Talking to Doctors About Eustachian Tube Dysfunction

[Kaelon]

Hi @Dr. Nagler,

Thanks again for all that you do for our community. I am hoping for your advice on how to best speak with an ENT.

My General Practitioner is fairly convinced that I am suffering from (in her words) "some form of eustachian tube dysfunction" brought about by inflammation or infection. I have responded very well to a standard 7-day course of antibiotics and a concurrent 15 taper-down course of prednisone (starting at 50 mg a day, and finishing at 10 mg a day). My Tinnitus was nearly silenced in both ears with the antibiotics, but after day 6 of the antibiotic treatment, came back to moderate volumes. Prednisone seems to provide milder relief to inflammation and some volumes, but not as much as I was experiencing during the first several days of antibiotics.

My GP is worried that because ETD is particularly complex to diagnose and treat (she told me that ETD generally resolves on its own, and most doctors take a wait-and-see approach), that I may need to be insistent about trying to get the proper tests and help from an ENT.

How would you recommend I discuss my condition with an ENT, and how can I be sure that I'm getting the right tests to diagnose my condition? To-date, I've only ever had a standard audiogram that showed minor conductive hearing loss in the higher ranges, but nothing concerning (and certainly nothing that I would notice). I also had a basic physical exam of my ears and some removal of compacted wax (which did not impact my tinnitus). I also had an MRI and MRA of my brain (but nowhere else) in the early days to rule out acoustic neuroma (which it did and all came back "unremarkable").

I haven't had any other tests to-date, but I've heard a lot of discussion about tympanometric measurements and other devices that can help diagnose conditions in the sinuses.

Please help!

Thank you for your sage advice and thoughts!

 

[Dr. Nagler]

Hi @Dr. Nagler,

Thanks again for all that you do for our community.

You are most welcome.

How would you recommend I discuss my (ETD?) condition with an ENT, and how can I be sure that I'm getting the right tests to diagnose my condition?

Well, @Kaelon, in the 11 1/2 months since I began posting on this board, that is undoubtedly the easiest question that has been posed to me.

The answer to your question is: I have no idea!

Honestly. That's it! I simply have no idea. I'm not an ENT, and I really know very little about ETD and ETD-like conditions. So once I found a Board-Certified ENT with a decent reputation (your GP can help you in that regard), I'd let him or her determine what tests would be appropriate given your presentation and physical findings.

Yea, I know. Not the sort of response you were looking for ... but it's the very best one I have for you nonetheless!

I do have a general guideline when I determine what tests I run on my own patients. Perhaps that will help. It's a guideline I've used throughout the 40 years that I've been a doctor. I never order a test unless the outcome of that test will help me make a decision. So when your ENT does determine what tests to order as part of your ETD work-up, before giving the "OK, let's do it," I think it's reasonable to ask your ENT how the outcome is going to contribute to a decision.

All the best -

Dr. Stephen Nagler