Blocked Eustachian Tube

[WG774]

Hufty - I last had an X-ray at the dentist last August. I asked if I had TMD, and he responded 'no'. However, I remain open-minded and intend to get a second opinion. My physio doesn't want to say 100% because she's not a specialist, but she thinks my TM joint isn't equal from side-to-side; but she made it clear that she's a 'general physio' and not someone who specialises in TMD issues.

Do you have any links that go into detail regarding fitting a catheter? I can't seem to find any info beyond a one-paragraph summary. Does it involve a general anaesthetic? What are the risks? How often can you have it done?

There must be a risk with catheters, otherwise every man and his dog with ET issues would be queuing up to get their ETs drained, wouldn't they? It seems like an ideal treatment to me; you get a blockage, you drain it. If you have another blockage 12 months down the line, you get it drained again... It seems too good to be true; there must be a drawback somewhere...

I don't get random headaches. I get them if I've been stressed (morning after a heated argument), or if I've strained my eyes the night before (I sometimes get this after a session looking for road name signs in poorly-lit areas). Aside from these scenarios, headaches aren't too big a worry. I get one if I have to spend a day in front of a PC (rare, but necessary once in a while).

I think Jock's onto something regarding speaking to the diving clinic linked to earlier. From what I can gather, divers put exponentially more strain on their ETs than frequent flyers.

I will admit that stress could well be a factor in my ET problems. The first time I had a serious glue ear as an adult was back in '93 (aged 22), when I was living in rented accommodation and undergoing massive turmoil in my personal life. Running my own company and doing ten different jobs doesn't help.

[mad_jock]

Speaking to one of the Aberdeen medics the hospital has a pretty good reputation and the tame ENT consultant ( Mr Neil Tolley ) has a very good reputation.

[WG774]

Unless anyone wants to correct me, from what I can make out, the trouble with having a myringotomy and a tube fitted is that it will drain the ear (good), but long term, it does nothing about ETD and you're back to square one.

[Hufty]

True, but according to my ENT geezer he has seen patients with fluid in the ear who have had it done then the fluid doesn't return. He was at a loss to explain why though when I asked!

With the TMJ stuff, my physio told me that my jaw joint was fine but my muscles were messed up.....so I guess that you can have the symptoms without being diagnosed with TMD??

I couldn't find much on the catheters really.....seems like it has fallen out of favour as a method of treatment....it does seem like a suspiciously good idea though?!

Personally, I've been around in circles with all this....still no nearer a solution despite all the research and doctors.

I am going to call that guy in the US this week from the headaches.com site....I don't get headaches either but he seems to talk about jaw, muscle and ligament stuff associated with ear "fullness" etc... I reckon it is worth a call. I have been seeing a chiropractor (a good one) too. I saw one last year and she managed to make my symptoms worse...they also moved from the right side to the left. Under this new guy they have moved back! My GP gets frustrated when I tell him this as he maintains there is no link but this is the same guy who told me "...you know more about ENT issues than I do."

[WG774]

For what it's worth - and I may well be totally wrong - but the more I think about it, the more I think I have a TMD / muscular / joint issue.

It's a tad odd that my ETD became worst after quitting smoking... Stress perhaps?

When my ETD flaired up for the first time since '93 back in 2002, I was going through the tail end of a truly ghastly court case (they all are - the only winners are the lawyers).

The problem gets worse as the day progresses and appears to be best when I get out of bed first thing.

The current bout of glue ear was not brought on by a cold or 'flu - it seems to have come out of the blue, and I'm not a hayfever sufferer.

At this moment, my non-clinician's opinion is that the disorder is brought about by tension in the muscles around the jaw and ET. The blockage *seems* to be worse after eating.

Regardless, it does appear that both our (Hufty and my) symptoms are very similar...

I wonder if the constant swallowing and popping, i.e. muscle attempts to clear the blockage, is causing problems due to some kind of fatigue? Maybe the best policy for me would be to focus on de-stressing (take up Yoga..), and the ET issue could go away in its own time... It does appear that my ET issues have reared their head during stressful periods in my life.

[gingernut]

WG has uncovered some interesting stuff here....Mac and ginge, you seem to have differing opinions but it would be very helpful for all of us if you could both offer an opinion on this and the Trigeminal Pharyngioplasty ...

Sorry mate, not really my area of expertise, may be worth searching something like "Medline" for further studies.

