Patient's Query
Hi doctor,
I had a sinus problem that was resolved two months ago. Since then, I have been experiencing autophony in one ear for the past two months. I used to clench my jaw a lot during the sinus issue, and now have some jaw pain.
All my audiometry and pressure tests are normal, and there are no issues with my MRI.
Please help.
Hi,
Welcome to icliniq.com.
Autophony can be caused by a patulous Eustachian tube. It is more common in females, those with hyperthyroidism, sudden weight loss, and post-pregnancy. Since you had a sinus infection, it may have masked the Eustachian tube issue, and you did not experience this problem before.
Ringing sounds (not autophony) can also be related to jaw problems, but this typically comes with ear pain. If you have pain in your jaw or ear while eating, you can try applying a hot compress to your jaw area and eating a soft diet. Also, try eating on the other side for a few days.
The tests you underwent may not detect a patulous Eustachian tube. To diagnose this condition, you should undergo diagnostic nasal endoscopy and nasopharyngoscopy. Treatment will be based on these results. Without a confirmed diagnosis, we cannot suggest any specific treatment.
I hope this has helped you. Please feel free to reach me again, in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
But, I have never had this problem before. Does sinus cause patulous tube?
Hi,
Welcome back to icliniq.com.
No, sinus issues do not cause any problems with the Eustachian tube. If you have an autoimmune disease such as hyperthyroidism, or if you have recently experienced pregnancy or sudden weight loss, these could cause a patulous Eustachian tube.
Sometimes, it is idiopathic, meaning there is no known cause for it. I would advise you to get an endoscopy.
Please revert with the report.
Patient's Query
Hi doctor,
Thank you for the reply.
I got scheduled for endoscopy. I will get back to you once it is done.
Hi,
Welcome back to icliniq.com.
Good. Please go ahead and revert back with the report.
Patient's Query
Hi doctor,
Here is my endoscopy report. The doctor told me that it does not show signs of PET. Can you suggest what else could it be?
Hello,
Welcome back to icliniq.com.
The endoscopy report seems to be normal. However, only if we compare eustachian tube orifices of both sides, then can we arrive at some inference. Also, we must have a video of nasopharyngoscopy during swallowing.
Only such a video can help us see if the eustachian tube orifice opens only while swallowing or it stays open even after that. As a trial basis, we can start you on Potassium iodide nasal drops or local estrogen drops. These are local, non-surgical treatment for the patulous eustachian tube.
However, Potassium iodide can be started only after a short work-up of your blood profile. The drops act locally to produce some congestion at the Eustachian tube orifice. Autophony is a problem difficult to tackle. In some patients, even after adequate treatment the symptoms do not recede.
A recent approach to treating PET is paper patching of the tympanic membrane. This is a novel approach whereby we place a thin paper of a particular make over the tympanic membrane, which prevents autophony and abnormal movements of the ear drum due to a patulous eustachian tube problem.
You can reach me at icliniq.com.
Thank you for consulting me.
Patient's Query
Hi doctor,
Thank you for the reply.
Can I start using estrogen drops even if I am not sure about PET?
Hello,
Welcome back to icliniq.com.
For the diagnosis of patulous eustachian tube you required to do the following tests:
If you can share the reports of the above two, then we can categorically say whether it is PET that is causing you the trouble. Starting estrogen drops without an adequate diagnosis may not be a good idea. Some other local applications that have some benefits are Hydrochloric acid, anti-cholinergics and Potassium iodide drops.
Do revert back to me with the above two reports and then we can proceed further in managing this.
Patient's Query
Hi doctor,
Thank you for the reply.
I am writing to you again as the autophony has improved, but I am now experiencing resonance in my nose and ear.
I hear my voice very loudly in one ear, and it seems to be traveling through my nose. There is no ear fullness or pain. I had an MRI done, which shows polyps in the maxillary sinus.
I am attaching the report. I also feel pressure on the bridge of my nose and pain around my right jaw. A TMJ X-ray, assessed by the dentist, shows a slight dislocation on the right side.
I also had an NCV (nerve conduction velocity) test, which indicated early Bell's palsy in the right ear. Could you please advise on what might be causing the echo? I have three specific concerns:
Additionally, my IgE levels are at 1000.
Hi,
Welcome back to icliniq.com.
I understand your concern.
You have a problem in your sinus that is a polyp, for which I presume you are already on treatment, that is, local steroid spray, etc. Have you been advised of any surgery? The polyp will not cause autophony.
Yes, it blocks the tube and causes pain in the ear and a ringing sensation but not autophony. According to me you do not have any problem in TMJ. Do you have any symptoms or pain while chewing? No bells palsy.
