Now with a Diagnosis: Chronic Allergic Rhinitis

[Ciaran88]

I posted recently about a sudden onset high pitch continuous tinnitus.

I have health anxiety and basically had a melt down afraid I was stuck with this quite loud and very distracting tinnitus forever.

I saw a GP who saw a lot of wax in the right ear, syringed it and took a cursory glance inside and said it was fine. Then went for an audiogram which was also fine.

I think remembered I had a friend who is an ENT surgeon of many years experience. He kindly took my history and examined me and the moment he looked into that right ear he said "aha" there's the cause.

Myself and my family all have allergic rhinitis grumbling away and I never took the nasal steroids advised, so I do often tend to be blocked up and lately a bit more so. Never with tinnitus though.

Anyway he could see a mucous effusion behind the left ear drum with muscles actually squishing out when I did a valsalva.

He's convinced this is the cause and said it will clear with time, with a short course of Prednisone and with steam inhalation and regular valsalva.

Now then, I trust him very much and a few days later after trying these things I notice maybe a slight improvement or at least more ups and downs rather than constant. The tinnitus is also much easier to localise on my head to the left ear than it was before when it was a bit louder (it's still pretty loud).

Anyway I just wanted to check with all you guys that there's nothing else I should be trying. I know that ETD and rhinitis can sometimes not clear up as quickly as they say and the tinnitus can drag on for quite a while so I wanted to try and avoid some mistakes and make sure I'm doing everything I can.

Also any other words of reassurance would be nice because I really am a terrible hypochondriac.

Also if it makes a difference, I was recently on a 2h30 flight, he thinks that might have helped dislodge women muscles deeper into the ear. Also I notice changes in pitch and volume when chewing or moving my jaw.

Two specific questions are: he says no antibiotics needed as no actual infection/inflammation visible and no pain. Sound ok?

Should I take antihistamines or will this dry up the mucous and make it harder to shift?

And lastly, what kind of time frame am I looking at for this mucous to move? Am I being too impatient expecting improvements rapidly?

 

[Aaron44126]

I can relate to some of your story. I'm dealing with tinnitus from ETD, it's been going on for almost two months. I went through the anxiety and depression phase, believing that it may be permanent when I first started reading up on tinnitus. However, what started as ridiculous high-pitched ringing has evolved over time. The volume slowly came down (starting after I had had it for about three weeks, though in my case the ramp up to maximum volume was gradual), and the sound began to change. I've heard some very strange sounds, but at this point it is usually a quiet electric buzz/hiss which is pretty easy to ignore. I notice changes every day or at least every few days, so I'm confident that I'm on a good path to healing, but it is slow. The tinnitus is so stubborn... I have had many times when it is so quiet that I think that if it was any quieter it would be gone, but it always finds a way to hang in there. I have finally experienced a few fleeting moments of silence, once or twice a day since Sunday.

I can relate to the tinnitus being difficult to localize when it is loud. It is in my right ear, in my case. I've found that I can easily check by covering one ear with my hand... I can always hear the sound right in my ear canal if my right ear is covered, but if I cover my left ear I do not get the same effect.

I did a six-day course of Prednisone... Not sure how much it helped (the tinnitus already seemed to be getting slowly better at that point). Recently I've been using a humidifier at night to hopefully help get the congestion/mucus moving out, as well as Valsalva from time to time (as gently as possible) to open the Eustachian tube and let the gunk drain out to somewhere. I've been on Flonase (nasal steroid) for about a month but only recently learned that it needs to be sprayed in a sort of perpendicular angle so that the medicine can actually reach the Eustachian tube.

There were days when I walked around with earbuds in, listening to quiet cricket sounds from a white noise app on my phone. If you can find the right sound, it can actually totally eliminate your tinnitus even at a very low volume level. (Certain sounds disrupt the neural firing pattern that causes tinnitus — total masking — and if you can find one that works for you and that is considerably less annoying than the tinnitus, you can get yourself a break.) Take care in using headphones or earbuds as they could make things worse, but I think if your tinnitus is not hearing loss related but it just from inflammation of the inner ear structures / Eustachian tube, it should be pretty safe. I haven't had to do this in a few weeks as my tinnitus has come down to an easily manageable level.

It seems right that no antibiotics are needed if you don't have an actual bacterial infection. It sounds like yours is allergies? Mine isn't so I haven't looked into antihistamines, but I don't think that you want to risk drying up the mucus, you should look into that carefully before making a decision. (I think that part of my problem now is that there is mucus that has been stuck in there for over a month, if I had realized what was going on sooner maybe I could have had it fixed by now.)

