Ear Congestion and Tinnitus After Cancer Treatment

Left ear feels clogged with tinnitus, and the pitch of sounds heard in both ears is different?

Hello Doctor, at the end of last year, I was indirectly diagnosed with nasopharyngeal carcinoma due to fluid accumulation in my left ear, and I underwent two months of radiation therapy.
After the radiation treatment, I occasionally experienced a feeling of fullness in my left ear, which could be relieved by pinching my nose and blowing.
Starting last Thursday, I initially felt a sense of pressure in my left ear that did not improve with the usual methods.
The doctor suspected otitis media, but after taking the antibiotics prescribed for a few days, my symptoms did not improve.
By Sunday, the feeling of fullness persisted, accompanied by a continuous high-pitched buzzing sound, and I noticed that sounds in my left ear seemed to be half a pitch higher than in my right ear.
Yesterday, I visited the doctor and underwent a hearing test, which indicated that there was no fluid accumulation or inflammation in the left ear, but the hearing test showed generally poor hearing in the left ear, particularly with a greater reduction in high frequencies.
Since I have been diagnosed with lung metastasis from the tumor, I am currently undergoing chemotherapy.
The chemotherapy drug Cisplatin seems to have ototoxic effects, and I am uncertain whether my symptoms are due to ototoxicity or other causes.
The feeling of fullness is very uncomfortable, and the perception of different pitch sounds is also quite distressing.
What could be the issue? Are there any ways to improve this? Thank you.

Joi, 30~39 year old female. Ask Date: 2020/04/29

Dr. Zheng Jueyi reply Otolaryngology

Hello, after radiotherapy for nasopharyngeal carcinoma, it is common to experience dysfunction of the Eustachian tube, which can lead to ear fullness or fluid accumulation in the ear.
It is advisable to seek medical evaluation to determine if drainage or the placement of tympanostomy tubes is necessary.
Regarding hearing impairment, it may be related to the effects of chemotherapy and radiotherapy.
It is recommended to monitor for any significant decline in hearing following chemotherapy, particularly in relation to the chemotherapy drug Cisplatin, and to continue tracking hearing levels for proper assessment.
Wishing you safety and health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/04/29

More Info

Understanding ear congestion and tinnitus after cancer treatment can be quite complex, especially for patients who have undergone treatments such as radiation therapy and chemotherapy. In your case, it seems that you are experiencing a combination of symptoms that may be related to both the treatment you received for nasopharyngeal cancer and the ongoing chemotherapy for lung metastasis.

Firstly, it is important to recognize that radiation therapy, particularly to the head and neck region, can lead to various side effects, including changes in ear function. The sensation of ear congestion or fullness, as well as tinnitus (ringing or buzzing in the ears), can occur due to several reasons:
1. Eustachian Tube Dysfunction: Radiation can cause inflammation and scarring in the tissues of the Eustachian tube, which connects the middle ear to the back of the throat. If this tube does not open properly, it can lead to a feeling of fullness or pressure in the ear. You mentioned that you could relieve some of the pressure by performing the Valsalva maneuver (pinching your nose and blowing), which suggests that Eustachian tube dysfunction could be a contributing factor.

2. Middle Ear Infections: Your doctor suspected middle ear inflammation (otitis media), which can occur post-radiation treatment. Even if antibiotics did not resolve the issue, it is possible that there was a transient infection or fluid buildup that has since resolved, but left residual symptoms.

3. Cisplatin and Ototoxicity: Cisplatin, a chemotherapy drug you are currently receiving, is known for its potential ototoxic effects. This means it can damage the inner ear structures, leading to hearing loss and tinnitus. The fact that you are experiencing a change in hearing, particularly in the high-frequency range, could indeed be related to the ototoxicity of the medication.

4. Changes in Auditory Processing: After cancer treatment, some patients report changes in how they perceive sound. This could be due to a combination of physical changes in the ear and neurological changes in how sound is processed by the brain.

Given these possibilities, here are some recommendations to help manage your symptoms:
- Follow-Up with an Ear, Nose, and Throat (ENT) Specialist: It is crucial to have a thorough evaluation by an ENT specialist who can assess your ear function and determine if there are any underlying issues that need to be addressed. They may recommend treatments such as nasal steroids to reduce inflammation or other interventions to improve Eustachian tube function.

- Hearing Aids or Sound Therapy: If your hearing loss persists, a hearing aid may help amplify sounds and improve your overall hearing experience. Additionally, sound therapy or white noise machines can help mask tinnitus and make it less bothersome.

- Medication Review: Discuss with your oncologist or healthcare provider about the ototoxicity of Cisplatin and whether alternative chemotherapy options are available that may have a lower risk of affecting your hearing.

- Hydration and Nasal Care: Staying well-hydrated and using saline nasal sprays can help keep the nasal passages moist and may assist in Eustachian tube function.

- Avoid Loud Noises: Protect your ears from loud environments, as exposure to loud sounds can exacerbate tinnitus and hearing loss.

In conclusion, while your symptoms of ear congestion and tinnitus can be distressing, understanding the potential causes can help guide appropriate management. It is essential to maintain open communication with your healthcare team about your symptoms and any changes you experience, as they can provide tailored advice and interventions to improve your quality of life during and after cancer treatment.

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