Dr. Mehak Agarwal
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Three weeks ago, I got off a flight, and around 24 hours later, tinnitus set in. I had never had it before, so it was very odd. On the flight, I was suffering from a bad case of contact dermatitis (what my PCP thought). I have already been to two different ENTs. The first one said that I have no hearing loss, there is no damage, and it should go away. Normal tympanogram as well (they say there is no pressure but that does not make sense because my ears can continually be popped). The second one said I have chronic allergies, but it is completely unrelated to tinnitus. I went to my allergist for an appointment and told him everything that was happening. He believes my eustachian tubes are swelling because of the allergy and that could be causing all of this. My symptoms: ringing in the ears (high pitched) for three weeks now, my ears have to continually be popped, sometimes when I pop them I experience a brief auto phony, my ears click every time I swallow, ears pop every time I yawn, but nothing is staying popped and it is driving me crazy. Doctors said tinnitus probably is not permanent, but this is driving me insane. I am 18 years old and currently, take the tablets Prednisone taper, and Azithromycin. Please help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. Is there any change in the symptoms at all? Any difference was seen with the medicines, steroids, and antibiotics you have taken? Is there any other associated nose or throat symptoms? When you took the flight journey did you have any nose or throat issues? Do you suffer from diabetes or blood pressure or thyroid issues? Can you upload the tympanometry and pure tone audiometry results in your next query so that we can review them? Tinnitus occurring immediately after landing is usually due to eustachian tube catarrh. During landing, the pressure outside the ear is significantly higher than the pressure inside the ear, and air gushes in through the eustachian tube and can push a lot of tubal bellows into the small orifice causing a tubal block. But the same should have got improved by this time with medicines as well as body healing. If that has not happened there could be some local pathology that is preventing the healing. You could also be suffering from sudden hearing loss in which one side loses hearing sense all of a sudden and can be accompanied by severe tinnitus. But is that so in your case? Do not you suffer the same problem on both sides? Do revert back to me with all details and I shall help you. Thanks and take care.
Patient's Query
Hello doctor,
Thank you for your reply. The problem is on both sides. I will have to upload the tympanometry later because I do not have a copy of it. But from what the doctors have told me, I have no hearing loss (they said something about 20 as a measurement) and that I have no fluid behind my ears. At the moment, my ears are aching and in pain on and off. It seems when the tablet Prednisone kicks in, the ringing gets mildly better for a while, but then reverts back before bed which could be a good sign. Is it weird that I feel like my ear is clogged when I do not think it actually is? I have been yawning a lot today and really do not know how to react. The ENTs have both said it is probably going away, but I would just like to know the cause. I have no hearing loss (noticed or tested), and it was sudden onset. I do not know for sure, but I may have flown with nasal congestion, but it was three weeks ago. The second ENT recommended Flonase, but my allergist said it would not do any good. Any chance that dermatitis could have caused some type of reaction? I know that the tablet Prednisone does not always help inflammation in the ears. This is also my second round of Prednisone. The first time was for contact dermatitis, but I tapered early because the side effects were awful.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Flonase (fluticasone nasal) will be worth a try. It is a local-action steroid with no systemic absorption. If nothing, it will not cause any side effects. Flonase should remove the congestion in the eustachian tube opening into the back of the nose. We should do a nasal endoscopy to rule out any pathology in the nose which may be clogging the eustachian tube orifice. Hope this helps. Thanks and take care.
Patient's Query
Hi doctor,
Thank you for your reply. Do you think the tinnitus will fade? It is weird because I am not sure I have eustachian tube dysfunction. My allergist said it is normal that my ears click when I swallow, but he cannot really explain the constant yawning and constant urge to pop my ears.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. We cannot comment on tinnitus unless we know the etiology. For the same, we should find out the cause of your problems as I underscored in the previous reply. If the tinnitus is associated with neural reasons it may not decrease. However, we can mask it and retrain the hearing to not give importance to it. It is called tinnitus matching and masking and tinnitus retraining therapy.
Patient's Query
Hi doctor,
Thank you for your reply. How would you determine the etiology of tinnitus? Do you think the flight played a role? Every time I yawn, I keep hearing autophony.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. When you yawn, the eustachian tube opens, and when it opens it is natural that you hear your own breathing sounds. That is normal. But when you start hearing the sounds a lot and when it becomes bothersome, we need to check if there is a problem with the patulous eustachian tube. The etiology of tinnitus is difficult to determine but forms the first step in treating tinnitus. We do the tests I mentioned and try to correlate clinically. The flight journey could have played a role as you have told but in your case, the duration seems prolonged and we need to factor in other reasons. Hope this helps. Thanks and take care.
Patient's Query
Hello doctor,
Thank you for your reply. Should I consult an ENT and tell him that I was recommended to get an endoscopy?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Ideally yes. We do not want to keep guessing what the issue could be without doing relevant examinations and investigations. Thanks and take care.
Patient's Query
Hi doctor,
Thank you for your reply. They gave me copies of the tympanometry and the ABR curves. One doctor I went to mentioned that I have TMJ, but I do not see how that could cause ringing out of the blue.
Hello,
Welcome back to iciniq.com.
I read your query and can understand your concern. TMJ (temporomandibular joint) does cause tinnitus sometimes. Thanks and take care.
Patient's Query
Hello doctor,
Thank you for your reply.
This morning I could barely hear the ringing. Later on, it started to come back. Do you think this is a good sign? I am talking to my doctor tomorrow about an endoscopy of my eustachian tubes because I have had a lot of pain today associated with my ears and around there too.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. I will still advise you to undergo an endoscopy. Unless we see inside your nose we will not know the cause. Hope this helps. Thanks and take care.
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Otolaryngology (E.N.T)
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