Q. I have hyperacusis in left ear with pressure and pain in the ear and mandible. What is my problem?

Answered by
Dr. B. Vageesh Padiyar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 14, 2021

Hello doctor,

I had a full audiogram four months ago, and it was normal. An MRI of the head with and without contrast and a CT scan of the neck (which included the brain's portion above the orbits with and without contrast) are also normal. These tests were done due to hyperacusis in the left ear, pressure in the right ear and under the right ear, and under the right mandible. I still have some symptoms, and due to health anxiety, I just wanted to ask if there was an issue with the facial nerve or brain that the MRI and CT would fail to pick up? Do I have a facial tumor?



Welcome to

I had a detailed look at the CT and MRI reports, and they both are unremarkable (attachment removed to protect patient identity). The smallest lesion involving the facial nerve anywhere from the brain stem (where it originates) along its entire course can be identified on MRI and CT. There is absolutely nothing that you need to worry about the tumor involving the nerve or the brain.

You have probably developed what we call eustachian tube catarrh, which has developed secondary to subclinical nasal inflammation or allergy.

The eustachian tube ventilates the nose and the ear. In a situation where it does not function, a negative pressure develops in the ear's side, leading to a feeling of vacuum, ringing sounds, feeling of fluid in the ear, and sometimes decreased hearing. (which may or may not be present).

This can be treated by attempting to open the tube by the following advice.

1. Use decongestant nasal drops containing Oxymetazoline or Xylometazoline three drops three times a day for one week. This decongestant can open the tube through the nose.

2. Take a tablet containing a combination of Phenylephrine and Levocetirizine, one tablet two times a day after food 12 hours apart for one week.

3. Doing Valsalva exercises.

4. Taking steam three to four times a day.

5. Refrain from the use of earbuds.

6. Avoid having anything cold or spicy for the next two weeks.

7. Please take care to avoid dust exposure. All nasal allergies have to be treated in a proper manner, failing which the catarrh will recur.

8. You can consider using Duonase nasal spray, two puffs in each nostril two times a day for six weeks.

9. Saltwater gargles eight to ten times for the next ten days.

10. Refrain from smoking and alcohol consumption.

11. Maintain a strict diet. Avoid spicy, oily, cold food, and beverages.

12. Consider taking an antacid, one tablespoon three times a day, one hour after meals for the next ten days.

This typically takes around one to two weeks for things to settle down.

You need to worry about absolutely nothing as this is a very common treatable entity that we come across.

I hope this helps.

Thank you doctor,

I did want to follow up and ask about the pressure and tightness. It is not just within the ear. It radiates along the right jawline, almost where the parotid gland is, and then goes under the mandible, almost where the subliminal salivary gland is. Again the CT found no inflammation in these areas. They even did an ultrasound of my neck before the CT, and it was normal. But is it possible that this is just muscle tension due to stress or anxiety? Or would this also be due to the negative pressure with the ear? I do not get that deep pressure feeling in my ear anymore, but still, I get this tightness feeling on the right side under the ear lobe and my right side of my mouth. I have no trouble swallowing and no sore throat at all. It seems to be intermittent and does not happen all day. My psychiatrist thinks it could be almost like a globus sensation that is not in the middle of the throat but more towards under the jaw or back of the throat and the side near the ear. I wanted to get your thoughts on this, as well.



Welcome back to

There will be tightness or heaviness anywhere below the ear along the jaw or neck up to the collar bone, and the site may vary from time to time. The reason behind this is the referred pain sensations due to common nerve innervations. A CT scan cannot pick up an ongoing eustachian tube or minor inflammation in the throat.

You might also be having GERD with LPR (gastroesophageal reflux with laryngopharyngeal reflux), which could be contributing to the tightness in the areas you have mentioned above. Muscle tension can also be associated with stress and anxiety.

Overall, the reasons for the problem could be multifactorial, and each cause should be treated together for maximum benefit. As far as GERD is concerned, there should be a proper dietary measure taken, mentioned in our previous conversation.

The globus sensation is mostly attributed to GERD with LPR. It takes around four to six weeks for the symptoms to resolve if the precautionary measures have been taken properly.

I hope this answers your query.

Thank you doctor,

Could residual symptoms of eustachian tube dysfunction still happen even if my ENT did the audiogram and checked for fluid/pressure, but it did not pick up anything? My ENT told me some negative pressure can still happen that can be felt. And stress and anxiety could also be a factor, like you said. He also said the MRI would have picked up on anything in the auditory canals if there was anything of concern, but it was normal. But as far as anything major, a normal MRI neck and CT would have detected anything, I assume correct?



Welcome back to

Symptoms of Eustachian tube catarrh are not always picked up in the tympanometry. If there is a significant fluid collection that is way more than normal, it does show up in the test. Similarly, a lesser functioning eustachian tube may not be picked up in the routine tympanometry unless there is a major glitch in the eustachian tube.

The patient might often be symptomatic (feeling of pressure, fluid, and ringing sensation) with a negative tympanometry or radiology report. I would want to treat the condition still appropriately and adequately.

A basic MRI can pick up any related anatomical problem related to the eustachian tube but does not show if it is functioning adequately in real-time unless a dynamic serial MRI has been done. Anything major would have been definitely picked up in the CT or MRI scans. Since they are all normal, I feel nothing major out there, and things should be fine with the mentioned treatment and precautionary measures discussed earlier.

I hope this helps.

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