Dear XXXXXXX,

I am Dr Ravinder Sharma ENT surgeon.

On the basis of information provided it appears that you have a retraction (indentation) of ear drum on left side. This can happen due to sinusitis. The following is a brief pathophysiological explanation of how sinusitis could lead to retracted eardrum:

In upper part of the pharynx (throat) on its lateral wall an opening called eustachian tube is present. The lateral (other) end of this tube opens in ear. This tube helps in equalizing pressure on either side of tympanic membrane and when we swallow or drink water this tube opens and some of the air enters middle ear through this tube.
If the sinus is infected there will be collection of secretions, blockade of sinus opening, impaired muco ciliary clearance and eustachian tube block. This leads to negative air pressure in middle ear causing sucking effect on tympanic membrane leading to indentation of drum.

Steam inhalation and blowing cheeks against closed nostrils and pursed cheeks and antiallergic and decongestants will helps in improving ventilation.

I hope this answers your concerns. Feel free to contact me if your need more information on this

With warm regards
Ravinder Sharma

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Dear XXXXXXX,

Thanks for the follow up query

There can be a feeling of fullness in ear because of eustachian tube block or fluid in middle ear. However dizziness is difficult to explain.

Balance is the function of inner ear (includes organ of hearing and organ of balance) and your present problem seems to be localized to the middle ear.

I would suggest you to get a pure tone audiogram and a tympanometry done. If it suggests asymmetrical sensorineural hearing loss (hearing loss in one ear of neural / inner ear origin) you may need a CT scan head to rule out a co-existent lesion in inner ear or brain stem.

Taking diuretic before a cause is established is something I do not advise my patient as hyponatremia and fluid loss which can occur with diuretic use may worsen dizziness.

I hope this answers your query. Do let me know if I can help you further.

With warm regards
Ravinder Sharma

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Dear XXXXXXX,

Thanks for the follow up query.

Mucinex D is a mucolytic and helps in clearing the secretions collected in ear or in the sinuses. With the CT scan normal I would say,

1. Get a pure tone audiometry done to know about the type and percent of hearing loss (if any). Even if a person has about 20 to 30 percent of hearing loss in one ear he may only complain of heaviness only. So this test should be done.
2. Get a tympanometry done. It has great diagnostic value to detect fluid in ear. Your history is also suggestive of fluid in ear. If there is fluid in middle ear and is not resolving with antibiotics, decongestants and mucolytics, then the next step in Myringotomy and Grommet insertion (small hone is made in drum and a ventilating tube is kept in ear drum under microscope). The results of this small operative intervention are wonderful
3. For sinus problem - CT scan of sinuses may suggest a diagnosis of chronic sinusitis. If medicines are not working and there is mucosal hypertrophy or polyp in sinuses it will require Functional endoscopic sinus surgery

I will sum up the above story --Possibly the medicines are not working in your case, so we have to move on to the next step - surgery. You have been treated correctly at the first step but now if the symptoms are not resolving we have to move on the next step- operative intervention.

I understand this is a bit frustrating; but do not worry. With the help of a good ENT surgeon you should be able to get back to normal soon.

I hope this answers your query. Feel free to contact me if I can be of help further.
If all your queries are addressed please close this discussion.

With regards
Ravinder Sharma

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Dear XXXXXXX,

Thanks for the follow up query.

I work as Professor in ENT in one of the medical schools in India. Therefore it would be difficult for me to find out the ENT surgeon with all these facilities at a place near you / States. But I think all these are basic tests and will be there in any tertiary care centre.

As far as flying with the retracted drum is concerned, air travel increases the risk of retraction of the drum especially during ascent and descent. If you do plan to fly in the recent future keep yourself engaged with a chewing gum in mouth. Chewing a gum causes repeated swallowing movement - this helps in opening up of the tube and equalization of middle ear pressure on either side of drum; thus decreases the chances of retraction of the drum and pain in ear.

Considering your situation, I would go step ahead and advise you some measures which you may follow:
1. Steam inhalation once a day
2. Buy some balloons and try to inflate 6 to 8 them both in the morning and evening. This improves the chances of opening up of eustachain tube.
3. You may take a combination of antiallergic and decongestant two times a day. For example Xylometazoline nose spray two times a day
4. You may also try methylprednisolone (steroid) tablets. In my patients I use 4 mg methylprednisolone morning and evening for a week. Come down to 2mg morning and evening for a week and thereafter gradually taper and withdraw.

