Ear and Nose Issues: Symptoms and Possible Solutions

Q: Ear and Nose Issues: Symptoms and Possible Solutions

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>Symptoms may be more pronounced in patients wi

Ear and nose issues?

Hello Dr.
Chi, my symptoms are as follows:
- My nose feels congested when I speak, and I also notice that I cannot breathe through my nose while sleeping at night.

- I experience tinnitus in both ears, with a decrease in hearing ability and resonance.

1.
Tinnitus: The left ear has a faint sound, while the right ear has a louder sound; when I sleep on my side, the tinnitus in the ear facing down becomes louder, and when I open my mouth, the tinnitus in the left ear also intensifies.

2.
Hearing loss: A pure tone audiometry test shows normal hearing in the left ear, but the right ear can only detect sounds above 80 dB to 90 dB, making it nearly impossible to distinguish sounds in a noisy environment.

3.
Resonance: When I speak, there is a significant echo in the right side of my skull, which changes with the volume of external sounds; the resonance sound is different from the tinnitus sound.
If I talk for an extended period, I also experience a feeling of fullness in the left side of my skull.

I would like to know what issues I might be facing and what examinations I should undergo.
Thank you.

Huang R, 40~49 year old female. Ask Date: 2022/11/14

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.
Symptoms may be more pronounced in patients with nasal allergies.
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: 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 managed with medication after consulting a healthcare provider.
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 an examination to rule out sudden hearing loss.
Regarding your statement, "My nose feels stuffy when I talk, and I also notice that I cannot breathe through my nose at night while sleeping," it is recommended to consult an otolaryngologist for further evaluation.
Wishing you good health and safety.

Reply Date: 2022/11/14

More Info

Hello! Based on your symptoms, it seems you are experiencing a combination of ear and nasal issues that could be related to several underlying conditions. Let's break down your symptoms and explore potential causes and solutions.

Symptoms Overview:
1. Nasal Congestion: You mentioned that your nose feels blocked when speaking and that you have difficulty breathing through your nose at night. This could indicate chronic nasal congestion, possibly due to allergies, sinusitis, or nasal polyps.

2. Tinnitus (Ear Ringing): You are experiencing tinnitus, with varying intensity in each ear. The left ear has a softer sound, while the right ear is louder, especially when lying down. This could be linked to issues in the auditory system, such as earwax buildup, eustachian tube dysfunction, or even noise-induced hearing loss.

3. Hearing Loss: The significant difference in hearing ability between your ears, particularly the right ear, which only responds to very loud sounds (80-90 dB), is concerning. This could indicate a conductive hearing loss, possibly due to middle ear problems, or sensorineural hearing loss.

4. Echo/Resonance: The echo you experience when speaking, particularly on the right side, suggests that there may be an issue with the eustachian tube or middle ear pressure. This can occur when the eustachian tube fails to equalize pressure properly, leading to a sensation of fullness and altered sound perception.

Possible Causes:
1. Eustachian Tube Dysfunction: This is a common issue where the tube that connects the middle ear to the back of the nose does not open properly, leading to pressure imbalances and symptoms like ear fullness, tinnitus, and hearing loss.

2. Chronic Sinusitis or Allergies: Chronic inflammation in the nasal passages can lead to congestion, affecting both nasal breathing and eustachian tube function.

3. Middle Ear Issues: Conditions such as otitis media (middle ear infection) or fluid accumulation can cause hearing loss and tinnitus.
4. Auditory Nerve Issues: If the auditory nerve is affected, it could lead to unilateral hearing loss and tinnitus.

Recommended Actions:
1. Consult an Ear, Nose, and Throat (ENT) Specialist: Given the complexity of your symptoms, it is crucial to see an ENT specialist who can perform a thorough examination. They may conduct:
- Audiometry Tests: To assess your hearing levels in both ears.

- Tympanometry: To evaluate the function of the middle ear and eustachian tube.

- Nasal Endoscopy: To visualize the nasal passages and check for any obstructions or abnormalities.

2. Allergy Testing: If allergies are suspected, testing can help identify specific triggers, allowing for targeted treatment.

3. Imaging Studies: In some cases, a CT scan of the sinuses or MRI of the head may be necessary to rule out structural issues.

4. Treatment Options: Depending on the diagnosis, treatment may include:
- Nasal Corticosteroids: To reduce inflammation and improve nasal airflow.

- Decongestants: To relieve nasal congestion.

- Eustachian Tube Exercises: Such as the Valsalva maneuver to help equalize ear pressure.

- Hearing Aids or Tinnitus Management: If hearing loss or persistent tinnitus is confirmed.

Conclusion:
Your symptoms suggest a multifaceted issue involving both nasal and auditory systems. It is essential to seek professional medical advice to obtain a proper diagnosis and treatment plan. Early intervention can significantly improve your quality of life, especially as you prepare for a career as a pilot, where clear hearing and nasal function are crucial. I wish you the best in your journey towards better health!

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