I have constant headaches, dizziness, tinnitus, and a sore throat. I have left-sided ear fullness, swollen lymph nodes, and a sensation of mass lateral to the left ear. I recently had an ultrasound of lymph nodes, and I am awaiting results. My blood reports are normal, and I am currently under the medication Citalopram. I was also infected with Epstein-Barr and herpes virus. I got an MRI scan done, but I am yet to get an opinion from an ENT. I have attached a copy of the reports below. I am worried about cancer. This has been going on for four years, and no treatment has helped. Can you please help me with the diagnosis?
Welcome to icliniq.com.
Thanks for briefing me regarding the problem. I had a look at the three MRI (magnetic resonance imaging) pictures you have sent (attachment removed to protect the patient's identity). However, we would like to see all the scan views (both axial and coronal) that are available. You can send us the report as well.
Two issues could be responsible for the symptoms you are facing.
The first issue, eustachian tube catarrh. This could have developed secondary to nasal inflammation or allergic pharyngitis. The eustachian tube ventilates the nose and the ear. In a situation where it does not function, a negative pressure develops in the side of the ear leading to a feeling of vacuum, tinnitus, dizziness, feeling of fluid in the ear, and sometimes decreased hearing. You might not develop all the symptoms mentioned above, and for now, you might be just having trouble ventilating the ear. This can be treated by attempting to open the tube with the following advice.
1. Using decongestant nasal drops containing Oxymetazoline or Xylometazoline, three drops thrice a day for one week. This decongestant is given to access the opening of the tube through the nose.
2. 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 (you can follow a video on YouTube for the same).
4. Taking steam 3 to 4 times a day.
5. Refrain yourself from the use of earbuds.
6. Please avoid dust exposure. All nasal allergies have to be treated properly, failing which the catarrh will recur.
7. You can consider Duonase (Fluticasone propionate + Azelastine HCl) nasal spray or its equivalent. Two puffs in each nostril, two times a day for six weeks.
9. Saltwater gargles 8 to 10 times for the next ten days.
10. Refrain from smoking and alcohol consumption.
This typically takes around 1 to 2 weeks for things to settle down. Once the nasal inflammation has settled down, the negative pressure in the ear will slowly reduce, and its associated symptoms will disappear.
The second issue could be GERD (gastrointestinal reflux disease) with LPR (laryngopharyngeal reflux). The most common reason for having this irritation in the throat with a feeling of a lump or something obstructing while swallowing saliva. It could be a feature of chronic silent GERD with LPR. Even though you might be asymptomatic or never have gastric issues in between, the inflammation in the throat often exists in the hidden form and can resurface when adequate care is not taken. Why does hidden acid reflux become so problematic? The stomach usually has got cells that release hydrochloric acid and thus keep the gastric environment acidic. Your entire mucosal lining from the mouth, throat, and food pipe (esophagus) is not meant to handle anything acidic. Of the three structures, the throat is the most sensitive due to its rich nerve supply. If in a given situation, your mouth, throat, or food pipe chronically comes in contact with acidic contents, an inflammation starts which the body initially takes care of, but once this compensation wears out, you start developing symptoms that you have mentioned.
Please try to follow the advice mentioned below.
1. Maintain a strict diet, eating on time.
2. Avoid spicy, oily, and cold food or drinks.
3. Keep a gap of two hours between meals and before bed.
4. Do not overeat, instead keep your stomach half empty and have regular intermittent light food like fresh-cut fruits in between main meals.
5. Saltwater gargling 8 to 10 times a day for 15 days.
6. Avoid alcohol and smoking as it can potentiate reflux.
7. Try to maintain a left lateral position while sleeping to reduce the chance of reflux.
1. Tablet Pan-D (Pantoprazole) 40 mg, once in the morning before breakfast for one month.
2. Syrup Mucaine gel (Oxetacaine + Aluminium hydroxide + Milk of magnesia) or its equivalent. One teaspoon, three times a day, 20 minutes before meals for one month.
Ensure you follow the precautionary measures as much as possible, as mere medications will not fetch long-term relief. Please understand that this typically takes 4 to 6 weeks for things to normalize and symptoms to subside. It chiefly depends on how much you have been able to follow the precautions mentioned above, as 80 % of the treatment lies there. There is absolutely nothing that you need to worry about as this is a treatable entity, and things will be fine. Your symptoms are doubtful to be cancer-related. However, we would like to have a look at the scans in detail. Let us know what they have reported in your MRI. The lymph nodes in the neck could be reactive due to chronic inflammation in the throat. It is not something to be worried about unless there is a progressive increase in the size and appearance of the lymph node.
I hope I have answered your query in detail.
If there is anything more you need to know, please let us know, and we will get back as soon as possible.
Thank you very much for your detailed reply. It was incredibly helpful.
I have uploaded a copy of my MRI file and the other two reports.
Welcome back to icliniq.com.
Thanks for getting back to us.
I had a detailed look at the scans you have sent (attachment removed to protect the patient's identity). There is evidence of some sinus inflammation which has been responsible for the eustachian tube catarrh, causing the ear symptoms you earlier mentioned.
The rest of the reports look unremarkable to me, and there is nothing significant that you need to worry about. Please try to follow all the instructions and advice mentioned. I am sure with time, the symptoms should come down, and you should be fine.
Please do let us know if there is anything more we can help you with. We will try to revert to you as soon as possible.
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