Ear Pressure and Dizziness: Is Garamycin Nasal Wash to Blame?

Dizziness, ear fullness, and scalp numbness?

Hello Doctor: I am currently using Garamycin nasal irrigation, adding 1cc of Garamycin to 300cc of saline, performing the irrigation for 6 days followed by a day of rest, and I have been using it for five weeks.
I have experienced ear fullness and dizziness, but I also have a history of systemic neurological disorders, so I am unsure if my ear issues are related to Garamycin.

Medical history: I have had chronic sinusitis for many years.
Last February, I experienced systemic inflammation and pain (in the urinary tract, eyes, throat, etc.).
Initially, I was treated with antibiotics, which provided some improvement after a period of use, but my symptoms were recurrent and did not resolve completely.
I took antibiotics for 8 months (Ciprofloxacin), during which I also experienced other acute inflammatory issues (such as acute pharyngitis with difficulty swallowing solid foods).
On September 17, 2021, an ENT specialist diagnosed me with acute pharyngitis after an endoscopic examination and prescribed 14 days of Augmentin.
Initially, my throat swelling decreased quickly, but I did not fully recover, and I frequently experienced throat pain with a sensation of a foreign body, along with heat intolerance and chills.

Three weeks after the acute pharyngitis, on October 3, 2021, I began to experience multiple neurological sensory abnormalities throughout my body.
A neurologist diagnosed me with polyneuropathy, which was occasionally accompanied by tinnitus, dizziness, and blurred vision.
I have been receiving treatment across various specialties and am currently being treated for an autoimmune disease.
Around early November 2021, I began using Garamycin nasal irrigation, which significantly reduced nasal secretions.
However, after two weeks of use, I started to experience mild ear fullness, which I initially did not pay much attention to.
Later, the sensation of ear fullness intensified, becoming paroxysmal and gradually causing tingling in my scalp.
I have also experienced intermittent dizziness, especially when focusing on moving objects (such as high-speed dynamic images on a screen), which has recently worsened.
While lying down with my eyes closed and not moving, I sometimes feel a slight sensation of rotation.

Given my existing polyneuropathy and widespread sensory abnormalities, I initially did not recognize the ear fullness and dizziness as concerning.
I would like to ask the doctor if Garamycin nasal irrigation could have ototoxic side effects, and if these can be detected through medical examination?

Bing Yu Ren, 20~29 year old female. Ask Date: 2022/01/05

Dr. Li Jiaxuan reply Otolaryngology

Based on your description, it is recommended to visit an otolaryngology clinic to check for possible inflammation of the eustachian tube and vestibular nerve.
The dosage of medications that typically enter the middle ear or inner ear through nasal irrigation is very small.
Wishing you good health.

Reply Date: 2022/01/05

More Info

The symptoms you are experiencing, including ear pressure, dizziness, and the use of Garamycin nasal wash, raise important questions about potential side effects and the underlying causes of your discomfort. Let's break down your concerns and provide a comprehensive understanding of the situation.

Understanding Ear Pressure and Dizziness
Ear pressure and dizziness can be attributed to several factors, including issues with the Eustachian tube, inner ear problems, or even systemic conditions. The Eustachian tube connects the middle ear to the back of the throat and helps equalize pressure. If this tube is not functioning properly, it can lead to a sensation of fullness or pressure in the ear, which may also contribute to dizziness.

Garamycin Nasal Wash and Its Effects
Garamycin (gentamicin) is an antibiotic that can be used topically, including in nasal washes, to treat infections. While it is effective against certain bacteria, it is important to note that gentamicin can have ototoxic effects, particularly when used inappropriately or in excessive amounts. Ototoxicity refers to damage to the inner ear, which can lead to hearing loss, tinnitus (ringing in the ears), and balance issues.

In your case, the use of Garamycin nasal wash could potentially contribute to your symptoms, especially if it is being absorbed systemically or if it is affecting the Eustachian tube's function. The fact that you have a history of chronic sinusitis and have been using this treatment for an extended period raises concerns about the cumulative effects of the medication.

Potential Causes of Your Symptoms
1. Eustachian Tube Dysfunction: This is a common issue, especially in individuals with chronic sinus problems. If the Eustachian tube is not opening properly, it can lead to a feeling of fullness in the ear and dizziness.

2. Ototoxicity: As mentioned, prolonged use of gentamicin can lead to ototoxicity, which may explain the ear pressure and dizziness you are experiencing.

3. Neurological Factors: Given your history of neurological issues, including multiple nerve-related symptoms, it is possible that your dizziness is multifactorial. The interaction between your neurological condition and ear-related symptoms could be contributing to your overall experience.

4. Sinus and Ear Infections: Chronic sinusitis can lead to secondary infections in the ears, which may also cause pressure and dizziness.

Recommendations
1. Consult an Ear, Nose, and Throat (ENT) Specialist: Given your symptoms and history, it is crucial to have a thorough evaluation by an ENT specialist. They can perform a detailed examination, including audiometry and tympanometry, to assess your ear function and determine if there is any fluid buildup or Eustachian tube dysfunction.

2. Review Medication Use: Discuss the use of Garamycin with your healthcare provider. They may recommend alternative treatments that do not carry the same risk of ototoxicity.

3. Consider Imaging Studies: If your symptoms persist, your doctor may recommend imaging studies, such as a CT scan, to evaluate for any structural issues in the sinuses or ears.

4. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing the issue.

5. Hydration and Humidification: Ensure you are well-hydrated and consider using a humidifier, especially in dry environments, to help maintain moisture in your nasal passages.

Conclusion
In summary, while Garamycin nasal wash may be beneficial for treating certain infections, it is essential to be aware of its potential side effects, including ototoxicity. Your symptoms of ear pressure and dizziness warrant further investigation by an ENT specialist to rule out Eustachian tube dysfunction, ototoxicity, or other underlying conditions. By addressing these concerns with your healthcare provider, you can work towards finding an effective treatment plan that alleviates your symptoms and improves your quality of life.

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