[Hufty]

I also find that my symptoms get worse as the day goes on.....on a 4 sector day by the time I'm finished I've got a pretty sore jaw from repeated swallowing to pop my ears. Also, I find (and I have no idea why) that if I eat or drink while in the climb or descent my ears block up! I also seem to lose a bit of hearing as the day goes on too while it seems to return the next day. I've tried relaxing too and really tried to de-focus on the symptoms but it doesn't work for me anyway..the tubes just ain't popping on their own!!

It is unbelievably frustrating when you sit in front of doctors and they just stare at you like you're some kind of nutter when you describe symptoms that they can't reconcile!!

[WG774]

I am waiting to get an appointment with a fellow who appears to be one of the top ENT surgeons in London. Somewhat worryingly, his assistant has referred to my issues as 'complex'... Hopefully that's because all ET issues are such, not just mine...

Anyway, I will post back here as soon as I've had the appointment.

[WG774]

The plot thickens...

Having got back from the GP, he is suggesting that I could have a problem relating to Acid Reflux, whereby acid is getting into my Eustachian Tubes...

This is the best link I've found so far in terms of explaining the issue, albeit targeted at kids: http://www.marci-kids.com/eerpharynx.html If you find a better link, do post it.

My visit to the GP has reminded me just how complex the diagnosis process is, and just how little an amateur like me really knows

Anyway, I do have one or two symptoms associated with the disorder, such as occasional gurgling noises emanating from my neck. I also suspect that my unconventional lifestyle with regards to rarely adhering to regular mealtimes could be an issue.

Anyway...no doubt there are a hundred and one other illnesses that can cause ET problems... Acid reflux is about as plausible as any diagnosis I've found, so I'm now on antacid pills and will see what happens...

I feel sorry for anyone finding this thread - there's no magic bullet - you'll probably have to try a hundred and one treatments to find a solution

[windowjob]

Sorry to be a wet blanket guys, but been there and done it all, TMJ investigation, MRI, septoplasty (twice), 3 grommets, on my second T tube plus mastoidectomy. And still have the blocked feeling and loss of hearing. I can also figure on one of the other medical forums in so far as I have hearing aids and thanks to some more enlightened medical attitudes and a helpful AME also hold a Class 1 medical!
The main problem is my right ear (funny that it's the same with others) but my audiologist said I would benefit from hearing aids in both ears - and he was right. I have small digital "in the ear" aids as I wear a headset but he reckons I could get better results with a behind the ear model.
Mine first started one day when I got a blocked ear and just couldn't clear it by swallowing and the hearing then went with it. The T tube definitely keeps it clear as I can actually hear the air escape when I blow my nose!
Good luck but I get the feeling you have to live with it - I've virtually stopped looking for a "cure" and accept it, reluctantly as otherwise it can take over your life always hoping for something new and being disappointed.

[pool777]

I am happy or unhappy (whichever way you want to look at it?!) to have found this thread. Ive recently changed airlines and 3wks ago on the descent experienced pain and couldn't equalise. Then, my ears popped but i was left with this blocked feeling in my left ear, i decided to go back flying and didn't experience pain but enough crackling and popping to warrant a trip to the docs who advised me to take ibuprofen and not to fly. Ive now been put on a weeks course of amoxycillin to prevent infection, ive tried nasal sprays and inhalants and its just not getting any better. Due to go back to my GP after my antibiotics are finished but from what im learning this may be something that i will just have to live with?... but what i really want to know is can i fly like this even though the GP (who i don't really think has a clue to be honest) is saying i can't. Im terrified that ill never be able to fly again.

[gingernut]

Ah yes, the acid reflux link. Surprising how many ent/breathing problems can be caused by this.

A coupleof things you could try- don't eat late at night, lose weight if needed, elevate the head of your bed by about a bricks height, eat smaler meals, stop coffeee and stop smoking. Your doc may trial an antacid.

Worth a try at least.

[WG774]

Another mucolytic to try is Erdosteine. I've been on Carbocisteine for around 10 days now - if I don't get a result in another 10 days I think I'll try Erdosteine.

Ginge - you've been really helpful, old chap - much appreciated. I am concerned that my GP has run out of patience and intends to leave me in the hands of specialists now - I get the impression his suggestion of Acid Reflux was a last-ditch attempt to help (although he could well have a point - I live on very hot food and invariably eat late at night...). If you can find a minute, would you be able to post a link regarding which foods are good / bad? I've been using Google, but there's so much conflicting info out there regarding foods...the amount of quack websites is shocking

BTW - Bricks placed under bed - thanks!

