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Q. I get buzzing sound in ears for the past few days. Kindly interpret my x-ray.

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 01, 2020

Hello doctor,

I am getting a buzzing sound in my ears for the past few days. I want a reading of the enclosed x-ray.

Currently, I am on Exforge for mild hypertension.

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#

Hello,

Welcome to icliniq.com.

I have gone through your x-ray (attachment removed to protect patient identity).

Bilateral maxillary sinuses appear hazy with suspected fluid level or polyps, more likely to be polyps. Mild deviation of the septum with decreased airway in the left side of the nose. Sphenoid sinuses are aerated well. Frontal sinuses also look unremarkable.

This is the reading for the x-ray enclosed by you. The sinus condition could be the reason for the buzzing, but we will need more clinical details to give you more decisive advice.

Do revert if you need any further help or advice.

Thank you doctor,

I had visited a local ENT doctor. According to him, there is neither excess wax in the ears nor loss of hearing in either ear. It is not age-related either. The sound is in both ears as if coming from inside. Even if I close my ears with my hands, the sound is still coming.

According to him, sinus congestion could be the reason for this. It is a eustachian tube problem. He gave Otrivin drops three times a day followed by steam, and Ibuprofen 400 mg twice a day, and Claritin 10mg once at night. This treatment is for three days. What is your opinion? I have a mild chronic sinusitis problem, but it is under control. I am taking one amla tablet daily. Can I do exercise, Pranayam like Kapalbhati, Bhastrika, Anulom Vilom, which I regularly do, along with medication? I have a mild hypothyroid problem for which I am taking Ayurvedic medicine, and it is improving.

#

Hello,

Welcome back to icliniq.com.

For the buzzing sound, we need to get a Pure Tone Audiogram with impedance audiometry done. If it shows specific findings, we need a SISI (short increment sensitivity index) test too.

The above will let us understand whether the issue is due to the inner ear (as shown by elevated SISI) or due to the middle ear (a conductive loss in hearing and some pressure changes in impedance audiometry). If there is a neural loss in the audiogram without any elevated SISI, it is due to age-related nerve degeneration.

We cannot hold your sinus responsible for it unless the impedance audiometry shows it. Middle ear issues could be due to eustachian tube catarrh or block, which may occur secondary to sinus issues.

So a complete ENT examination starting with ear and including nasal endoscopy is needed. As I told you, we would first go for all the hearing tests, but one by one. We would usually avoid x-rays because, in the age of CT (computed tomography) scans, x-rays show next to nothing. The preferred investigation for sinuses are non-contrast CT scan (not x-rays or MRI), but we resort to CT only when we see something in nasal endoscopy.

I will be proceeding this way if you are coming to me. But if you are unable to do the hearing tests (PTA and impedance) due to any reason, then I would still check for signs of middle ear issues through an ear examination rather than subject you to radiation due to the x-rays.

With regards to the treatment given to you, I would say the Brufen is unnecessary. Nose drops and Claritin (Loratadine) will help with the sinus. Brufen is a strong pain killer. Continue the rest of your medicines.

Meanwhile, if you are hypothyroid, please take thyroid hormone supplements and do not follow Ayurveda. Hypothyroidism can also cause a lot of airway related issues. The upper airway, in fact, is continuous with the ear through the eustachian tube.

I hope this helps.

Thank you doctor,

I had done a tympanometry and reflex threshold measurement test. I do not know what the result was. He prescribed medication after this test and the x-ray. One day, I felt much better with this treatment, so I have decided to give this treatment a go.

I want to know whether I can do Jal neti, Pranayam like Kapalbhati, Bhastrika, Anulom Vilom, and Bhramari if you know about them, which I have been doing earlier also. I would take your advice and would start taking allopathic thyroid medication.

#

Hello,

Welcome back to icliniq.com.

Continue your yogic exercises, whatever you have mentioned. Instead of normal water in Jal neti, use 200 ml water with a pinch of salt and a pinch of soda bicarbonate. That will make the water similar in composition to body fluids and help physiologically.

Thank you doctor,

As discussed with you, I continued with Otrivin and steam twice a day and an antiallergy tablet once. I am much better since yesterday. The sounds in my ears have reduced considerably. I can sleep comfortably. From today, I plan to use stop Otrivin and only steam twice a day and antiallergy at night. I want to know should I use any nasal spray like Rhinocort or Avamys for my nasal allergies. I plan to go to the doctor after two to three days for a follow-up and check-up. Also, I want to know what precautions I should take for this not to happen in the future.