Check out this video for some tips. Here's a good ETD resolution story from this forum. I think that you will be looking at a slow recovery, but hopefully you will begin to notice that it is getting a little bit better every few days. Sometimes I get frustrated that it is not getting better fast enough, or that I might be reaching a "final state" with what I have now being permanent, I remind myself that it has been getting constantly better and it is for sure noticeably better now than it was a week ago, and that at the moment there is no reason to believe that the trend will not continue.

 

[glynis]

I am a sever asthmatic under the sever asthma unit
I also suffer with allergic rhinitis causing post nasal drip and ear infections both drums are now a funny colour and bulging and Tinnitus through the roof.

I will be seeing ENT to sort out sinuses and my ears.
I take lots of asthma medication and for my nose I use Naisonex steroid spray and Carbocsistine and Fexofenadine.
Love glynis

 

[Ciaran88]

I can relate to some of your story. I'm dealing with tinnitus from ETD, it's been going on for almost two months. I went through the anxiety and depression phase, believing that it may be permanent when I first started reading up on tinnitus. However, what started as ridiculous high-pitched ringing has evolved over time. The volume slowly came down (starting after I had had it for about three weeks, though in my case the ramp up to maximum volume was gradual), and the sound began to change. I've heard some very strange sounds, but at this point it is usually a quiet electric buzz/hiss which is pretty easy to ignore. I notice changes every day or at least every few days, so I'm confident that I'm on a good path to healing, but it is slow. The tinnitus is so stubborn... I have had many times when it is so quiet that I think that if it was any quieter it would be gone, but it always finds a way to hang in there. I have finally experienced a few fleeting moments of silence, once or twice a day since Sunday.

I can relate to the tinnitus being difficult to localize when it is loud. It is in my right ear, in my case. I've found that I can easily check by covering one ear with my hand... I can always hear the sound right in my ear canal if my right ear is covered, but if I cover my left ear I do not get the same effect.

I did a six-day course of Prednisone... Not sure how much it helped (the tinnitus already seemed to be getting slowly better at that point). Recently I've been using a humidifier at night to hopefully help get the congestion/mucus moving out, as well as Valsalva from time to time (as gently as possible) to open the Eustachian tube and let the gunk drain out to somewhere. I've been on Flonase (nasal steroid) for about a month but only recently learned that it needs to be sprayed in a sort of perpendicular angle so that the medicine can actually reach the Eustachian tube.

There were days when I walked around with earbuds in, listening to quiet cricket sounds from a white noise app on my phone. If you can find the right sound, it can actually totally eliminate your tinnitus even at a very low volume level. (Certain sounds disrupt the neural firing pattern that causes tinnitus — total masking — and if you can find one that works for you and that is considerably less annoying than the tinnitus, you can get yourself a break.) Take care in using headphones or earbuds as they could make things worse, but I think if your tinnitus is not hearing loss related but it just from inflammation of the inner ear structures / Eustachian tube, it should be pretty safe. I haven't had to do this in a few weeks as my tinnitus has come down to an easily manageable level.

It seems right that no antibiotics are needed if you don't have an actual bacterial infection. It sounds like yours is allergies? Mine isn't so I haven't looked into antihistamines, but I don't think that you want to risk drying up the mucus, you should look into that carefully before making a decision. (I think that part of my problem now is that there is mucus that has been stuck in there for over a month, if I had realized what was going on sooner maybe I could have had it fixed by now.)

Check out this video for some tips. Here's a good ETD resolution story from this forum. I think that you will be looking at a slow recovery, but hopefully you will begin to notice that it is getting a little bit better every few days. Sometimes I get frustrated that it is not getting better fast enough, or that I might be reaching a "final state" with what I have now being permanent, I remind myself that it has been getting constantly better and it is for sure noticeably better now than it was a week ago, and that at the moment there is no reason to believe that the trend will not continue.

Thanks for the replies guys, the weird thing is (maybe you can relate) that whilst I always knew I was a nasally and bunged up person and had had a diagnosis of chronic allergic rhinitis with a post nasal drip since a teenager (and not made because of any emergency just part of general workup for a headache I was worried about) I have never had any major problems like this before with it. Maybe it was the flight that did it but I noticed it for the first time right after rigerously cleaning the floor of my kitchen..

I did the special technique of getting nasonex into the middle ear and milking it with val salva and for about 2 hours afterwards the tinnitus was absolutely terrible and instead of just one pitch it was whirring all over the place at different tones and volumes.

So I slept half upright with my right (the most affected) ear tilted upwards - not easy to get to sleep like that but I did and in the morning I woke up with literally zero tinnitus..

Stood up and walked around and it came back, took the nasonex in the special way again and yeah ow it's loud and y ear feels full blah blah.