[WG774]

One thing we haven't covered yet in the thread is the sheer variety of exercises that can be performed to open the ETs.

I have never felt comfortable with the Valsalva btw. The list below is copied from a Scuba Diving website:

One problem with the Valsalva manoeuvre is that it doesn't activate muscles that open the eustachian tubes, so it may not work if the tubes are already locked by a pressure differential (see illustrations). It's also easy to blow hard enough to damage something. Instead of using the Valsalva next time, try one of these:

* The Toynbee Manoeuvre. With your nostrils pinched, swallow. Swallowing pulls open your eustachian tubes while the movement of your tongue, with your nose closed, compresses air against them.

* The Lowry Technique. A combination of Valsalva and Toynbee: While closing your nostrils, blow and swallow at the same time.

* The Edmonds Technique. While tensing the soft palate (the soft tissue at the back of the roof of your mouth) and throat muscles and pushing the jaw forward and down, do a Valsalva manoeuvre.

* The Frenzel Manoeuvre. Close your nostrils, and close the back of your throat as if straining to lift a weight. Then make the sound of the letter "K." This forces the back of your tongue upward, compressing air against the openings of your eustachian tubes.

* Voluntary Tubal Opening. Tense the muscles of the soft palate and the throat while pushing your jaw forward and down as if starting to yawn. These muscles pull the eustachian tubes open. This requires a lot of practice, but some divers can learn to control those muscles and hold their tubes open for continuous equalization.

If someone practiced the above techniques regularly over a period of months, is there a chance that the ETs will improve, in the same way that muscles improve with physiotherapy? Why shouldn't this be the case?

What I have learnt so far:

Cut out mucus-forming foods / drinks - the less mucus in your system, the less there is to get into your ETs.

Cut out foods / drinks that can cause excess acidity - excess acid is a known irritant to the ETs in people with an acid reflux tendency.

Get into the routine of performing ET exercises several times daily.

[WG774]

BTW - There have been many studies conducted over the years into the ET function in air personnel. If it interests you, put this string into Google: "Eustachian tube function in selection of airmen" - the Pubmed website has numerous studies; you get the abstract, but you have to pay for the full article.

[speedsalive]

help

Guys..I ve been having this for somtime. I fly non pressurized upto 10K abt 4 to 6 times a day and eversince i stated this, I ve been having EU problems.

Would it make anydifference if i Go into pressurized aircrafts? The other thing is, What if u get the junk behind the eardrum drained out by surgery and not putting the tubesa afterwards???

My doctor says that should be fine and when i asked abt hearing loss due to scars and hardening of the eardrum, he says i dont have to worry a sigle bit abt it.

and last, If this does not work out, What if i get them permanant tubes in? I know the tubes will keep the PE tube open from outside and u wont have to worry about the pressure difference and mucus getting into the EU tube.
The problem with ther permanant tubes are that it leaves perforations. but as long as it is there, wont it b OK??

[Hufty]

I'm not sure about ET muscle exercises....AFAIK there are four muscles that control the tubes so is there a risk that if exercise one, perhaps the others will work less effectively? Kind of like having poor posture and the jaw muscles developing oddly as the chew with your head in an odd position?

I have seen that list of tube opening techniques and for flying the best one I reckon is "Voluntary tubal opening"...I can keep them open for a few seconds at a time but it does hurt my jaw which might in instelf be contributing to my ETD...ironic really

There was a post right at the beginning of this thread with some useful "what have I learnt" stuff...(sorry dont' know how to do quotes so have just pasted it in!)

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Obviously try steam inhalation, that might shift the mucus.

Nasal sprays - Nasonex or Flixonase. Could try a good dose of Otrovine but can only use it for a week I think.

Also, expectorants (e.g. Benadryl) are designed to work on chesty coughs but can also loosen mucus elsewhere.

Drink LOADS of water - if you are well hydrated it can help it run out.

Ear Candles - bit crazy - didn't work for me but you never know.

Acupuncture.

Herbal remedies to open up the tubes - tried loads but can't remember the names...a good herbalist will help you.

Cut out dairy, alcohol, starchy foods and load up on fruit and veggies....all can create mucus (search for "mucus forming foods" on Google).

Get your GP to do allergy tests and food intolerance tests for the same reason.

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I find that drinking a lot of water does help as does going to the gym. These decongestants work (as far as I am told) by stimulating a kind of adrenalin response which causes the tubes to open up....fight or flight response I guess. Working hard at the gym generates the same kind of response and it kind of clears my head as does drinking a lot of water.

