Eustachian Tube Dysfunction After Ear Surgery

Regarding the Valsalva maneuver and Eustachian tube obstruction?

Thank you, doctor, for taking the time to answer my questions despite your busy schedule.
In early July, I developed sinusitis that led to otitis media, resulting in a feeling of fullness in my ear and tinnitus.
I visited a small clinic near my home and took medication until the end of the month.
Since I was going abroad, I underwent a myringotomy to drain fluid from my ear, after which the feeling of fullness disappeared.
However, the tinnitus has persisted until now, in October.
When I pinch my nose and blow, my left ear feels normal and pops, but my right ear pops and then I immediately hear a collapsing sound (similar to a popping noise).

1.
Is the popping sound I hear when I pinch my nose and blow the sound of the Eustachian tube or the eardrum?
2.
What could be the cause of this? Could it be related to the myringotomy I had? I recently had an endoscopy and the incision from the myringotomy is still present.

3.
The tinnitus has not improved in three months.
Generally, the sound is manageable, but at night it becomes very loud.
In the morning, I also hear a muffled sound in my ear.
What should I do?

707, 20~29 year old female. Ask Date: 2018/10/17

Dr. Li Jiaxuan reply Otolaryngology

The Eustachian tube must be open for the tympanic membrane to vibrate and produce sound.
If the tympanic membrane is inflamed, its movement will not heal.
It is recommended to manage the inflammation of the tympanic membrane (hoping for its healing).
If it affects sleep, tinnitus medication may be necessary.
Please consult an otolaryngologist.

Reply Date: 2018/10/17

More Info

Eustachian tube dysfunction (ETD) is a common issue that can arise after ear surgery, particularly in cases involving the middle ear, such as tympanostomy (ear tube placement) or tympanoplasty (eardrum repair). Your symptoms, including the sensation of fullness in the ear, persistent tinnitus (ear ringing), and the popping or collapsing sound when you perform the Valsalva maneuver (pinching your nose and blowing), suggest that you may be experiencing ETD.

1. Understanding the Sounds: When you pinch your nose and blow, the sound you hear when your ear "pops" is typically related to the Eustachian tube equalizing pressure between the middle ear and the external environment. If you hear a "popping" sound followed by a sensation of collapse, it may indicate that the Eustachian tube is not functioning properly. This could be due to inflammation, blockage, or structural changes resulting from your previous ear surgery or ongoing issues like sinusitis or allergies.

2. Causes of Eustachian Tube Dysfunction: ETD can occur for several reasons. In your case, the history of sinusitis and middle ear infection may have contributed to inflammation and swelling of the Eustachian tube, making it difficult for it to open and close properly. Additionally, if you had a tympanic membrane perforation (a hole in the eardrum), it could affect the normal pressure regulation in the middle ear, leading to further complications.

3. Persistent Tinnitus: Tinnitus can be a frustrating condition, especially when it persists for months. It can be exacerbated by stress, fatigue, and changes in hearing. The fact that your tinnitus is more pronounced at night may suggest that external sounds are less distracting, allowing the internal noise to become more noticeable. It’s essential to address the underlying causes of your tinnitus, which may include managing any ongoing Eustachian tube dysfunction or middle ear issues.

4. Management Strategies: Here are some strategies that may help alleviate your symptoms:
- Nasal Decongestants: Over-the-counter decongestants can help reduce nasal swelling and improve Eustachian tube function. However, consult with your doctor before using them, especially if you have other health conditions.

- Nasal Steroid Sprays: These can help reduce inflammation in the nasal passages and Eustachian tube, improving drainage and function.

- Allergy Management: If allergies are contributing to your symptoms, managing them with antihistamines or allergy shots may provide relief.

- Eustachian Tube Exercises: Continue performing the Valsalva maneuver or try the Toynbee maneuver (swallowing with your nose pinched) to help equalize pressure.

- Consultation with an ENT Specialist: If your symptoms persist, it’s crucial to follow up with an ear, nose, and throat (ENT) specialist. They may recommend further evaluation, such as tympanometry or audiometry, to assess your middle ear function and hearing.

5. When to Seek Further Help: If you experience worsening symptoms, such as increased pain, discharge from the ear, or significant hearing loss, you should seek medical attention promptly. Persistent issues may require additional interventions, such as further surgical options or specialized treatments.

In conclusion, Eustachian tube dysfunction can significantly impact your quality of life, especially after ear surgery. Understanding the underlying causes and seeking appropriate management can help alleviate your symptoms and improve your overall ear health. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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