Eustachian tube dysfunction, TMJ, or something else?

Ever since a thunderstorm last June, I’ve been experiencing symptoms of eustachian tube dysfunction on a daily basis: clicking in my ears every time I swallow, intermittent muffled hearing in both ears, a feeling of fullness in both ears, and an intermittent feeling of pressure similar to the pressure that one gets when flying. The left ear seems to be affected more so than the right. Initially, I saw my GP who treated me with antibiotic ear drops twice, and then oral antibiotics once, all in a period of two months. In addition, I began taking claritin or other allergy medications last summer thinking that maybe I had developed new allergies to something. I then saw an ENT in August who diagnosed me with “very mild eustachian tube dysfunction” and put me on an inhaled nasal steroid. It did nothing. When I followed up with the ENT 2 months later, he said that there was no evidence of eustachian tube dysfunction and that the medication must be working well. Yet, I was still having symptoms. He referred me for a sinus CT scan and a consult with an allergist. The allergist determined that I have no allergies, environmental or otherwise. He (the allergist, who previously worked in an ENT office), felt that based on the symptoms I was describing, I had significant eustachian tube dysfunction and mentioned that I might want to try tubes in my ears. In the interim, the CT scan came back negative. When I followed up with my ENT, he scoped my eustachian tubes/sinuses and found nothing. His answer was “very mild eustachian tube dysfunction for which there is no treatment”.

Since last June I’ve had five (yes, FIVE!) audiograms done. On the days when I’m experiencing the above symptoms severely, the hearing in my right ear is about 10 dB worse than my audiogram below, and the hearing in my left ear is about 10-15 dB worse. But nobody seems to have any answers. My audiologist recommended I get a second opinion, as the intermittent hearing loss in my left ear is starting to affect my ability to function daily. She didn’t want to sell me a hearing aid for my left ear because she wasn’t convinced the hearing loss seen on the various tests was accurate based on whatever medical issue might be occurring. So for now, I remain unaided in the left ear. (Of note, the audiogram in my signature was done on a “moderately bad hearing day”. On a good day, my hearing ranges between about 15-20 dB in my left ear.)

So…now that spring has finally arrived, the symptoms, which have persisted daily since last June, are much, much worse! My left ear feels clogged and intermittently drains clear fluid at night. I’ve been told I don’t have an infection. The clogged feeling is worst upon waking. Usually it takes about an hour of frequent swallowing, yawning, and coughing to get my left ear working. But for that first hour after waking, I’m having immense difficulty hearing out of it. I keep assuming the hearing in that ear is declining. But then I have a day like yesterday, where I was literally hearing a pin drop in the other room, my daughter’s voice was perfectly clear, and the TV was on a much lower volume than what I normally use, and I think something else is going on. I just don’t know what it is.

I’ve recently been thinking that I have TMJ. At very least, I clench my teeth at night, and I’ve noticed myself doing it during the day as well. My jaw is almost always sore, and I’ve noticed that my hearing in both ears is (subjectively) worse on days when I’m anxious and seem to be clenching more. So I’m booked in to see my dentist next week about TMD. Could the clicking, intermittent muffled hearing, and all of the symptoms I described above be related to TMJ? Or should I be looking at something else. I’m on a wait list to see a otologist, but the appointment won’t likely be until December… In the interim, I have no idea what to do. I feel like I need a second hearing aid on my bad days, but then I have really, really good days when my left ear seems fine! I don’t want to spend money on a hearing aid if the issue is a medical one that can be corrected, but I just don’t know where to go because nobody seems to think anything is wrong other than “very mild eustachian tube dysfunction.” Does anyone have any thoughts? Are there treatments I can be trying at home to confirm a diagnosis of some sort? Should I be looking into alternative health care? I’ve tried chiropractic care and massage for very tight muscles in my neck and upper back. Several sessions of each did nothing. But I’m feeling lost. Every single day, though, I usually have at least a few minutes where the hearing in my left ear clears up, which makes me think that the current level of hearing loss isn’t permanent. Or am I just wishfully thinking? I don’t know anymore.

Kerry

Did your doctor prescribe Flonase nasal spray? It helps some people with eustachian tube dysfunction. This site describes the correct way to use it:

I’m a lifelong bruxer and clincher myself, but only when I’m sleeping. Your dentist can fabricate a bite guard which will help reduce the wear and tear on your teeth, but it won’t stop the behavior. There’s no known cure for it. I use a splint called the NTI device to keep my teeth apart. More info here:

http://www.chairsidesplint.com/

Rasmus-Braun;

