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Chronic ear pressure
Christian1113 posted:
Dr. Moser,

I've been dealing with a constant ear pressure in my right ear for about a year now. It feels full and I constantly feel the need to "pop" it. The condition is also exacerbated by exercise (running and lifting weights). I have seen two ENT doctors as well as two dermatologists. Both ENT specialists said my ears looked perfectly clean and healthy.

I have had 4 theories as to what could be causing the pressure:

1) ECZEMA-I have eczema in my right ear and originally thought the pressure had something to do with it or the mild steroid cream I was using to alleviate the itching (since steroids thin out the skin in the area). Due to excessive wax build up due to the eczema, I have been using q-tips to clean this ear out 1-2 times per week. However, over the last couple of weeks, I have also been experiencing similar issues in my left ear, which does not have eczema.

2) TMJ- I wear a mouth guard for grinding my teeth and have been told I may have TMJ and should see a dentist specializing on that issue. It is on my to-do list but I haven't had a chance yet. I have also been suffering from chronic tension headaches from the past decade which might be related to the TMJ.

3) WISDOM TEETH- I am 30 and have not had my wisdom teeth removed. I understand that the roots grow upward and can cause complications. They are not impacted and my ENT said this would not be causing the pressure although I am sceptical and am considering getting them removed just to check the box. I am seeing an oral surgeon this week for a consultation.

4) BAROTRAUMA- I fly often and work on the 20th floor of a building- not sure if this could be putting train on my ears.

The issue is chronic and extremely bothersome and distracting constantly. I am a very busy professional working 60-80 hours a week and usually on the road so finding the time for treatment has been challenging. I am willing to invest the time and money if there is a good chance of treating the symptoms but am worried that this may just be something I need to learn to live with.

I would greatly appreciate your advice here. What are my options? What sort of specialists should I consult? Can you recommend anyone in the Los Angeles area?

Thanks so much, Christian
Rod_Moser_PA_PhD responded:
WebMD does not permit us to refer you to a specific physician or clinic, but you should have no problem finding a good specialist in the LA area...both for a dentiist for your TMJ and and ENT for this annoying ear pressure of yours.

You have had this probem for a year, my friend. Regardless of your over-working habit, you occasionally have to take some time for yourself to deal with these issues. You are not going to get a definitive diagnosis or an effective treatment via the Internet.

Ideas? That I can do. Your theories? Some may be valid.

I doubt that your ear eczema is the true underlying issue for your ear pressure, unless you have a painful, secondary otitis externa. People with eczema tend to have allergies, and allergies CAN be an underlying issue IF your problem is in the MIDDLE EAR, and not the inner ear (both areas can cause "pressure" sensations).

Try to break that Q-tip habit, and it is safe to use HYDROcortisone creams -- the over the counter stuff -- not the more-potent prescription topical cortisones. The potent ones will definitely thin the skin with chronic use; rarely with the safer, less-penetrating hydrocortisones.

Barometric pressure changes can be contributory to middle ear / eustachian tube problems, but in most cases, your symptoms would transient...not constant.

Due to nerve pathways, both a problem in your third molars AND the TMJ can cause referred ear pain, fullness....and yes, even headaches. Although someone who choses to work 80 hours a week is bound to get some tension headaches.

The ball is in your court. The ONLY way for you to get properly examined...diagnosed...and treated to to actually SEE a few medical professionals. Make the time....
Christian1113 responded:
Dr. Moser,

Thank you so much for your prompt response. I certainly appreciate that I will need to take the time to consult several medical professionals. That is certainly the path forward I intend to pursue regardless of work commitments- I'm sorry if my tone suggested otherwise.

I guess my frustration lies in that over the course of the last year, I saw one ENT 5-6 times and being unsatisfied with the progress, switched to another one. (The first was a recommendation from my PCP, the second, from a friend). I've visited the second ENT about 5 times and our last visit involved a referral to a dentist for TMJ- there was no other follow-up plan and I was left pretty disappointed. The visit before that, I was referred to a dermatologist, who really didn't have much to say but prescribed a couple of creams for my ear. When I mentioned the wisdom teeth theory to this ENT, he told me not to worry about getting them removed which given your response, is a bit concerning.