Reports within normal limits (attachment removed to protect the patient's identity). And also, for the test to be positive, it should be done within three days to one week of symptoms. Treatment for Bell's palsy is oral steroids for two to three weeks.
So are you taking oral steroids? Yes, your IgE levels are very high, which is causing polyps. But allergy again does not cause autophony but ringing in the ears.
Patient's Query
Hi doctor,
Thank you for the reply.
There are a few things that are happening. Sensitivity to sound in one ear is a lot. Sometimes when I am talking, I feel pressure on the nose bridge or as if something is getting stuck there.
My ear drum feels vibratory while talking, and of late, I have got a little buzzing sound in the ear, especially in a quiet room. In noisy or not very quiet surroundings, I do not get the noise in my ears.
Currently, I am only using Duonase nasal spray twice a day. Does polyp in the maxillary sinus also cause resonance? I have been taking the nasal spray for weeks now, but no response, so should I talk to my doctors about removing them?
I am not taking any oral steroids for the slight palsy, but should I be taking something else? Also, my jaw feels stiff some days and hurts a little. I also hear some clicking sometimes sounds while eating. What out of all this could be causing the ear problem, and how do I fix this?
Kindly prescribe any medication if necessary.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Pressure over the nose is due to sinusitis or deviated nasal septum. Steroid spray is effective in sinusitis or polyps. Should use for at least a month and then notice.
You will have to take spray even after surgery because recurrence is high. Clicking in the ear and buzzing is due to sinusitis and jaw stiffness. To reduce jaw stiffness, do hot fomentation.
There are a few exercises for it. And have a soft diet. Chew food from the side which is not stiff. Sensitivity is different. Maybe you are not able to differentiate between two symptoms.
I think for the ear problem, you should wait once the nose and jaw problem subsides. It might get reduced on its own.
Steroids for Bell's palsy are effective only if you take them early. Since you are unaware of the onset, I will not advise you to take it.
Patient's Query
Hi doctor,
Thank you for the reply.
This helps as it helps me identify most of my symptoms as sinusitis. There is no feeling of blockage in the ear, though. And some sounds hit hard and are louder than usual in the affected ear.
So this is all sinus. Also, this problem has been going on for more than two months, right after I got a bad sinus attack where my ears and chest were fully clogged. Both feel free of blockage, but the ear echo and sound sensitivity have persisted.
Does it usually take this long for sinuses to heal?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Let your sinus symptoms subside then we can decide about the ear. Take steroid spray. If it does not subside, you have to undergo surgery. Take spray for a month.
Patient's Query
Hi doctor,
Thank you for the reply.
My hearing test shows an AD-type curve, and the doctor said it indicates a hypermobile TMJ. Could this be causing my ear problem? My ear is very sensitive to sound, and I feel the eardrum vibrate when I talk. If so, how can this be fixed?
I am attaching the reports.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Yes, that can be the cause. AD type of curve is seen when there is an ossicular discontinuity. That is, ear bones are not synchronizing well. But you told me before that your audiometry and all pressure tests are normal.
Did you not get tympanometry done before? Audiometry for some doctors (including me) means both pure tone audiometry and tympanometry (impedance audiometry). Kindly attach your pure tone audiometry report also.
Patient's Query
Hi doctor,
Thank you for the reply.
I am attaching the other hearing test I got done. However, there is no hearing loss that I am experiencing. Also, could This be something that the sinus triggered? Because it all started after the sinus attack. And is ossicular discontinuity something to worry about? Does it fix itself?
Hi,
Welcome back to icliniq.com.
I understand your concern.
A sinus infection does not cause any ossicular discontinuity. However, if it is for a long time, you can get an ear infection. Kindly attach your report and also get repeat tympanometry done.
The ossicular discontinuity cannot recover by medicines. We need to get HRCT temporal bone done to see your ossicles. If repeated, tympanometry again shows an AD-type curve.
Get repeat pure tone audiometry also. If high resolution computed tomography (HCRT) also shows ossicular discontinuity, then exploratory tympanotomy is required.
Patient's Query
Hi doctor,
Thank you for the reply.
I am attaching the audiometry reports. These were done at the same time as the tympanometry. Is an AD-type curve always associated with hearing loss? If not, in what cases does it occur without hearing loss? Also, does surgery completely cure this?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Get a repeat of tympanometry and pure-tone audiometry. Hearing loss is not always present, but knowing the status of your hearing is essential. If the repeat tympanometry shows an AD-type curve, get an HCRT of the temporal bone done.
Based on that, further management will be planned. Without a CT scan, it is difficult to determine the success rate of the surgery.
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Answered byDr. Mehak Agarwal
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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