I have fluid in my middle ear. Is there any way to clear it?

Hello,

Welcome to icliniq.com.

Fluid in the middle ear is called serous otitis media (glue ear or otitis media with effusion). What we do in such patients is give medical management (antibiotics, decongestants, mucolytics, nasal sprays) and if it fails we go for myringotomy and grommet insertion. Myringotomy involves making a small cut in a portion of the tympanic membrane, sucking out the fluid and then insertion of pressure equalization tube (ventilation tube = grommet) which stays for few months and then comes out by itself.

Coming to your problem, the symptoms of giddiness or off balance are common with fluid in the middle ear. A decisive diagnosis requires a demonstration of fluid inside using a tympanometry test. This test measures the compliance of the middle ear at different pressures and when there is fluid the compliance is blunted. It gives a B-type curve in the tympanogram. Clinically we see using an otoscope that the drum is bulged out, the typical landmarks are obscured, the cone of light is distorted and sometimes we even see bubbles. Additionally, in history, there is some fullness of the ear, hearing loss, dizziness, lightheadedness, gurgling sounds inside the ear, etc.

If you were to come to me, I would be doing a full clinical ENT examination and then do a tympanometry test. Complete ENT examination helps us to rule out conditions in nose and throat that could have caused this fluid collection. In your case, thus, I would advise that you go to an ENT and get your ears checked by an otoscope or otoendoscope. Such an examination also rules out any other pathology that may be masking as fluid in the middle ear. If your GP had done otoscopy and then made the diagnosis, then I would suggest to you to get the tympanometry test done. Normally, fluid from middle ear gets drained to the back of nose via the eustachian tube, that also functions to equalize pressure on both sides of the eardrum.

Eustachian tube block or catarrh results in malfunction of the tube resulting in reduced ventilation of the tube consequent negative pressure which sucks out fluid into the middle ear. An obstructed tube will reduce the drainage of normally produced mucus and cause collection. I hope this helps you. Let me know what medicines you are on. If getting the test is difficult, you may take the medicines for two weeks and then see for improvement and decide about the test then. It does take some time to resolve. But six weeks is a long time. Either the medicines are not working or are inadequate. Or there may be some physical block or growth in the back of the nasal cavity. This would require a nasoendoscopy or radiological investigation. Such a thing will cause additional nasal symptoms (block, running nose, headache, facial pressure, facial pain, reduced sense of smell, postnasal drip).

Do revert back with all details and we shall help you with the right advice. If you share the details of the medicines you are taking, I shall check if they are fine.

Hello,

Welcome to icliniq.com.

TMJ (temporomandibular joint) problem and grinding of teeth will not affect the functioning of the tube. The GP has indeed looked through the otoscope which does appear like the instrument you described. So I am reasonably sure that the diagnosis he has made is correct.

Fullness, tickling feeling, feeling of movement, etc., are indeed symptoms of fluid inside the middle ear. The outer ear (where you apply oil) is separated from the middle ear by an intact eardrum (ensured by otoscopy by your GP, if it were not intact he would have been given a different treatment). Such a separation will render oil application useless, maybe some psychological relief it afforded to you then. It will not worsen (same reason, that the drum is intact, although maybe bulged out due to the fluid inside it).

I shall give you some suggestions regarding medicines. If you have completed the course of antibiotics then there is no need for fresh antibiotics now. Continue the Nasonex nasal spray (Mometasone). It is a locally acting steroid that reduces the inflammation inside the nose and nasopharynx), take two puffs from each side twice daily. Follow the instructions properly while spraying, as given in the pamphlet. Take the spray for two weeks. It can be taken for months also, but I would want to review you at the end of two weeks.

I suggest taking Fexofenadine 120 mg (Allegra/Fexy/Fexidine) once in the evening for two weeks. This will remove any allergic inflammation and edema inside the tube or middle ear. Also, capsule Mucolite 30 mg (active ingredient is Ambroxol hydrochloride) twice daily before food. This reduces the tenacity of mucus and helps it out of the tube. Take it for a week and make it once daily after that. If within a week no improvement take it thrice daily for the second week. Tablet Singulair 10 mg (active ingredient Montelukast) once in the morning for two weeks. Also acts to reduce allergy and edema. A combination of Trypsin-Chymotrypsin-Bromelain-Rutoside or a few of these ingredients. These will also reduce the inflammation inside the ear and tube.

Steam may be used once daily. Do not overdo the steam as it can cause worsening allergy and sinus symptoms. If you have not found improvement with steam till now, I would say stop it. Do not close the nose and blow air into the ears. This will push any remaining sinonasal infection and secretions into the ear and that is not what we want now. Once you are free of all inflammations, you may do this maneuver (Valsalva). If you do not find improvement in two weeks, then we need to do:

1. Nasal endoscopy.
2. Tympanometry.
3. Pure tone audiogram.

Do follow these instructions and let us know the progress.