So I guess my follow-up questions would be- (1) how do I find an ENT who will work with me to get to the answer and (2) how can I work with them to develop a plan of attack. Also, I was just trying to get a general sense of how often such conditions are treatable so I can set my own expectations about results.

I am certainly not hoping on a diagnosis over the internet but am trying to cast my net across multiple sources so that I can be better informed in any future discussions. If there are any other resources you could suggest, I would also appreciate that as well.

Thanks again and best regards, Christian
Rod_Moser_PA_PhD responded:
Check the US News and World Report listing of "best ENT hospitals". They do a new one every year. This would be a good place to start looking for an ENT specialist, however, you won't really know of your personalities will mesh until you meet them. Some specialists are excellent technical clinicians, but lack a bit when personalities were handed out. Some are very personable, but perhaps not as experienced. If you can find BOTH, then great.

You are a person who wants to be actively involved in your own care....good for you. However, not all medical providers will view this as an asset. Personally, I would rather treat one informed patient than a dozen "sheep".

Not all of your symptoms are likely attributred to one, universal diagnosis, but they do have "cross-over" symptoms in many cases. Finally, doctors are like chefs...they all "cook" a bit differently. Medicine is not an exact science, so there is plenty of room for treatment variability.
LeoWF responded:
Hi Christian: Have you solved your ear pressure problems yet? I have very similar ear pressure problems. Mine began over a year ago & I thought was related to sinus drainage caused by an allergy to my high blood pressure medicine. Several changes of BP medicines have reduced the drainage & persistent cough, but the ears still feel plugged and my hearing is muffled. My general physician says my ears are clean and clear, so I got him to refer my to an ENT. The ENT says the same thing, except my hearing tests shows that I have a 50% loss in both ears. I have now an appointment set for an Allergist to find out if an allergy to my medicines or what-ever is causing this condition. My initial thoughts about this being caused by a side-effect of my BP or other prescriptions hopefully will be answered by the allergy doctor. Are you taking any new medicines that coincide with your ear problems. Good luck & keep on searching for the cause, if you haven't discovered it yet. LeoWF
hkat35 responded:
have the same issue in my left ear. i literally start to go a little nuts because of the hearing deficit on that side once it really gets going. i try equalizing the pressure by plugging my nose and "sucking in" or "blowing out" but after an initial reclibration to normal pressure, it blows again. exercise makes it worse. sinus issues make it worse. chewing gum can make it worse. i noticed that if i turn my head upside down it "drains". (i cannot feel fluid and my ear does not leak, but i can feel the pressure give way and let my eardrum return to its normal shape.)

i finally started asking doctors what they saw. they all said my ear looked good, no sign of infection or physical damage. each one prescribed some form of decongestant that only relieved the severity of the symptoms temporarily. i say temporarily because i am going on my third year with this issue and it is getting progressively worse.

i finally had a nurse practitioner look in my ear and test the pressure. she discovered that although the ear drum looked healthy and pink, it was rigid. and bulging. and not vibrating.

the only thing i have in common with you is being thirty-ish and still having my wisdom teeth. and my lower left wisdom tooth is a complete mess which causes swelling on that side of my jaw. LOTS of swelling.

i am pretty sure that is the source of my issue and since it sounds so similar to my situation, i am curious as to what you have done and if it worked. i am a nursing student and single mother of three young kids so i do not have time to go get my teeth pulled. and taking time off to have people rip teeth out of my head is not something i want to do if it didn't seem to work for you.

i realize we may not have the same issue, but in trying to evaluate my situation, i have not been able to find anyone experiencing anything similar. so, like i said, it would be interesting to hear what you have done about your ear!

