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Post Op Grommet Insertion Tinnitus
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knotty150 posted:
Hi All

Going to make this post very basic, can get carried away and end up divulging a full length novel describing my situation at times....

2 years ago I got a cold, ever since that I've had problems with tinnitus. More recently however, the tinnitus seemed to almost completely die away but I was left with this sensation of trapped fluid behing my eardrum. Every time I lied down on my left ear and applied pressure, I'd experience the sensation of pressure building up and liquid moving around, the pressure sensation would relieve with a "pop," sensation, as though a quantity of liquid had shifted within my ear, but would soon come back as I applied pressure to the ear I was lying down on.

Hope that makes some kinda sense, anyways, went to see an ENT consultant, had a hearing test and my hearing had declined in comparison to other hearing tests I had had prior to the most recent test (date 1st March 2012). ENT consultant said it could be 2 things:

1. Though I showed no sign of infection/fluid, there is some space behind the eardrum where fluid can become trapped, not be visible through an otoscope and cause these problems I'm experiencing, more recently, the hearing loss.

2. The hearing loss/sensations are all down to permanent inner ear damage and thus irreparable.

I decided to be "optimistic," and went with option 1, and decided to have a grommet inserted in my left ear. I had it fitted on 13th April 2012, its now the 17th and the tinnitus is worse! Immediately after it seemed ok, the 14th was ok but by midday 15th, I'd developed this "wooshing," noise in my left ear, louder than I've ever had it.

My question, mainly aimed towards Dr. Moser, is this a common side effect of a grommet insertion? If so, when can I expect this tinnitus to subside/improve? I'm all too familiar with tinnitus but prior to the op, the tinnitus had improved but it was just the sensation which were really griping me. Now, I find myself contemplating the need for anti-anxiety medication, as I'm having a hard time managing the notion that this "wooshing," could well be permanent, and I'm beginning to regret having the procedure done.

Any help is very much appreciated!

Rich
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yanksgirl responded:
Rich--what is a 'grommet insertion? I just had a 'shunt' insertion for treatment of vertigo and Meniere's. I started out with horrible tinnitus in 2008 but over the next couple of years that subsided, left me with partial hearing in one ear--now wear a hearing aid. Then developed 'vertigo' and then 'drop attacks' so had the 'endolymphatic shunt' insertion--incision behind the ear and a shunt inserted and a gentamyacin medication injected. I have extreme dizziness but now vertigo now for 3 weeks, but nausea from the dizzy's and having to go to P.T. for balance therapy due to all this. Only 'mild tinnitus' going on now. It could be it will take awhile for swelling in your ear to go down--that was what my doctor told me. 4 to 7 weeks or longer, so I understand you being 'down', believe me! Some days are difficult to handle being dizzy literally all day and thus nauseated. I hope things improve for you. yanksgirl
 
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knotty150 replied to yanksgirl's response:
Hi Yanksgirl

Grommet insertion is a ventilation tube placed in the ear drum. After last night however, the tinnitus seems to have reduced a bit. When lying down on my "grommeted," ear, I sometimes get the sensation that fluid is slowly seeping out, and with each little seep comes a tiny bit of tinnitus relief. I do however feel that it's possible the fluid behind my ear is perhaps too thick to pass through the narrow opening in the grommet, can anyone confirm if this is possible, and if its possible to treat thick fluid by use of ear drops or if there are any dangers given that I've got a grommet etc?

I don't know if to acknowledge the procedure as being a success/failure. Given that I'd gone through 2 years of tinnitus, for it to eventually die away to nothing but then get the "fluid," like sensations, I think going ahead with the procedure was a bit of a gamble. Risk tinnitus returning but ease the pressure/sensations? Perhaps it's too early to be talking about success/failure just yet, but the level of anxiety I've encountered was disturbing me, thinking that I'd made a very, very wrong choice to have the tube inserted...

Suppose it might take some time, any feedback is much appreciated. Many Thanks!
 
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Rod Moser, PA, PhD replied to knotty150's response:
There is considerable post surgical inflammation after tube insertion. You may need to give it several more weeks. The symptoms you are experiencing are common and will resolve with time. If there is no improvement the tubes can be removed.

There are special antibiotic/steroid drops that are used for these symptoms and are safe with tubes. The ENT would need to perscribe them.
 
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knotty150 replied to Rod Moser, PA, PhD's response:
Many thanks for your repsonse Dr. Moser!

Just an update. It's now been 8 days since my grommet operation and things do seem to have improved quite considerably. I no longer have loud white noise tinnitus, it seems to have subsided to a quiter, high pitched tone which is no way near as bad as the immediate post-op noises.