Interestingly (and nobody believes me) I suffer less when I am flying as HP not NHP. Perhaps because I am busy operatng the plane rather than sitting doing the paperwork there is a higher level of adrenalin release (esp. on take off etc.) Perhaps it is just that I am thinking more (descent planning etc.) that my mind isn't on it?? Who knows..

WG have you been to a chiropractor?

[WG774]

To be honest, I think most people (I know I do) are less aware of any kind of ailment if their mind is diverted elsewhere.

As I’ve posted many times in other discussions, Ear Candles are the WRONG circuit for ET issues. Not only that, but they’re illegal in Canada and I know people who’ve burnt their eardrums with them. One of the most comprehensive ENT sites on the ‘web has a warning about them on EVERY page… (BTW – that link has videos of myringotomies and the like – not for the squeamish, but worth checking out if you want to know about that kind of thing).

I tried acupuncture a few years back for stress. It worked, but to be honest, I think it was the meditative aspect – not the treatment itself. Maybe I should try it again. What worries me is that I’ve become fervently cynical about alternative therapies since then, and if you don’t believe, it’s unlikely to work…

I now take a 30-minute cross-country run every week day – so far it hasn’t done a lot apart from temporary relief, which I suspect is due to general endorphin production from exercise.

I drink an average of 3 litres of water a day, more if it’s hot.

The chiropractor is a good suggestion. I definitely am guilty of poor posture and I suspect that years of abuse could have taken its toll.

One thing I will say is that I have found that the valsalva manoeuvre is lacking in 3 ways:

You risk ear drum damage if you blow too hard
It can push crud / infected tissue further into the ear
It doesn’t do anything to exercise the muscles around the ETs

Considering divers put more stress on their ETs than pilots, I’m inclined to think they’re a good source of advice for ET exercises and the like. Having said that, only an idiot takes everything they read on the Internet on face value – caveat emptor and all that. Do thorough research before trying anything, preferably with the advice of a pro before attempting any scheme.

Interestingly, my MRI report says I have “marked mucosal thickening in the maxillary antra – and minor mucosal thickening in the anterior and posterior ethmoid cells”. The plan is to eliminate dairy and wheat (very difficult in the latter case) and use an inhaler for hot water / eucalyptus oil once or twice a day.

BTW – The link between acid reflux and ETD is conclusive. It’s uncommon, but there’s no doubt of the connection – worth investigating if you have any kind of heartburn / excess acid issues.

[WG774]

Speedsalive – I don’t think it’ll make much of a difference whether you’re in a pressurised AC or not – either way, your ET function will be tested.

I have performed hours and hours of research into myringotomy complications and the like. Your concern is due to scarring, which can perforate the drum and affect its performance. Providing (as Mac said) you don’t get the tubes put in by your local plumber, you should be ok. Perforations are reversible, but you don’t really want to be in that position.

I understand your temptation just to have a standard myringotomy first without tubes (the visual appearance of grommets concerns me somewhat…will they freak out children if they see them?), and feel the same way myself. However, from what I can make out, you will increase your chances of getting out the gunk if you have tubes fitted… There are myringotomy studies that contradict each other… Some say that laser myringtomy (no general anaesthetic) leaves less scarring / perforations, whereas others say that conventional micro-scalpel leaves less scaring. One thing most studies confirm is that the grommets will stay in longer with conventional surgery.

BTW – there’s likely to be more bacteria in the air of a pressurised AC (from what I understand – I don’t want to incur the wrath of Mac again), so I would look into whether there’s likely to be a higher chance of something undesirable getting into the ear in a pressurised AC. Having said that, if all is healed, I’m not sure if you’d have a problem. You’re better off asking Ginge or Mac on that one.

[windowjob]

Standard grommetts can't be seen, they're very small and a long way down the ear canal. The downside of them is they are actually designed to be forced out of the eardrum naturally after a period when the hole then heals up. Mine lasted about 8 months each time which is why I had a "T" tube fitted. This acts exactly the same way but is designed to be more or less permanent -only problem was the first got totally blocked by ear wax and had to be replaced but still effective over a year later.
I still think that one day I will wake up, swallow and find the blocked feeling has gone and I can hear normally again, but realise it's almost certainly not going to happen after 4 years.
Hope exercise/drugs/chiro etc do work but I've yet to find anyone who has got back completely - sorry but you ought to know.