Persistent Ear Ringing and Nasal Issues: A Comprehensive Guide

Q: Persistent Ear Ringing and Nasal Issues: A Comprehensive Guide

Response： A1： An active magnetic resonance angiography and carotid duplex ultrasound examination can be performed. <br>A2： It is recommended to consult the ENT department and the neurology department. <br>Director Yeh Da-Wei of the ENT department at Hsinchu Hospital.

Incurable disease?

Hello! I often use the computer and maintain a hunched posture.
Two to three years ago, I started experiencing persistent tinnitus in my left ear (the sound is louder at night and less noticeable during the day, but I can still hear it if I pay attention).
I also hear a sound like water being squeezed out when I exhale at the top of my left neck.
A year ago, I frequently felt stiffness on the left side of my neck while sleeping, and I started to have mild tinnitus in my right ear as well.
I feel pressure in my head (especially at the junction of the upper neck and head), severe daytime sleepiness, and when I slightly exert force to rinse my nose, it often results in blood spots.
When I traveled abroad, I had nosebleeds for two weeks (every morning I would wake up with dark-colored blood in my nose)! I consulted a doctor who said I had a cyst in my nasopharynx (which was found to be benign).
However, I still frequently noticed blood streaks in my nose.
I then visited Chang Gung Hospital, where the doctor informed me that I had a severely deviated septum and swollen nasal mucosa.
After undergoing surgery, my daytime sleepiness significantly improved, but other symptoms persisted.
My nose still bleeds easily.
I have also seen neurologists and orthopedic specialists for my neck, and I underwent CT scans of my head and neck as well as X-rays of my neck, but the doctors said there were no issues.

I gradually discovered that my nasal swelling is primarily on the left side of the inferior turbinate.
If I become a bit anxious, I sometimes feel a sensation of pressure that feels like it might burst, which is similar to symptoms in my neck or extending to the top of my head.
However, this sensation changes with my movements and exertion (relaxation).
Occasionally, it appears on the right side or in the nasal septum or the upper sinus area, as well as deep in my nose near the throat.
As long as I relax or chew something, the nasal swelling symptoms lessen.
I now understand that I need to slightly relax my nose to prevent bleeding.
When my left nostril swells and I do not relax, exerting force can easily lead to bleeding.
My gums also bleed easily.
I feel like there is a sensation of high blood pressure, but I do not have hypertension.
Now, when I sleep, I often feel tension in my neck that is hard to relax (it feels like I am constantly pushing against the pillow), making it difficult to fall asleep.
Relaxation does not significantly alleviate these symptoms, nor does it completely eliminate the tension in my head and neck; it only helps to reduce it.
I feel that this may be related to blood circulation.
Have I undergone enough tests (the normal CT scan of my neck indicates that I likely do not have vertebral artery or vascular compression)? Or do I need to undergo magnetic resonance angiography? Which specialty should I consult for my situation? I have taken muscle relaxants, but they have not helped.

Azheng, 30~39 year old female. Ask Date: 2011/03/18

Dr. Ye Dawei reply Otolaryngology

Response: A1: An active magnetic resonance angiography and carotid duplex ultrasound examination can be performed.
A2: It is recommended to consult the ENT department and the neurology department.
Director Yeh Da-Wei of the ENT department at Hsinchu Hospital.

Reply Date: 2011/03/18

More Info

It sounds like you are experiencing a complex set of symptoms involving persistent ear ringing (tinnitus), nasal issues, and discomfort in your neck and head. Let's break down your concerns and provide some insights based on medical knowledge.

Understanding Your Symptoms
1. Tinnitus: The ringing in your ears, particularly in your left ear, can be attributed to various factors. Tinnitus is often associated with hearing loss, exposure to loud noises, ear infections, or even stress. Given that you have a history of nasal issues and neck discomfort, it's possible that these factors are contributing to your tinnitus. The fact that the sound is more pronounced at night may indicate that environmental noise is masking it during the day, making it more noticeable in quieter settings.

2. Nasal Issues: You mentioned experiencing frequent nosebleeds and a diagnosis of a deviated septum, which can lead to nasal congestion and increased pressure in the nasal passages. The presence of blood in your nasal discharge could be due to the irritation of the nasal mucosa, especially if you are blowing your nose forcefully or if the air in your environment is dry. Surgical correction of a deviated septum may alleviate some symptoms, but it does not guarantee the complete resolution of nasal bleeding or congestion.

3. Neck and Head Discomfort: The tightness and discomfort in your neck, particularly at the base of your skull, could be related to muscle tension, poor posture (especially if you spend long hours at a computer), or even referred pain from your ear or nasal issues. The sensation of pressure or fullness in your head may also be linked to sinus congestion or tension headaches.

Diagnostic Considerations
You have undergone several imaging studies, including CT scans and X-rays, which have not revealed any significant abnormalities. This is reassuring, but if your symptoms persist, further evaluation may be warranted. An MRI could provide more detailed information about soft tissues, including the brain and blood vessels, which might help rule out vascular issues or other underlying conditions.

Recommended Actions
1. Consultation with Specialists: Given the multifaceted nature of your symptoms, it may be beneficial to consult with an ENT (Ear, Nose, and Throat) specialist for your nasal and ear issues, and a neurologist for your head and neck discomfort. A comprehensive evaluation by these specialists can help identify any underlying conditions that may be contributing to your symptoms.

2. Management of Tinnitus: While there is no definitive cure for tinnitus, various management strategies can help. Sound therapy, cognitive behavioral therapy, and relaxation techniques may provide relief. Additionally, addressing any underlying conditions, such as nasal congestion or neck tension, may also help reduce the perception of tinnitus.

3. Nasal Care: To manage your nasal bleeding, consider using a saline nasal spray to keep the nasal passages moist. Avoid forceful nose blowing, and if you notice frequent bleeding, it may be worth discussing with your ENT specialist for potential treatments, such as cauterization of bleeding vessels.

4. Neck and Posture Management: Incorporating ergonomic adjustments to your workspace, practicing good posture, and engaging in regular stretching or physical therapy may alleviate neck tension. Techniques such as yoga or mindfulness may also help reduce stress and promote relaxation.

5. Monitoring Symptoms: Keep a diary of your symptoms, noting any triggers or patterns. This information can be valuable for your healthcare providers in determining the best course of action.

Conclusion
Your symptoms are indeed complex and may require a multidisciplinary approach for effective management. While the tests you've undergone are helpful, further evaluation by specialists may provide additional insights. Remember to communicate openly with your healthcare providers about all your symptoms and concerns, as this will aid in developing a comprehensive treatment plan tailored to your needs.

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