What I find quite encouraging is, when I lie down on my grommeted ear, I'll often feel some liquid move within my ear and the tinnitus will change, in a way that would put logic to the suggestion that there IS actually liquid behind my ear and that it's physical displacement is what causes these sensations/noises. It does feel like the liquid behind my ear drum is thick which is preventing it from immediately passing through the grommet.

I've a consultation with me ENT doctor on the 27th and will outline my symptoms to him then. Will keep everyone posted.
 
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Rod Moser, PA, PhD replied to knotty150's response:
Most thick, middle ear fluid is aspirated before the tube (grommet) insertion, but fluid can quickly reaccumulated (but this fluid tends not to be as thick and viscous). It should drain out of those tubes.

Let me know how your next visit goes....
 
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knotty150 replied to Rod Moser, PA, PhD's response:
Thank you for your response.

What makes me think the fluid may be too thick/viscous for it to drain through the tubes is the fact that IF it is the case the fluid like sensations I feel (fluid seeping slowly towards my eardrum when I lay down), then the fluid has been dormant within my middle for all of two years! Is it possible that because this potential fluid has been in my middle ear for so long that it's become incredibly thick/viscious? It certainly feels like it, hence why it's my personal opinion that some kind of ear drops would be required to help dissolve it.

Next consultation is this coming Friday, I'll keep you posted.

Thanks again Dr. Moser, you are a wealth of knowledge!
 
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Rod Moser, PA, PhD replied to knotty150's response:
This is called "glue ear" -- when the middle ear flud (effusion) becomes so thick and sticky that it cannot drain down the e-tubes, be reabsorbed, or go through the tubes. The ENT trys to avoid this by aspirating this glob of mucous at the time of the tube insertion, so it would seem less-likely that this is happening to you right now. Your tube can certainly get compromised by any debris from post-operative blood, to mucous, to wax, so this is why a special steroid/antibiotic eardrop is often prescribed.

Let me know what happens....
 
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knotty150 replied to Rod Moser, PA, PhD's response:
Afternoon Dr. Moser

Just had my consultation and got to say, I'm not best pleased. For a start, they didn't have access to my previous hearing tests so straight away were not able to tell me if the grommet insertion had any effect on my hearing. They just said my hearing is pretty much normal with the exception of the high frequencies which are slightly less than average. Secondly, my consultation was with a different doctor than stated on my appointment letter. Theres absolutely no consistency with my consultants, I never see the same doctor more than once and I genuinely feel that none of the doctors have a specific and thorough knowledge of my precise situation.

I mentioned the sensations I had, as though there was thick fluid behind my ear drum which wasn't properly draining through the grommet. The doctor said that at the time of the operation, he'd used suction and that my ear was dry. I then proceeded to tell him that the following Monday after my operation, I felt some liquid drip through my ear, inseted my little finger into my ear and evidently saw some fluid on the end of my finger. He said that lying down during the operation may have prevented fluid from being suctioned out and that if I did have thick fluid, it wouldn't have been that which drained out through the grommet.

I then asked if some ear drops may be prescribed to help thin this "vicsous," fluid that I feel is present within my ear, he just said ear drops wouldn't do anything.

Frustrated by it all really. When alone in a quiet environment, I'll experience tinnitus. However, the tinnitus seems to subside when I lie down on my ear for a certain period of time and feel the sensation of thick fluid shifting within my ear. I've done some research and I believe there are some ear drops that would help thin thick fluid but to have this option dismissed seems hasteful and perhaps an oversight from the doctor.

Maybe I'm an awkward patient and expect too much from the UK health service but when I genuinely feel my symptoms could be cured only to not have things explained thoroughly or consistently I find very annoying. I am willing to accept that these symptoms I experience are just the effect of permanent, irreperably middle ear damage, but would also hope that every treatment option is considered prior to being written off as a lost cause.
 
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Rod Moser, PA, PhD replied to knotty150's response:
I am really sorry that you had an unproductive visit.....

A few observations:

1. Doctors are like chefs. They all cook a bit differently. Some are excellent; some can make you sick. Seeing different doctors and having different opinions is common; including care in the U.S.