Contact your nearest doctor / ENT surgeon and discuss about xylometazoline and steroids. You can take them both under the professional guidance of those specialists.

I hope this should address your concern. Do let me know if I can help you further.

Wish you a speedy recovery

With regards
Ravinder Sharma

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Dear XXXXXXX,

Thanks for a follow up query.

So you have left ear hearing impairment and right ear retracted drum. I would suggest you to follow the guidelines I have mentioned in my reply. If you continue with these guidelines you can buy time till you reach a better health care facility in United States. I am pasting it again:
1. Steam inhalation once a day
2. Buy some balloons and try to inflate 6 to 8 them both in the morning and evening. This improves the chances of opening up of eustachain tube.
3. You may take a combination of antiallergic and decongestant two times a day. For example Xylometazoline nose spray two times a day
4. You may also try methylprednisolone (steroid) tablets. In my patients I use 4 mg methylprednisolone morning and evening for a week. Come down to 2mg morning and evening for a week and thereafter gradually taper and withdraw.

If these measure are not working after a week or ten days operative intervention will help. These medicines can help you to avert further deterioration.

With the limited resources this appears to be the best option. Do let me know how you feel after a week or 10 days.

I hope this answers your concern. Feel free to contact me if you need more help.

With regards
Ravinder Sharma

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Dear XXXXXXX

Basically the problem is with the eustachain tube. It may affect one or the both ears. I am pretty sure you will have improvement with this medication.

wishing you speedy recovery

with regards
Ravinder Sharma

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Dear XXXXXXX

Thanks for you folllow up for query

I am sorry to say that there is no scientific basis for this maneover. I have tried my best to help you out with the limited resources (as you have mentioned it earlier in your query).
Right now I can undestand your situation and assure that there will be improvement if you follow the instructions I have given. No doubt medicines do have a role in improving your condition but general measures like steam inhalation, blowing your mouth with closed nostrils and pursed lips (or inflating balloons) do have a role. Besides I see no problem in getting mucolytics, antiallergics and decongestants as most of them are OTC (over the counter) preparation. They will be available at any medical shop or walmart outlet. Give a try of seven to ten days and give me a call .i am sure you will feel better.
I would further add - Something is better than nothing . It is worth trying the established tricks
Wish you good luck
with warm regards
Ravinder Sharma

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Dear XXXXXXX
Thanks for the follow up query
Fluid behind the drum is always abnormal.
Normal position of tympanic membrane is because of the equal pressure on either side of tympanic membrane. If there is tubal blockade(eustachian tube - which connects the nasopharynx with middle ear there is a drop in pressure in the middle ear called as negative air pressure. If this increases further it may cause transudation of fluid from capillaries in the middle ear. This is called as secretory otitis media. This causes impaired conduction of sound through tympanic membrane and bones of ear causing a feeling of heaviness or hearing loss in ear

So the answer to your question is
Fluid in middle ear is always abnormal
It is possible that one can have retracted drum with or without fluid in the middle ear

I hope this answers your concern
with warm regards
Ravinder Sharma

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Dear XXXXXXX
Thanks for a follow up of your query
Valsalva maneovre is done to relieve the eustachain tube block and improve middle ear ventilation. If it is done too hard, it can cause rupture of drum. As you said that you feel that air is coming out of the ear it may be due to perforation of ear drum.

As you are already under treatment I do not see that flying will be a problem now. In your follow up visit to the doctor I would advise you for a otoscopy (examination of ear with otoscope) can accurately tell about the consitin of ear drum

I hope this answers your concern
with regards
Ravinder Sharma

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Dear Sir
Thanks for a follow up of your query

Perforation of ear drum may heal by itself if the ear is kept dry and there is no secondary infection (in ear or in the adjoining area - sinuse or throat) . In majority of cases the perforation heal by itself in 8 to 12 weeks.

I hope this answers your concerns Feel free to contact me if you need more information about it

with regards
Ravinder Sharma

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