You are correct....Puerto Rico is long way from USA based teaching hospitals.
As you might imagine with a condition as long standing and complex as yours, where your personal MD'S who have had hands-on access to you, your complete history and all possible tests -- and yet been unable to come up with a correct diagnosis -- it is impossible for me to figure this on by chatting online.
Yes, I could give you a laundry list of differential diagnosis possibilities, but that would not solve your issue as this is probably not, as you already know, something that can be dealt with at home...even if you could put a name to the problem.
So. Even in Puerto Rico there must be a collection of highly trained sub specialists....I would start with an Ear, Nose & Throat doctor as well as an internal medicine specialist.
As you already found out throwing random antibiotics at the problem is not the way to go.....
Does this make sense to you?
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Dr. Rick MD FACS