My ENT never did prescribe flonase. The first medication I tried, omnaris, essentially did nothing, but then we moved on to avamys which seems to just be taking the edge off the symptoms. But I’ve definitely never had “relief” since this all began last summer. Some days are better than others. For example, today is a good day. I have my hearing aid turned down 3 notches from it’s usual setting and was able to watch and understand the TV easily at a volume level of 14 this morning. Normally, I need to have the TV volume up at 18 or 19. There’s been almost no clicking in my ears when I swallow or yawn all day, and sounds are crisp in my good (left) ear, whereas on a bad day, they’re muffled. I’ve noticed that my sleep position seems to make a difference in my hearing, which leads me to think that head, neck, and upper back muscles are contributing to the eustachian tube dysfunction and/or TMJ. But ultimately, I’m pretty convinced there’s something actually going on in my sinuses or eustachian tubes. Why? Well, whenever I lay flat, my head gets that congested feeling like when you have a really bad cold, and my hearing gets muffled. If I lay on one side, the hearing in the ear facing up gets muffled and gets the sensation of having water in it. If I switch sides, the muffled sensation in my ear usually changes sides within a matter of minutes. I wake up very congested every morning; sometimes I can clear my ears right away, and other times it takes up to six hours to get my hearing to its “normal” state. Some days my head just feels congested, like with a sinus infection, all day and my hearing is just muffled.

I’m seeing my dentist this coming Friday regarding TMJ. As I mentioned above, a TMJ diagnosis hasn’t been confirmed. I do strongly suspect it, though. I’m willing to try using a splint to see if that will make any difference. In the interim, I’m also taking an OTC muscle relaxant every few nights before bed to see if that helps. So far it seems to help. Anyway, I’d just like to get to the bottom of this. I’m finding it really frustrating to have fluctuating hearing loss because I just never know how a day’s going to go. If it were just me, I’d probably be fine. But my daughter’s getting frustrated because she never knows if she has to talk really loudly or use her regular voice, and at 3, she just doesn’t understand why I don’t hear her sometimes and other times, I ask her to talk more quietly when she’s using the same volume she used the day before. She’ll adapt, as will all of us, I’m sure.

Anyway, I’m curious if anyone else has any experience with TMJ/eustachian tube dysfunction, and if so, what you did to treat it.

Kerry,

I have never had any TMJ problems, but a retired oral surgeon who did TMJ surgery once told me he always told his patients to avoid the surgery at all cost and would only operate on someone who insisted on TMJ surgery because he said the after effects of the surgery was usually worse than the patients original problem. Has you ENT checked you out for any lingering middle ear infections? I’ve read that a lot of people can have middle ear infections that go un-diagnosed for years simply because their doctor missed it.

Seb;

I’m not even remotely interested in going the surgical route, so no worries there! TMJ hasn’t actually been confirmed with me yet, but I’m highly suspicious which is why I’ll be meeting with my dentist to discuss this on Friday. When I met my dentist for the first time last fall, he did a very thorough head and neck exam and felt that my TM joints were much tighter than they ought to be. At that time, he asked if I clenched my teeth because, according to him, the muscles were “so tight that you must be doing something”. Anyway, I’ve been monitoring for facial pain since I last saw the dentist and I’m pretty sure I clench. I believe the first step in treatment is NSAIDS, which I’m very hesitant to use due to known concerns that they cause hearing loss. The second step is a splint, and since I have pretty decent medical coverage through my husband’s job, I’ll probably go that route if he recommends it.

Me ENT has insisted nothing is wrong with my ears. That said, he also diagnosed me with otosclerosis based on one audiogram from early last summer, despite the fact the three subsequent audiograms that were done, including one in his own office, didn’t look at all like otosclerosis. He told me repeatedly that surgery would “cure everything” and that I wouldn’t need a hearing aid. Needless to say, I don’t trust him all that much, hence the reason I’m getting a second opinion from a well-respected otoloneurologist in my city. The ENT I’ve seeing has quite a poor reputation, enough so that back when I was still practicing, I never referred any of my patients to him because he was known to be a bit of a jerk. Anyway… I’ve been to other fantastic ENTs in my life, so I know they’re not all like that. I don’t feel as though I have a middle ear infection. I’ve had many of them in my life; however, I do feel like there’s fluid in there and the ENT insists there isn’t. Only 10 more months until I can get a second opinion.

Thanks for your input!

Kerry

Another friend of mine who I have known since I was 2 and he is 86 had a terrible problem with jaw pain from grinding and clenching his teeth and about 20 years ago he had to have all his teeth crowned because of it and after crowning all his teeth the dentist wanted to sell him a custom mouth guard for something like $600, Mel refused and went to a sport store and bought a do it yourself mouthguard kit for about $20 and it solved all his problems. He didn’t have eustachian tube problems that I am aware of though.

What is it with ENT’s either being good or just plain bad? The last one I went to seemed more interested in the fact he was retiring in Oct than even looking in my ears(he never even touched me)and I came away with the feeling he had retired already and this was last March. I hope this new one can finally solve your problems or at least come up with the correct diagnosis.