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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17647
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have a very recent ear problem, otherwise generally well

Resolved Question:

I have a very recent ear problem, otherwise generally well and free from colds. On 5th November I was exposed to rapid sequence of firework explosions over a 10 second period which was unbearable.

I visited my GP and have been referred for an MRI – he said my ear drums were okay.

My symptoms are:

• unable to equalise pressure inside and outside my ears (I have tried yawning, blowing my nose and so on) – the right ear is the most effected (both ears are clear of wax)
• slight pain in my right ear
• tinnitus (hissing noise)
• reduced hearing
• discomfort being is crowded environments.

I was free of all these symptoms before the firework explosions.

In your view what conditions could I be suffering from?

Having surfed the net, barotrauma keeps coming up as a possible condition.

Will the MRI identify conditions such as barotruma?

Assuming it is barotruma, what are the treatments?

I am due to fly on holiday in a few months time – is it safe to do so? What would be the implications? Are there precautious I can take when flying?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information:
Was any other office evaluation of the ears done, such as audiometry or tympanometry?

Customer: replied 3 years ago.

I had a hearing test which showed that my hearing is typical for someone of my age. The right ear was below average.

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There are several issues to consider in this situation.

It certainly is true that there could be acoustic barotrauma to the ear. In more severe cases, there can be bruising or haemorrhage of the ear from the barotrauma. It is possible that there is Eustachian tube dysfunction, which could have also started at the same encounter if you responded in such a way as to clench the muscles that work the Eustachian tubes. It also could be a coincidence that the symptoms started after the fireworks, so that other problems could be present, such as other conditions that can affect the ears (e.g., infection, inflammation or growths in the ear) or Eustachian tubes (e.g., allergies, sinus infection).

The MRI can detect certain aspects of acoustic barotrauma, such as haemorrhage or more significant bruising, but it will not detect all cases of acoustic barotrauma. Therefore, a normal MRI does not exclude the possibility of acoustic barotrauma. The MRI can also assess several of the other causes noted above.

Additionally, tympanometry if a good test to assess and monitor Eustachian tube dysfunction. The MRI can assess the anatomy of the Eustachian tubes, but the tympanometry is better at assessing function.

There are several options for treatment of barotrauma. Many people do well with conservative management to allow for healing. Other options for treatment include steroid nasal sprays or a short course of decongestant nasal sprays. In more severe cases, such as if there is significant haemorrhage, then surgery may be necessary.

It is likely that this would be better by the time that you will be flying in a few months, but if there is any ongoing difficulty with equalizing the air pressure, then there may be an issue. Flying again before the barotrauma has recovered can exacerbate the condition. If you are still having symptoms, using the steroid nasal spray would be appropriate, and if this eases symptoms, then there would be less risk. There are some pressure equalizing ear plugs that can be tried, although the response of different people can vary significantly, so it is usually better to not rely solely upon this intervention to allow for flight. There also are various exercises that can be done to try to open the Eustachian tubes, several of which you have tried, but my patients generally have more success with chewing gum.

If you have any further questions or need clarification, please let me know.

Customer: replied 3 years ago.

Thank you for your response. I can confirm that I was told that I do not have any infection. Also the doctor put a camera up my nose which I was told looked fine (not sure what he was looking at).


 


Does this change your prognosis in anyway?


 


When I go for my next consultation, what questions would you suggest I ask?


 


Thank you for your help.


 


 


John Crawford

Expert:  Dr. D. Love replied 3 years ago.
It certainly would rule out any infection of the portion of the ear that is visible, but the other possibilities remain.

At this point, since the evaluation is still being performed, the primary questions have to do with the evaluation, including the results of the MRI. If the diagnosis is uncertain, then it would be appropriate to ask about whether to also do a tympanometry. Once the diagnosis is identified, then it would be appropriate to ask about what treatment would be appropriate and the long-term prognosis.

Customer: replied 3 years ago.

You have been most helpful. One question I meant to ask previously was relating to pressure equalizing ear plugs.


 


Can you recommend any websites on the subject or brand names to look at.


 


Thank you.

Expert:  Dr. D. Love replied 3 years ago.
Here is a website that sells ear plugs:

http://www.earplugstore.com/earplugforfl.html.

There are no studies that support one brand over another.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17647
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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