#

Hello,

Welcome back to icliniq.com.

Continue steam. Use Avamys once daily. In your ENT review, get impedance audiometry done.

No smoking. Avoid dust pollution and cold foods. Continue antihistaminics until you visit an ENT.

Thank you doctor,

Whether CT scan or MRI can serve all purposes of a nasal endoscopy? I do not want to avoid an invasive procedure if the cost is not an issue.

#

Hello,

Welcome back to icliniq.com.

In our clinical rhinology practice, where the goal is to diagnose and describe more details about the sinonasal tract (nasal airways and sinus openings), the three investigations' roles are as follows.

1. Nasal endoscopy - a direct vision of the nasal cavities, sinus openings, normal turbinate structures, back of the nose, openings of bilateral ear tubes, etc. Invasive because we put a long camera inside. But it will involve no cuts or pricks. The doctor can give sufficient local anaesthetic and decongestants using cotton pledgets kept in the nose for 10 minutes before the endoscopy. Endoscopy shows the exact nature of discharge, exact color and characteristic of the nasal mucosa. Check what exactly is blocking the sinus openings, if there is any fungus, allergy or deviated septum, or space constraints in the nose.

2. CT (computed tomography) - a plain CT of nose and sinuses will give details about bony structures excellently and check if there is any bony obstruction inside the nose, the lining inside the sinuses over the bone are normal or thickened, or any growth inside. It will also check if there is any fungal debris inside the nasal cavity. A CT is like multiple x-rays. It involves radiation. CT is a must before we decide to operate. It is helpful to find out more anatomic/pathologic details as to what is causing the disease. It does not replace an endoscopy but gives more information and supplements it.

In our clinical practice, we do an endoscopy and CT routinely. Endoscopy is more like an office clinical examination. Whereas a CT is more like a test that is ordered.

CT contrast and MRI scans for the nose are ordered when we know that there is a disease, and we want to check if there is any brain complications or brain extension of the disease or into the eyes. MRI shows soft tissues in a better way. If there is a leak of brain fluid through the nose, then we do the latter in addition to endoscopy. MRI does not have any radiation. For a routine diagnosis of sinuses related issues, MRI tends to over-diagnose. It shows minor changes as very severe or significant. That leads to unnecessary medical or surgical management.

I would suggest you for an endoscopy and, if warranted, go for a CT. However, the clinical decision taken by your doctor will have to be respected as he only will have the best idea of what is going on inside your nose as he alone has seen it and followed you up.

But endoscopy, CT, and MRI are not the exact options. They all have different roles in our investigation and management.

Thank you doctor,

My first doctor had also done an impedance test, as mentioned by you, and he also confirmed that there is fluid in the right middle ear. When he started with Brufen, Otrivin, and antiallergy tablets, he felt it was due to sinusitis. Somehow not happy with his approach and continued use of Brufen, I visited another doctor.

She did a hearing check and said that it is normal for my age. She also did the Tymp test and confirmed that there is fluid in my right middle ear. She did an endoscopy and told me that there was no polyp or growth, but there was an allergy in my nose, causing the problem. She prescribed steam, Rhinocort Aqua, and Allergodil, two puffs each twice a day, and Betaserc 16 mg for five days in the evening, if the sound disturbs me and I am unable to sleep due to sound. Also, can I take 10 mg antihistamine at night, if it helps me sleep? She mentioned that it would take two weeks, though it would start getting better in one week. By the way, I have chronic rhinitis for 10-15 years, but recently for the last year or so, it has been under control also due to taking one tablet of Amla daily. What is your opinion about her approach and treatment and also whether I can continue to take Amla?

A loud layman thinking, earlier due to occasional allergy aggravation, there was morning sneezing, watering nose and it would be normal in a few hours. Now since it is not coming out, is it dried up and collected inside as an allergy? Also, whether this type of tinnitus is affected by loud noise? What allergy tablet would you suggest, which would help me sleep?

#

Hello,

Welcome back to icliniq.com.

I guess the second doctor's approach is more scientific. You can take Amla. It is the richest source of vitamin C and will help in keeping COVID-19 also away from you.