Anyway I at least wonder if this is all a good pointer towards the cause being pressure in the middle ear rather than some permanent issue.

But I suppose I will have to give it time. I'll stop the antihistamines as I don't want to dry anything up it already feels thick, and I'll stick to Vicks and steam.

Like you say it's such a bizarre and persistent problem (tinnitus) and somehow even the weirdly electrical high pitch sound of it all makes it hard to believe it can be caused by something so simple and mechanical rather than neurological damage but I guess we just have to trust the wealth of experience out there others have had and stick to the regime.

Also we should probably remember that if we are posting on here with ETD we are a self selected group of people who either 1) worry about it more than a lot of other people who just get the diagnosis and get on with it and one day realise it's gone whereas we like to talk talk talk and worry (me) or 2) people for whom recovery takes longer than expected.

I suppose there's a lot of people out there who get this for about 2 weeks after a flight or a cole and then they're good as new..



Glynis I'm tempted by a mucolytic like yours but my ENT says they're no good - do you notice much benefit?

 

[Eric P]

I can also somewhat relate to this (at least the pain of getting a real diagnosis!). My Tinnitus started in June out of nowhere, no real symptoms other than the ringing. I was terribly distraught over it for the first few weeks, but I've since calmed down a lot. About 3 weeks later I went on a weekend vacation about 2 hours away, and on the drive there and back I had this pretty significant feeling of pressure and slight pain in just my right ear. It went away on its own after a few hours though.

Then I went on another car trip 2-3 weeks later with the same problem occurring. Unfortunately, it stayed with me the second time around. Waking up in the morning, it would be 80% gone, but it would always come creeping back throughout the rest of the day. When I swallow or yawn, there is a loud crackle in my ears, and I can practically feel the Eustachian Tube returning to its "normal position" for just a few seconds before going right back to how it was. It got gradually worse and worse over the next week until I couldn't stand it and went to my GP.

He looked in my ears which looked normal, but when he looked in my mouth there was a significant post-nasal drip going down the back of my throat. He thought I was having ETD as a result of allergies or some kind of reaction. He put me on Afrin (3 days)/Flonase/Claritin. The Afrin worked great (for the 3 days). But after a week of relief, everything slowly started coming back. In the last few weeks I've developed sensitivity/pain to certain types of sounds.

I've since been to an allergist, and all the allergen tests he ran came up completely negative. This didn't come as a huge surprise as I have never had allergy problems my whole life, and the post-nasal drip I was having was not associated with any other common allergy symptoms.

Also went to a dentist to be evaluated for TMJ, but there was nothing signifying any sort of dysfunction.

I then went to an ENT with all of this. They were next to useless. The one guy insisted the dentist who had been diagnosing TMJ for 15 years was wrong, and that I should just get a mouth guard made. Kind of stuck as to where to go now.

 

[Ciaran88]

... does anyone even get better? At first I thought that a diagnosis of chronic mucous build up in the inner ear and a happy pat on the back from the ENT saying it would clear up in a few weeks was the end of the ordeal but the more I read about it the more it seems like basically nobody ever gets rid of their T even if it is from ETD...

 

[Aaron44126]

It can go away if ETD is your cause. In fact, it probably will if your ETD is not ongoing/chronic. As yours is allergy related, you will probably want to take preventative steps to manage that in order to make sure that this does not become an issue again in the future.

It may take a few days/weeks even after your Eustachian tube seems to be "unblocked", while everything settles back down to normal. Again, here's a resolution story that you should read if you didn't see my link last time.

There are way more panic stories than resolution stories online. People post more when they have a problem, but not everyone comes back to report what happened in the end.

In my own case, I have experienced brief moments of silence since Sunday so I know that it is possible. I had one this morning for a few minutes. Also, this morning I've already had several times when I had to really stop and listen to tell if my tinnitus was still there. Even if it doesn't totally go away, it can change over time, and believe me, it's not my preference but I'd be OK if what I have now is permanent... Compared to the intense high-pitched ringing that I had early on, a tiny little buzzing is no big deal. But I can notice it changing every few days so I continue to have hope that it will eventually be totally resolved.

Take a step back. There's no magic fix, you might be waiting for a while. Observe for a few days and weeks and see if you can tell that it is changing. Change is good (as long as it is not getting worse). There are going to be ups and downs.

 

[glynis]

The Carbocisteine helps thin down the mucous so I don't feel like I'm choking on it.
Love glynis

 

[Ciaran88]

Thanks again for the replies guys.

Since this all started I think things got worse and now are possibly getting better.

For example in a quiet room it's possible for me to be tinnitus free for some time, but noises, movements and things like swallowing can kick things off again.

