Hi there and thanks for your question. Based on the description of your symptoms, I'm concerned for a condition known as Eustachian Tube Dysfunction (ETD). The ear is divided into three parts: the external ear includes the visible part of the ear (the pinna) and the ear canal; the middle ear is the air-filled space behind the eardrum that contains the three middle ear bones (the ossicles); and the inner ear contains the sensory organs of hearing (cochlea) and balance (semicircular canals). The Eustachian tube is a narrow tube that connects the middle ear to the back of the nose. Normally, the Eustachian tube opens with every swallow or yawn to act as a pressure-equalizing valve for the middle ear. It also serves to drain the mucus produced by the lining of the middle ear.
Blockage of the Eustachian tube isolates the middle ear space from the outside environment. The lining of the middle ear absorbs the trapped air and creates a negative pressure that pulls the eardrum inward. The eardrum is thin and pliable, like plastic wrap, and is densely innervated. When it becomes stretched in*****, *****ients often experience pain, pressure, and hearing loss. Long-term blockage of the Eustachian tube leads to the accumulation of fluid in the middle ear space that further increases the pressure and hearing loss. This is called serous otitis media. Should bacteria contaminate this fluid, a middle ear infection may result, called acute otitis media.
Chronic blockage of the Eustachian tube is called Eustachian tube dysfunction. This can occur when the lining of the nose becomes irritated and inflamed, narrowing the Eustachian tube opening or its passageway. Illnesses like the common cold
are often to blame. Pollution and cigarette smoke can also cause Eustachian tube dysfunction. In many areas of the country, nasal allergy (allergic rhinitis) is the major cause of Eustachian tube dysfunction. For reasons which are unclear, the incidence of allergies is increasing in the United States. Obesity can also predispose a patient to Eustachian tube dysfunction because of excess fatty deposits around the passageway of the Eustachian tube. Rarely, Eustachian tube blockage may be the sign of a more serious problem such as nasal polyps
, a cleft palate, or a skull base tumor.
Since it sounds like you've tried multiple medical therapies, I thought I'd mention some surgical options. The primary goal of surgical treatment is to bypass the Eustachian tube and re-establish ventilation of the middle ear. This will restore hearing, relieve pressure sensation in the ear, and reduce the tendency for middle ear infections.
A tiny incision can be made in the eardrum and any fluid within the middle ear suctioned out. In adults, the incision often stays open long enough to allow the swelling in the Eustachian tube lining to resolve. After the eardrum heals (usually within 1 to 3 days), the middle ear fluid may re-accumulate if the Eustachian tube lining has not recovered.
Pressure Equalization Tubes:
After making an incision in the eardrum and suctioning out any middle ear fluid, a tiny hollow tube made of plastic or metal is inserted into the eardrum. Over time, the tube is pushed out as the eardrum heals. A pressure equalization tube usually provides middle ear ventilation for 6 to 12 months. Often, the Eustachian tube will have recovered by this time and the pressure equalization tubes need not be replaced. However, longer lasting tubes are available for more chronic problems. In adults, the procedure takes about 5 minutes and can be performed in the office using a topical anesthetic. In children, a light general anesthetic is needed.
The major disadvantage of pressure equalization tubes is that water must be kept out of the ear. This requires using earplugs or a cotton ball smothered in petroleum jelly while bathing. Swimming usually requires custom earplugs fit individually to the patient’s ear. Water that gets into the ear canal can carry bacteria through the tube into the middle ear space and cause an ear infection. This is noted as a purulent drainage (white, green, or yellow pus) from the ear. This type of ear infection can be easily treated with antibiotic eardrops.
The other risk of either a myringotomy or a pressure equalization tube is that the incision may not heal. This may eventually require surgery (tympanoplasty) to patch the hole.
Ultimately this is a good discussion to have with your ear, nose and throat physician. When medical therapies fail, like the nasal sprays you've tried, then surgical correction may be necessary. I hope this information is helpful for you, and I wish you well and good luck. Regards, ***** *****