2. ENTs in our geographic area, and I suspect in most of the U.S. use an eardrop (brand name Ciprodex)...a combination of ciprofloxacin (an antibiotic that is safe in the middle ear space) and a steroid (for inflammation). Once the drops are instilled, the tragus (a part of the outer ear) is pumped to force some of these drops through the tubes/grommett. Studies have really proven that this helps to prevent clogging, reduce inflammation/infection that has the potential to prematurely extricate (cause it to be pushed out by pressure) the tubes/grommett. Many UK doctors use metal grommetts which have a little bigger flange, so perhaps extrication is not a big problem there. I do not know if this eardrop is available in the UK, but I suspect it is....perhaps under a different proprietary name. FYI: It is expensive here!

3. Hearing testing at this point may not have been accurate, but it would have been nice to see.

Did the ENT mention at all if the tube was "open"? This can be visualized on exam. Your general practitioner can determine this, too.

I don't think you should consider yourself a lost cause. Make, yet another, ENT appointment now for a month or so from now when you can get it....for ANOTHER follow-up. Maybe you will get a more compassionate ENT next time.
 
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knotty150 replied to Rod Moser, PA, PhD's response:
Thanks for your response Dr. Moser

Apologies for my late response. I will book an appointment to see a GP who I know will listen to me, and I'll also express a preference over an ENT should I be referred.

I really am quite certain that these sensations I get are fluid behind my eardrum. I lie down on my grommeted ear and after 10/15 mins, I'll feel something suddenly seep down towards my ear, at which point I'll switch to lie down on my other ear and feel this fluid seep back down my canal. The fact it takes all of 10/15 mins for the fluid to shift implies to me that fluid is very thick, where thin fluid would simply drip out quite easily.

Also, when I pinch my nose and blow air into my eustachian tube while I'm standing up, I'll feel air escaping through my grommet. However, once I've lied down on my ear and felt this seeping sensation, I'll use the same technique of pinching my nose and blowing air into my ET, but I wont feel the air escape through my grommet, as though the fluid has seeped down and blocked the grommet preventing air from escaping.

Over the past 2 yrs I've had numerous hearing tests, however the test I had before my grommet insertion revealed a degree of hearing loss in comparison to other tests. If it's not fluid, what on earth is causing the hearing loss? If it didn't annoy me so much I'd actually find it funny that something which I believe is really quite simple, can bypass so many different doctors/consultants....

Questions:

Lets just presume what I'm saying is correct and that I do have some very thick fluid behind my ear drum. If I just left it, would it dry out/drain through the grommet? Is there anyway at all I could expose this to a doctor? Should I suggest the medication you mentioned in your post?

I know my opinion perhaps doesn't count for much in the medical world but I genuinely think that right now, unless I do have some sort of medicine to help thin this "fluid (I use the term loosely)," that it's going to struggle to drain through the grommet.
 
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Rod Moser, PA, PhD replied to knotty150's response:
Unfortunately, you cannot really change the viscosity of this fluid, even with eardrops. Those drops really try and keep the grommet opened, but if the fluid is glue-like and sticky, it will not drain through the grommet and certainly not the narrow Eustachian tubes. Over time, the fluid may be reabsorbed by the body, but it doesn't really dry out per se.

On a routine exam, a generalist may or may not see the fluid (depends on where it is at the time). An ENT has a better chance because of the magnification of his/her instruments, but even then, it may not be obvious.
 
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knotty150 replied to Rod Moser, PA, PhD's response:
Thanks for your response, I honestly think this is the case with me.

So is there nothing I can do? In one sense I find it quite reassuring that its possible (probable I think) that there is fluid behind my ear drum, but frustrating that I might not be able to do anything about it.

Would you suggest anything? Would a physician consider allowing me to lie down until I feel the fluid seep against my ear drum, then insert a syringe and attempt to suction the fluid out? Perhaps an obscure method of treatment but when your in my position, you just thing of anything...
 
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Rod Moser, PA, PhD replied to knotty150's response:
That would NOT be a good idea....If your grommet was occluded (clogged), you could either suck it our or rupture your eardrum.

So...there reallly is nothing YOU can do at home to aspirate middle ear fluid. Your ENT would need to do this.
 
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knotty150 replied to Rod Moser, PA, PhD's response:
Sorry Dr. Moser I don't think I explained myself properly there.

What I meant was, would it be considered unorthodox for me to, during an appointment, attempt to expose this "fluid," by lying down and then asking the GP/ENT to examine my ear? I only ask because although I've explained these symptoms to the consultants I've seen, not one of them has asked me to physically lie down and try to provoke this fluid into sight. They've all seemed quite happy to carry out a routine examination and be done with me.

I'll arrange to see my GP next week, I'll run the exact same questions by him and see what he cant arrange.

Thanks for all your help Dr. Moser, you are a massive help!


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