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Dr. David
Dr. David, Board Certified MD
Category: Medical
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Experience:  Board Certified Physician
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Please could you look at the following and suggest a

Resolved Question:

Hello
Please could you look at the following and suggest a possible diagnosis/advisable path for me to take to seek treatment, what I should be asking doctors to look at beyond what I am currently doing etc?
Male: Aged 34
Current symptoms and a history of symptoms below that which lead up to the current ones:
Onset of Hissing Tinitus in right ear two weeks ago.
Not too loud but loud enough to be heard in quiet rooms/at night, gets worse lying down on stomach, quieter on my back.
Pressure in both ears. Valsalva manoeuvre not unblocking right ear very easily
Mild Pain in both ears but stronger in left.
Some sensitivity to noise.
Continuing symptoms: Occasional headache pain in forehead/jaw/eye/around temples. Sinus like but I don't really have a cold or anything like that. Mainly left side but sometimes on the right. Often it is brief twinges or longer moments of pain, especially in the sinus areas.
Clicking in jaw, mainly left side, upon opening mouth, yawning etc. Occasional pain in my teeth
Occasional mild dizziness.
Neck and lower back pain.
Anxiety has been growing during this time, though I have tried to keep it under control and have had a lot of worried days. This has spiked over the last week or so with the onset of the hissing ear symptoms.
History:
In mid September I had a morning of heavy lifting and got a bad headache that afternoon. Plus backache, neckache.
The following day I had "pressure" in my forehead on the left hand side, onset of headache, mainly mild. But certainly varied in intensity from time to time
Over the weeks that followed, I was getting pressure and headaches in the forehead temples, mainly on the left but also on the right side of my head as well as pain behind my eyes, in the cheekbones... typical "sinus" locations.
I'd often wake up with the headache.
However I have not had a cold. I felt and do still feel a little bit bunged up, especially in the mornings but nothing too bad. So sinus like pains but no true noticeable cold like sinus infections.
Though maybe I have something affecting my sinuses anyway?
I was also suffering with "out of my head" like sensations, to start with quite frequently but less so now, kind of like my sight would shimmer somewhat and I'd have trouble seeing things right for a time
After two weeks of this I visited my GP clinic.
First visit to the Doctor revealed high blood pressure, which had spiked from when I'd had a test taken a few weeks before.
Was sent away on orders to get a monitor and keep an eye on it for a week. Returned and it was still high but dropping.
Bloods were taken, the standard for diabetes, that sort of thing and I was given the flu jab and told to see a BP specialist.
Saw him a week later, he took my blood pressure and it was still dropping so he felt that given my age (34) he didn't think I needed to be put on medication. Blood results came back okay, slightly elevated cholesterol given I am overweight but nothing of note that he could see to be worried about.
I went to get my eyes tested for the vision problems, I described my symptoms and they did tests. My eyes were found to be healthy, nothing wrong with the back of the eye that could cause pressure, etc.
I also considered whether it might be a problem with fillings, one in particular had given me the kind of headache and nerve type pressure before. The dentist X rayed it and checked the rest out and found no problem. She was concerned over possible grinding at night (I live alone so I don't know if I grind or not) and I have a mouthguard to wear at night.
So possible TMJ issues given that and the "clicking"?
A couple of weeks after this some of my initial symptoms were getting better, the out of my head feeling was happening less and less and the sharper sinus type pains were getting quieter though no where near gone.
I decided to pursue the chiropractic route to see it there was a problem.
I started to notice the hissing T sound a week before I went to chiro and it has been there ever since then. It varies in intensity and seems to be modifiable depending on whether I am sitting up, lying down, on my front (worse) or on my back, (evidence that this makes it better)
I have had two sessions with the chiro thus far and I think it is starting to have some effect, though my neck still aches and my back still aches.
The headaches and above mentioned sinus type pains and the out of head feelings seem to have improved somewhat.
This brings us uptodate.
In summary, the headaches are getting better, slowly but the hissing T/ear pressure, ear ache etc is now my main worry.
Do you have any advice on how to proceed further? The chiro was confident that the T would go away of its own accord in time as it was related to my neck but I am not so sure.
I have had this kind of hissing T before and in time it did go away and getting my ear pressure to equalise did help in that, but I cannot help but worry over it happening again.
Thanks
Alex.
Submitted: 21 days ago.
Category: Medical
Customer: replied 21 days ago.
Additional: I meant to add that I spoke to the Chiro about the jaw clicking etc, thinking it may be TMJ related but he seemed to think that it was okay and not causing me any trouble. Can this rule out TMD problems or is it worth asking a GP to take a look at regardless?
Expert:  Dr. David replied 21 days ago.

This is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 21 days ago.

you should not be doing valsalva to unblock your ears. this can rupture your ear drums

try to yawn and thrust your lower jaw forward at the same time to open up your throat and eustachian tube which can help drain fluid out of your inner ear

you can also take allergy medications and steroid nasal sprays to keep your sinuses clear which helps your Eustachian tube drain properly

if your anxiety symptoms are bad, you may need anti-anxiety medications

you should be checked for grinding your teeth at night which can worsen TMJ joint inflammation

a bite guard in your mouth at night time could help

let me know if you have questions.

Customer: replied 21 days ago.
Hello Doctor DavidThank you for that.What exactly should I be checking for when it comes to TMJ joint inflammation as I currently have a biteguard? Will the biteguard sort it, or should I see my Doctor/dentist to look closer for inflamation given the pain I noted? Any medications I should be asking to take to help clear something going on there?Or is it a matter of time fixing it?My major concern is the hissing T. Would you put that down as being caused by the TMJ/inner ear problem? Should I ask Doctor to look for infection given the ear pain or otherwise pursue other options to help with draining fluid/clearing this pressure feeling that seems to keep coming back?Is this a matter of treat it with steroids and give it time to heal in your opinion?I know Tinitus can be a long and drawn out problem, in your opinion does my Tinnitus sound like its coming from these issues, rather than from anything else? Is it just a matter of see what happens and whether it goes away if I can clear this ear pressure?I did wonder about steroid nasal sprays? Are they recommended to help with eustachian tube issues even without any apparent signs of a cold etc? I have not yet tried them, thinking they were for cold issues etc but I shall try them if you think they may help.Many thanks
Expert:  Dr. David replied 21 days ago.

bite guard can help over time

try not to grind your teeth during the day.

bad anxiety can cause tension and tight jaws

massage therapy, yoga, deep breathing exercises can help you relax.

you don't need a steroid injection at this time

make sure your doctors clear out ear wax out of your ears.

if you have stuffy nose, congestion, this can cause some of your symptoms

Customer: replied 21 days ago.
Okay. Thank you for that. I shall go and see my GP to ask for ear to be dewaxed as per your suggestion.One final question if I may.
Could you elaborate on the steroid injection? Its purpose and when it would potentially be employed in treatment in ear problems?Many thanks
Expert:  Dr. David replied 21 days ago.

steroid injections are only used for patients who have severe pain in the TMK joint from severe inflammation.

it doesn't really help the ear

only the TMJ joint.

Let me know if you have other questions.
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