I took a shower this morning and didn't think I had gotten any water up my nose but right after I could hear and feel it sloshing around my middle ear. Probably a clue there are ETD issues.

Also since using the nasonex and doing regular valsalva I find that the pitch and volume of the tinnitus changes whereas when it started it was a single pitch and completely constant... maybe some sign of movement, whatever is up there I think it's very thick and the ETs are probably nearly jammed shut most of the time.



I had to leave a restaurant yesterday as it was too noisy and really aggregating the tinnitus, is this something expected with ETD?

 

[Aaron44126]

I dunno, I'm rather sure that mine is from ETD (right ear only). I have had the sensation of fluid sloshing around, both feeling and hearing it. However, the tinnitus doesn't seem to be reactive to other sounds... Being out in a restaurant is nice because it covers up the sound well.

 

[Ciaran88]

I dunno, I'm rather sure that mine is from ETD (right ear only). I have had the sensation of fluid sloshing around, both feeling and hearing it. However, the tinnitus doesn't seem to be reactive to other sounds... Being out in a restaurant is nice because it covers up the sound well.

Yeah.. this is the main thing that's worrying me. It doesn't seem to fit with most ETD stories and it makes distractions very hard.

 

[Aaron44126]

Indeed. However, everyone's tinnitus is different. You will learn the "mechanics" of yours as time goes on.

I've gotten pretty good at feeling whether the ET is open or shut. There are a few techniques that can be used to keep it open for an extended period of time... However, even though I know there is some gunk in there, I haven't been very successful in getting any more than a small amount to drain out. (I understand that this will likely happen naturally, it just takes a while.... as in weeks.) The ET is very small so surface tension can keep the fluid in there... If it is thickened up with mucus that doesn't help either. Some people report better success if you bend over (as if to reach down and touch your toes).

You can do the Valsalva maneuver to open the ET, but to keep it open so that stuff can drain out, you have to maintain the pressure. I think that this shouldn't be done too often as it can cause other problems, that is a lot of pressure to be putting on your eardrum. I recently discovered the Lowry maneuver which is also effective at opening the ET, but without putting pressure on your eardrum. It takes a little bit more practice to figure out how to get it to work consistently.

Bear down (like you're trying to poop) --- this creates some pressure lower in your body...
Take a deep breath...
Pinch your nose...
And swallow.

If you do this right, the ETs should open, you should feel the pop near your ears. I find that they (sometimes) seem to stay open unless I swallow again or move my head around too much.

 

[Ciaran88]

Indeed. However, everyone's tinnitus is different. You will learn the "mechanics" of yours as time goes on.

I've gotten pretty good at feeling whether the ET is open or shut. There are a few techniques that can be used to keep it open for an extended period of time... However, even though I know there is some gunk in there, I haven't been very successful in getting any more than a small amount to drain out. (I understand that this will likely happen naturally, it just takes a while.... as in weeks.) The ET is very small so surface tension can keep the fluid in there... If it is thickened up with mucus that doesn't help either. Some people report better success if you bend over (as if to reach down and touch your toes).

You can do the Valsalva maneuver to open the ET, but to keep it open so that stuff can drain out, you have to maintain the pressure. I think that this shouldn't be done too often as it can cause other problems, that is a lot of pressure to be putting on your eardrum. I recently discovered the Lowry maneuver which is also effective at opening the ET, but without putting pressure on your eardrum. It takes a little bit more practice to figure out how to get it to work consistently.

Bear down (like you're trying to poop) --- this creates some pressure lower in your body...
Take a deep breath...
Pinch your nose...
And swallow.

If you do this right, the ETs should open, you should feel the pop near your ears. I find that they (sometimes) seem to stay open unless I swallow again or move my head around too much.

Yeah I think I just need to fight the urge to analyse it too hard, it just leads to over fixation. The ENT didn't think much of it, and I suppose that if there is pressure issues and mucous in the middle ear then it will affect how things are conducted so somewhere in there I guess you can find a reason for it.

My tinnitus is now starting to fluctuate a lot. There are times when it literally disappears, but sounds or movements always bring it back before long.

After starting all these meds the sheer quantity of mucous pouring down the back of my throat is getting pretty incredible too.

I find it very easy to pop my ears with valsalva but as you say I think the issue is it remaining chronically shut to natural pressure equalisation and mucous drainage, so keeping it open is key... I'll try Lowry, and my ENT said basically it will happen randomly some weeks/months after starting nasal steroids.

I wonder what is required to happen in there for the tinnitus to resolve completely. Does the retracted ear drum we get from the chronic negative pressure need to move back into the normal position? Because from what I've read that takes months. Or maybe it's enough to just get that tube open and keep it that way, in which case worst case scenario is get one of the new procedures (balloon/tube insertion)?