Ear Problems: From Ear Infections to Eustachian Tube Issues

Q: Ear Problems: From Ear Infections to Eustachian Tube Issues

Hello, the issues you mentioned could be due to： 1) Eustachian tube dysfunction： This is the most common cause and can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over. <br>2) Sudden sensorineural hearing loss. <br>3) O

Ear problems

Hello, Doctor.
I started experiencing ear problems around the time of the Lunar New Year this year.
Initially, I mistakenly thought there was a bug deep in my right ear, as I felt pain and itching deep inside.
After seeking medical attention, I was diagnosed with mild otitis media, but there was no improvement after taking medication.
Besides the aforementioned deep pain in my right ear, it has changed to a feeling of fullness, almost as if my ear is covered, along with mild tinnitus.
Subsequently, the discomfort spread to my right ear and the surrounding area, especially with numbness behind my ear, extending to sharp pain in the right side of my head.
I consulted a neurologist and underwent an EEG, which showed no abnormalities.
About a week ago, I suddenly felt dizzy while sleeping and experienced mild fever, but I had no nasal or throat issues.
I consulted both a neurologist and an ENT specialist at a regional hospital.
The neurologist diagnosed me with vestibular neuritis, while the ENT specialist suggested it might be due to displaced otoliths.
I suspected it could be an Eustachian tube issue and requested an endoscopy, but the doctor felt that ear pain could not extend to the numbness and pain around the ear.
Today, I noticed that when I touch my neck, the area on the upper right side of my throat, about 2 to 3 centimeters from the upper left side, feels different; the right upper area feels swollen internally and is painful when pressed.
Recently, I have also been experiencing dry mouth and throat.
When I pinch my nose and blow, I can only hear a faint sound of air in my left ear, while my right ear feels completely blocked.
Typically, I first feel the eardrum bulging in my right ear before it happens in my left ear after exerting pressure.
I would like to ask if the above symptoms could indicate an Eustachian tube problem.
Would an X-ray of the ear help clarify these issues? Should I immediately go to another hospital for an endoscopy? I also want to inquire if it is possible to have an endoscopy and neck ultrasound done during an outpatient visit to avoid multiple trips to the hospital.
This situation is very distressing, and I would greatly appreciate your clarification.
Thank you very much!

Wu, 20~29 year old female. Ask Date: 2020/08/19

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the issues you mentioned could be due to: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over.
2) Sudden sensorineural hearing loss.
3) Otitis media: a) Acute otitis media: often occurs alongside upper respiratory infections (like colds) or sinusitis, and in severe cases, there may be ear discharge.
b) Chronic otitis media with acute exacerbation: usually occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to unclean water or improper ear cleaning.
All of the above conditions can be treated with medication through medical consultation for appropriate improvement.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof room where you press a button in response to sounds, rather than just a tuning fork test), and it confirms that you do not have sudden sensorineural hearing loss, then medication may suffice.
However, if you have not had pure tone audiometry, it is advisable to visit a hospital for testing to rule out sudden hearing loss, as the golden treatment period for sudden sensorineural hearing loss is two weeks, and early treatment yields better results.
Could it be an Eustachian tube issue? Would an X-ray of the ear help address the above problems? Most Eustachian tube issues are determined clinically, and X-rays provide limited assistance.
I would like to inquire if an endoscopic examination or neck ultrasound can be performed immediately during an outpatient visit.
Most ENT departments in hospitals can perform endoscopic examinations on the spot, but neck ultrasounds may require scheduling.
The specific tests needed can only be determined after a personal consultation.
Wishing you peace and good health.
Sincerely, Dr.
Chi Chao-Yun, Head of ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2020/08/19

More Info

Your symptoms suggest a complex interplay of ear and possibly Eustachian tube dysfunction, which can lead to various complications if not addressed properly. Given your history of ear pain, pressure, and the recent development of dizziness and potential vestibular issues, it is crucial to understand the underlying mechanisms at play.

Firstly, the Eustachian tube connects the middle ear to the back of the nose and throat, helping to equalize pressure and drain fluid. Dysfunction of this tube can lead to a feeling of fullness in the ear, muffled hearing, and even pain. Your description of the sensation of your ear being "covered" aligns with Eustachian tube dysfunction, which can be exacerbated by allergies, infections, or even changes in altitude, such as during flights or when diving.

The fact that you have experienced ear pain that radiates to the surrounding areas, including the back of your head and neck, could indicate referred pain from the ear or possibly a secondary issue such as tension in the neck muscles or even a neuralgia. The tingling or numbness you feel around your ear could also be related to nerve irritation or inflammation, which might be linked to your vestibular symptoms.

Your recent episodes of dizziness, especially when combined with a mild fever, could suggest vestibular neuritis, which is an inflammation of the vestibular nerve, often following a viral infection. This condition can cause significant balance issues and is typically diagnosed through clinical evaluation and sometimes imaging studies.

Regarding your concerns about the right side of your throat feeling different and painful upon palpation, this could indicate a localized infection or inflammation, possibly related to the ear issues or even a separate condition such as a lymph node enlargement due to infection or other causes.
As for your question about imaging, a plain X-ray of the ear is generally not very useful for diagnosing Eustachian tube dysfunction or other ear-related issues. Instead, a CT scan of the sinuses or temporal bone may provide more insight into any structural abnormalities or infections. An endoscopic examination of the nasal passages and Eustachian tube may also be beneficial, as it allows direct visualization of the area and can help identify any obstructions or inflammation.

In terms of immediate next steps, it would be advisable to seek a consultation with an otolaryngologist (ENT specialist) who can perform a thorough examination, including a possible endoscopy, and assess your Eustachian tube function. If you are experiencing significant discomfort or if your symptoms worsen, it may be prudent to visit an emergency department or urgent care for more immediate evaluation.

In conclusion, your symptoms are indicative of potential Eustachian tube dysfunction, possibly compounded by vestibular issues and localized throat discomfort. A comprehensive evaluation by an ENT specialist, including potential imaging and endoscopic examination, will be essential in determining the exact cause of your symptoms and guiding appropriate treatment. It is crucial to address these issues promptly, especially given your concerns about becoming a commercial pilot, as ear and balance issues can significantly impact your ability to fly safely.

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