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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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

singulair can be used with anti-allergics unless the latter is a combination of antihistaminic with montelukast in which case you don't have to take singulair which is also montelukast. betaserc starts acting in a few hours after taking. myringotomy to drain out the fluid is like a small incision over the ear drum. it doesn't affect the hearing. rather by helping remove the fluid inside the ear and maintaining equal pressures inside and outside the ear drum, it helps in hearing better. All the therapies you read in the internet or watch in YouTube can be tried. However, since we seem to know the cause of tinnitus in you, the best possible treatment is to address the cause. The other treatments you mentioned are for those whose tinnitus doesn't have any cause or is intractable.

No. Mask doesn't put pressure to cause symptoms like these. You can take betaserc once a while for this. Avamys used once daily is more beneficial than whatever you are using now. Allergodil has Azelastine which is also an antihistaminic like Cetirizine or levicetirizine. But since the spray Is locally acting, it shouldn't produce any sleep. Alprazolam can be used for tinnitus in cases where the cause of tinnitus cannot be found out. Unlike in yours. Alprazolam is a central depressant. It can cause central nervous system actions. Thyroid supplements will not have those side effects.

safe to use earphones, you are not a fit candidate for masking matching techniques. but no harm in trying those. if you are having fluctuating tinnitus the reasons could be serous otitis media / meniere's disease. but in your case it is more likely serous otitis media. why you are not a fit candidate for masking matching - because we are able to pin point to a cause for your tinnitus.

this type of tinnitus can be worsened by stress or loud sounds. valsalva exercise can help in opening up the tubes forcefully and help drain the collected fluid inside the ear drum.

Valsalva shouldn't be done during an acute infection. Do not use excessive pressure while blowing air into the ears. If valsalva is done during an infection then it will push the infection into the ear