Eustachian Tube Balloon Dilation for ETD: Ask Me Anything

Here to report after balloon dilation.

I had the procedure done and have experienced only minor improvement so far.

Last year, I started experiencing symptoms of TTTS and slight hyperacusis during an extremely stressful period. I took Zoloft after Propranolol and Hydroxyzine failed to help, and my excellent doctors did not want to prescribe benzodiazepines. On day three, I had a severe adverse reaction, which I believe was caused by Zoloft or a combination of Zoloft and Hydroxyzine. The next day, after the neck swelling (as part of the muscle rigidity I experienced from the adverse drug reaction) subsided, I immediately heard a "wong" sound, followed by the persistent loud tinnitus that has been with me 24/7. My PCP prescribed steroids about two weeks in, but they did nothing. The ENT prescribed another pack two months later (the earliest I could see them), and the tinnitus became somewhat quieter during that time.

I was a hermit for the first two months but started getting out more. I noticed that when I drove over any small hill, my ears would get pressure that required swallowing to fix (baro-challenge ETD). I also experienced crackling sounds, etc.

A brain MRI showed nothing remarkable. More nasal antihistamines with no result led the doctor to suggest balloon dilation. I had the procedure done, and I am now almost three weeks post-procedure. The procedure itself was very easy. I was put under with Propofol and was up an hour or so later. I had some significant bleeding that was gone by the end of the first night, but my nose was sore for the first week and a half. I also had a lot of drainage that I couldn't get rid of (you can't blow your nose for the first two weeks or shouldn't, though I had to at times). During the first week, I was very concerned I had made things worse as I was experiencing autophony (hearing my own voice), which can be a sign that the Eustachian tubes have become patulous. But that has largely subsided. I can say that the fullness from driving over hills doesn't happen as frequently but still occurs. I also notice my swallowing/tubes opening much more significantly. If I drink something or eat something wet, sometimes my tubes are much more audibly opening/closing temporarily.

I would suggest getting a second opinion from an ENT if you are interested. I know all of us, when we approach doctors with tinnitus, still have that 3-6 month hope that it’s all correctable and might go away, and we are basically willing to try any intervention. If you can control yourself and have access, get a second opinion before undergoing the procedure.

So, did it expand my Eustachian tubes? Yes, but only partially. Driving still triggers it over hills, just much less frequently and severely. Did it fix tinnitus, hyperacusis, and TTTS? No. I am seeing another doctor (a Neurotologist), who likely can’t help me, but I'm going to give it the ol' college try. I am sleeping somewhat better in that I'm getting 4.5-7 hours of interrupted sleep (usually 3-4 hours, then up, then knocked out again), which I generally attribute to starting to habituate to the tinnitus.

I still hold a theory that all of my symptoms are interrelated to hyperactivity in the brain and that all of my hopes are futile as there is no real fix. However, I have a doctor who may be willing to prescribe Gabapentin. While I’m concerned with medications making everything worse, I have to say that living life in a somewhat constantly anxious state is no way to live either.

 

Why did your doctor suggest balloon dilation? Did he think you have ETD? If so, what made him come to this conclusion? For instance, what does your audiogram look like? Did you get a CT scan done? If so, did it show anything? ETD is commonly diagnosed when it should not be.

I have lots of middle ear issues and 24/7 awful tinnitus. I also had tubes put in my ears. My CT scan shows some abnormalities in the middle ear space and mastoid area, but according to my audiogram, my Eustachian tubes are functioning normally.

You might want to check your tympanogram reading on your audiogram. Also, ETD causes some conductive hearing loss.

 

Honestly? I think it's the only thing they could treat.

My overall hearing is great, with a minor (10-20 dB) loss in the 6-8 kHz range. I will say that my tinnitus was quite loud and around the higher end of the frequency range on the day I had it, so I'm betting if I retested it, it would look even better. My tympanogram was fine.

I also have 24/7 awful tinnitus. I had a clean brain MRI. I have hypertrophy of my turbinates, which the ENT is convinced is due to allergies, but antihistamines did not change it at all.

I experience negative pressure that builds when driving, and when I equalized pressure in the office, the doctor could see the eardrum pulling back. I have been experiencing pressure as if my ears need to pop, and my ears would progressively get more full just from driving and experiencing elevation changes in flat Ohio (think hills with 50-60 feet of elevation, not like the mountains of West Virginia). This didn't happen until after the onset of tinnitus/hyperacusis.

I didn't have much faith that ETD was a panacea, and truth be told, I don't think dilation truly solved the fullness while driving completely—though it is somewhat reduced. However, when you are dealing with all of these conditions, you'll try anything after sitting in doctor's offices for months with nothing to do but use antihistamine spray.

 

Please update if you end up trying Gabapentin. I'd love to know how it goes.

 

Hi,

How are you today? I seem to be dealing with several issues. Initially, I experienced a spike in my tinnitus and hyperacusis after attending a concert. Although I was wearing fully sealed earplugs, the occlusion effect or bone conduction might have triggered a resurgence of both conditions. Additionally, I've developed increasing pressure on the left side of my head, which I can occasionally relieve. I've had this issue before, but it has worsened due to the irritation.

I had a CT scan done, and everything appears normal. I've been doing nasal rinses, inhalations, and using decongestant nasal spray and ointment. One day, it felt somewhat normal, but then it became blocked again, and it’s been extremely difficult to open it up. The more I try to equalize the pressure, the more I feel a slight pain on that side of my face.

During my visit to the ENT specialist, an audiogram (I have a cookie-bite curve) also showed conductive hearing loss.

I'm now considering using a corticosteroid spray as the next step.

 

A brief update:

I believe it takes weeks for the brain and hearing to adjust after a setback. This period is always marked by tension, and staying positive requires a tremendous amount of energy. Unfortunately, this is simply the reality, given that our ears are so closely connected to our brains. If they were located near our toes, it might be easier not to focus on them.

 

I still have the ETD-type issue, but it truly only shows itself when driving or when I am ill, and there is extra drainage. I still have tinnitus. I am glad I tried ETD balloon dilation, as it didn't necessitate grommets, etc.

 

How can I determine if the constant pressure is due to Eustachian Tube Dysfunction (ETD) or the result of inner ear hearing loss on the left side?

I've had an issue with my left ear for over 20 years and have always struggled with pressure equalization. An ENT diagnosed me with conductive hearing loss but found nothing abnormal during the otoscope exam, and a CT scan at the hospital didn’t reveal anything either. The ENT mentioned it could be scarring, but he felt limited in what he could do.

The pressure doesn’t feel like it's from inner ear hearing loss; it genuinely feels like there’s something in the middle ear or the Eustachian tube. It’s very uncomfortable, and I don’t know how much longer I can live with it like this. I’d like to be sure of the cause before considering hearing aids.

Would a tympanostomy tube theoretically relieve the pressure immediately? Is it risky, and does anyone have experience with this procedure?

 

Very strange. After a night with half a Temesta (which I only use maybe twice a week), the pressure and discomfort in my hearing have improved significantly. Could it be that muscles are involved in this pressure?

I used to have severe hyperacusis, and perhaps my ears and the surrounding areas are still in "defensive mode" after attending a DJ event, even though I wore professional earplugs. Maybe the bass irritated my ears and affected my hearing?