Nasal and Ear Symptoms: When to Seek Further Evaluation

Q: Nasal and Ear Symptoms: When to Seek Further Evaluation

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

Nasopharyngeal-related issues?

Hello Dr.
Chi,
I have been experiencing issues with allergic rhinitis and post-nasal drip, with my nasal discharge being clear.
About three months ago, I noticed blood streaks when I coughed up mucus after waking up one morning (this happened only once).
In the past month or two, I have occasionally felt a sensation of ear fullness, tinnitus, and headaches, all of which are unilateral and on the left side.
I visited a clinic, and the physician diagnosed me with sinusitis.
An otoscopic examination confirmed that there was no otitis media.
After taking medication, I noticed significant improvement in my post-nasal drip symptoms, but the unilateral tinnitus, ear fullness, and headaches persist.
These symptoms have not occurred before.

I would like to know if typical allergic rhinitis can cause ear and headache symptoms, or if this is more indicative of another condition (such as nasopharyngeal carcinoma).
Would you recommend undergoing a more comprehensive nasopharyngoscopy at a major hospital? Thank you!

Ya, 30~39 year old female. Ask Date: 2022/06/20

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 (such as colds) and sinusitis, and in severe cases, there may be ear discharge.
b) Chronic otitis media with acute exacerbation: This 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 appropriately treated with medication after consulting a physician.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where sounds are presented and you respond by pressing a button, rather than just using a tuning fork), and it has been confirmed 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 examination to rule out sudden hearing loss, as the optimal treatment window for sudden sensorineural hearing loss is within two weeks, and early treatment yields better results.

Regarding your description: There are many causes of nosebleeds, the most common being thin nasal mucosa leading to bleeding from forceful nose blowing.
However, other potential causes include nasopharyngeal or nasal cavity tumors (such as nasopharyngeal carcinoma), sinusitis, fungal infections, allergic rhinitis, hypertension, coagulopathy, and nasal trauma, among others.
It is recommended to consult an otolaryngologist for examination.
If oral medication is not effective, you may also consider cauterization of the bleeding nasal vessels using medication or laser treatment.
Wishing you safety and good health.

Reply Date: 2022/06/20

More Info

Hello! Thank you for sharing your symptoms and concerns regarding your nasal and ear issues. Based on your description, it seems that you have a history of allergic rhinitis and post-nasal drip, which can indeed lead to various complications, including ear and head symptoms.
Allergic rhinitis is characterized by inflammation of the nasal mucosa due to allergens, leading to symptoms such as nasal congestion, runny nose, and sneezing. The post-nasal drip you mentioned occurs when excess mucus accumulates in the back of the throat, which can cause irritation and lead to coughing or throat clearing. This condition can also affect the Eustachian tube, which connects the middle ear to the back of the nose and throat. When the Eustachian tube is not functioning properly, it can result in a sensation of ear fullness or pressure, tinnitus (ear ringing), and even pain.

Your experience of unilateral (one-sided) symptoms, particularly the ear fullness, tinnitus, and headaches, raises some important considerations. While allergic rhinitis can contribute to these symptoms, the presence of blood in your mucus and the persistence of your ear symptoms despite treatment warrant further evaluation.
Here are some potential causes for your symptoms:
1. Eustachian Tube Dysfunction: This is a common issue in individuals with allergies or sinus problems. It can lead to a feeling of fullness in the ear, tinnitus, and sometimes even pain.
2. Sinusitis: Chronic sinusitis can lead to inflammation and infection that may affect the ears, causing similar symptoms. The fact that you have experienced improvement with medication suggests that this could be a contributing factor.

3. Nasal Polyps: These are growths in the nasal passages that can result from chronic inflammation, often seen in individuals with allergies. They can obstruct airflow and drainage, leading to further complications.

4. Other Conditions: While less common, conditions such as tumors (including nasopharyngeal carcinoma) can present with similar symptoms, especially if there is unilateral involvement. However, this is less likely given your history of allergic rhinitis and the nature of your symptoms.

Given your concerns, especially regarding the blood in your mucus and the persistence of your symptoms, it would be prudent to seek further evaluation. A referral to an otolaryngologist (ENT specialist) for a comprehensive examination, including a nasal endoscopy, would be advisable. This procedure allows for a direct view of the nasal passages and sinuses, helping to identify any structural issues, polyps, or other abnormalities.

In summary, while your symptoms may be related to your history of allergic rhinitis and sinus issues, the presence of blood and the persistence of your ear symptoms suggest that further evaluation is warranted. An ENT specialist can provide a thorough assessment and recommend appropriate treatment options based on their findings. It's essential to address these symptoms promptly to prevent potential complications and improve your quality of life.
I hope this information helps, and I wish you the best in finding relief from your symptoms!

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