howardschumann replied to Christian1113's response:
I have had chronic ear pressure in my left ear for nine years (no hearing loss, no tinnitus). Ear, Nose, and throat doctors say - sorry there is no treatment. The only help I have gotten is with acupuncture, but the benefit only lasts a few days. There must be something developed in the last nine years that will help.
Rod Moser, PA, PhD replied to howardschumann's response:
What is your diagnosis, Howard? What did the doctor tell was the REASON for your ear pressure, and why there was not any treatment?
alex2505 responded:
I have had the exact same issue for 6 years now. Seen 3 different ENT's. The first two were useless and pretty much gave up on me...said I need a hearing aid, since my hearing in the effected left ear is reduced by 50%. at this point I don't even care about the haring loss as much as the pain of pressure. I constantly have the urge to pop my ear...feels clogged all the time, but at times much worse. I should mention that I also had 2 MRI's and they showed nothing. My current ENT thinks I may have Monears dissease, so he put me on Diaretic pills, but after a month on them, see no improvement.
I also have all my wisdom teeth and believe they may be
Rod Moser, PA, PhD replied to alex2505's response:
You didn't finish the sentence, but it is unlikely that your wisdom teeth are causing your problem.

Menieres disease is difficult to treat and cannot be cured. Tests, like the MRI, are usually normal with Menieres. Many ENTs do not like to treat Menieres (it frustrates them as well), so if you can find a Menieres specialist, that may be helpful to confirm your diagnosis and to provide you with some more definitive treatment to control your symptoms.
alex2505 replied to Rod Moser, PA, PhD's response:
Sorry about that. For some reason, it would not let me put any more characters in.
I wanted to say that my Wisdom teeth have not been removed, and I did see a dentist some 7 years ago, who recommended at least I take two of them out, since they were pretty bad and kind of flipped on their side. I remember it not bothering me at the time, so I just opted not to take them out. Right now I am desperate to do anything. I have spent more time reading about my issue on the web then spending time with my children. I was washing my car 2 months ago, and as I bent down, my left ear completely closed. I could not get it open at all, but ended up going to sleep and waking up better. The issue is progressively getting worse. Wish I could cure this, it is awful to live like this. My next appointment is in February with the same ENT #3, so I will see what he thinks. I should also mention that when I have pressure like this in the ear, I usually gently press below the ear (right at the jaw line) and I can hear a mixture of air and fluid..hard to explain, but after I push in and hear this mixture, I get a bit better..relieves the pressure. I believe is someone had a camera small enough to go through the nose and end up on the inside of the ear, they could see what is there, but it could be wishful thinking. I am sure you can see my desperation in my writing..I am at a loss at this point. I live in Canada and we get free medical up here, but I am not sure about the quality of it all at this point. I read Christian1113 symptoms (as well as many others), and feels like I have an exact issue, but nobody seems to have a cure. At least I am glad you think my wisdom teeth are not the issue here. Perhaps TMJ???
I do hope I don't have Meniere's Disease, but I feel even if I do, at least I will have some closure. Thanks so much and sorry for my rambling.
Rod Moser, PA, PhD replied to alex2505's response:
Let me qualify that statement a bit....

A person can have more than one medical problem at a time. You could have TMJ problems or an issue with your wisdom teeth, but they are not causing ALL of your symptoms, so you still may have Menieres. Since I can't examine you, this is only a blind guess.

See a dentist that specializes in TMJ problems. He or she can also give you an opinion about the need to remove those wisdom teeth since they are that crooked.

There are some fine doctors in Canda. Don't dismiss them because your care is free.
alex2505 replied to Rod Moser, PA, PhD's response:
Thank you so much Dr. Moser. I will keep everone here up to speed with my prognosis, and hope it helps others. You taking the time to answer and comment on people's questions and concerns etc. here is absolutely incredible and worth a big thank you. Again, don't read too much into my comments about doctors up here, as I mentioned, I am just going through a lot and maybe expecting a cure too soon, but after 6 years and 3 doctors, I am starting to be a bit grumpy....just a bit.
Thank you again doctor.
Rod Moser, PA, PhD replied to alex2505's response:
You are entitled to be grumpy.....six years is a long time! One thing that patients often have trouble appreciating is the limitations of medical intervention. As much as doctors would like to cure everything that walks in their examining rooms, not everything can be definitively diagnosed or cured. Doctors don't like to talk about these makes them feel inadquate, but they do understand the ambiguity. Patients just want to get better.

Believe it or not, you and your doctor share the same goal, but unfortunately, the body often has other ideas. These things frustrate your doctor, too.

Don't give up on modern medicine yet (including Canadian medicine). There are still some diagnostic stones to be overturned in your case. Maybe....just maybe...someone will find the 'smoking gun' and offer you a more definitive treatment.

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