Regarding the sprays, she has given a steroid, and the other is an antihistaminic. Both are fine and continue the same. Regarding her saying, it will take some time for resolution, that is also correct. And the choice of antihistamine for you to take, how about Cetirizine Hydrochloride 10 mg of it? It will produce sleep, but it needs to be taken twice daily. Levocetirizine also produces sleep but can be taken once daily, and 5 mg of it is enough. These are the second-generation antihistaminics that do not cause excessive sedation and an acceptable or nil amount of mouth dryness. If you want more sedating once, you can try Avil (Pheniramine maleate) or Chlorpheniramine maleate. But these are very sedating and can cause dryness of the mouth, constipation, etc. I suggest Levocetirizine should be enough.

Regarding the tinnitus, if the reason for it is the fluid, then it should go once the fluid goes off. If the fluid does not go off in one to two months, we can make a small nick in the eardrum, suck out the fluid, and then put a grommet tube to avoid recurrence.

Can you upload your hearing test reports so that I can have a look at those? Otherwise, I cannot comment on your hearing status. I need to see the reports and graphs once.

Thank you doctor,

I take amla in tablet form once daily at night. As suggested by you, I will continue to take it. Regarding antiallergy tablets, presently, I am taking Loratadine 10 mg at night. It does produce sleep sometimes, but sometimes it does not. If you suggest Levocetirizine 5 mg with minimal side effects, I will take 5 mg Levocetirizine once daily at night time. During this tinnitus, I need something to help me sleep.

Can you comment on the use of Betaserc 16 mg? I am taking one at night with food. It does reduce the sound and helps me sleep. The first day, I felt a little bit of gas, but it was fine the second day. How long can I take it safely, and should I try with a reduced dose of 8 mg, and after how many days? I will try to get a hearing report and tymp test report and upload it.

I have a great belief in Homeopathy. At times, it has done wonders, and I want to try that also.

#

Hello,

Welcome back to icliniq.com.

Levocetirizine 5 mg should produce some more sleep as a side effect than Loratidine 10. Aas the former is an earlier drug in the second generation antihistaminics. No harm in taking that.

Betaserc (Betahistine Dihydrochloride) is a vestibular drug that improves the blood circulation in the inner ear arteries and vessels. If it helps you feel reduced tinnitus, then nothing wrong with taking it. It does cause some acidity. In the long run, as you suggested, I would advise you to reduce its dosage. You can reduce to 8 mg and then later 8 mg every alternate day and can continue the medicine for a month or two as per your need. It will not cause any serious side effects. But you can let us know if you feel anything different during its course.

I do not know much about Homeopathy. Although we do not know about its components, the system is not a scientific one. It does have some helpful solutions to a couple of problems that allopathy does not have a complete solution. But we hear a lot of reports that homeopathic medicines have a high steroid content. So I advise caution.

Thanks - can otrivin be used with avamys and allergodale, as it seems that, at times, otrivin followed by steam did give me some relief. Can i take Betaserc 16 twice a day. Sometimes it feels that it takes time for its effect.

Can antibiotics be used to cure middle ear fluid faster?

Are three any hearing aids which can cancel or reduce the sound of tinnitus? Anything which can help reduce the sound mainly at night. If the sound is too loud, you cannot sleep even with antiallergy?

In case the tinnitus is due to loss of hearing, then what is the treatment ?
# otrivin shouldn't be used for more than 4 to 5 days. we do give otrivin for condition like yours followed by steam. but that's usually in the initial stages and then we institute nasal sprays like avamys.

if you wish, you may use otrivin for a few days and follow it up with steam everytime.

can take betaserc twice daily but it's not a good idea to keep taking it for prolonged durations as it is a vestibular suppressant which suppresses the normal functions.

antibiotics do have a role. we give antibiotics in the initial stages of the treatment with otrivin. sometimes, you can give a low dose of clarithrimycin as an anti-inflammatory rather than antibiotic

I do give such a treatment in some intractable cases

there are hearing aids which can negate the tinnitus sound but we give those only to patients with no known cause of tinnitus. in you the most likely cause is the middle ear dysfunction and it has to be treated before advising hearing aids

tinnitus due ti loss of hearing can be treated in mnay ways - behavioural therapy, tinnitus retraining, tinnitus matching and masking, hearing aids, implants etc

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