yes, GERD can lead to middle ear problems.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology