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

Hi,

Welcome to icliniq.com.

I can understand your concern.

I had a detailed look at the CT (computed tomography) and MRI (magnetic resonance imaging) reports (attachments removed to protect the patient's identity), and they both are unremarkable. 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 three drops of decongestant nasal drops containing Oxymetazoline or Xylometazoline 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. Do Valsalva exercises.

4. Do steam inhalation three to four times a day.

5. Refrain from using 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 Fluticasone propionate and Azelastine (Duonase) nasal spray, two puffs in each nostril two times a day for six weeks.

9. Do 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 foods, 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 since there is absolutely nothing and this is a very common treatable entity that we come across.

I hope this helps. Do get back if you have any further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

Glad to have you back.

There will be tightness or heaviness anywhere below the ear along the jaw or neck up to the collarbone, 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, as 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.

Hi,

Welcome back to icliniq.com.

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 appropriately and adequately. A basic MRI can pick up any 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 there is nothing major out there, and things should be fine with the mentioned treatment and precautionary measures as discussed earlier.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

Glad to have you back.

There is absolutely nothing that you need to worry about. A CT scan usually picks up the minute details. I am quite certain that there should be nothing out there that points towards cancer or malignancy of the throat and associated regions. Please do not search anything related to your symptoms on the Internet as half the information on the Internet tends to increase your anxiety levels and does no good. Please do not worry as far as this aspect is concerned.

You can stay on regular follow-up and let me know if there is anything that I can help you with.

Thank you.

Hi,

Welcome back to icliniq.com.

Thanks for briefing me regarding the problem. The general advice that I give to all my patients is to refrain and avoid cleaning your ears on your own. The reason behind this is that cleaning your own ear increases the possibility of traumatizing delicate structures inside your ear canal which can be catastrophic in the long run. In your case, Carbamide peroxide (Debrox) itself is a horrible irritant to the ear canal and ear drum, and in the absence of wax, it causes inflammation over the ear drum which may not be very conspicuous to the person examining in the emergency.

If you have been able to hear properly, the possibility of perforation is very unlikely. The eustachian tube has no involvement here unless you have been having a feeling of a blocked ear prior to the use of Carbamide peroxide (Debrox). For now, you can consider taking the tablet Sinarest (a combination of Phenylephrine, Paracetamol, and Chlorpheniramine) one tablet in the morning and evening after food for 10 days. This may create little drowsiness and if it does in your case, you can take one tablet at night. As previously mentioned, kindly refrain from using anything to clear your ear. If you feel that there is wax accumulated or impacted, you can use wax dissolvent drops and then get it removed under vision via suction by a specialist.

I hope this answers your query. Do let me know if there is anything more that you need to know or want to enquire about.

Thank you.

Thank you.

Hi,

Welcome back to icliniq.com.

1. If there has been some inflammation in the ear drum or retraction due to middle ear negative pressure, a dull hue with the absence of a cone of light over the drum can be seen. This can cause some feeling of blocked ear or fluid accumulation, but the examiner will not find anything as such in the ear canal. Drops have little effect and do give mild relief.

2. A perforation if present cannot be missed if examined properly with an otoscope using a good bright light source. Besides, if there was a perforation, you will notice a sudden loss of hearing which I doubt is present in your case.

3. The auditory nerve and vestibular nerve are located at a much deeper level and have no possibility of being damaged with cleaning as such.

4. You can take any of the drugs mentioned in our previous conversation. It can be taken separately. A slightly less effective alternative is the tablet Allegra-M, (a combination of Fexofenadine 120 mg and Montelukast 10 mg) which has to be taken once in the morning and another in the evening after food for 10 days. There is absolutely nothing that you need to worry about. Things should be fine in 10 days' time.

I hope this helps. Do let me know if there is anything that I can help you with.

Thank you.