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Pulsatile Tinnitus after surgery
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Mitzi57 posted:
Hi Dr. Moser, I developed pulsatile tinnitus about six weeks after Tympanoplasty surgery in June, 2011 to fix a retracted eardrum. Then I had a tube put in a couple months later. The pounding was really bad during the holidays into spring, 2012. My ear was also very sensitive to sounds, like a gong going off in my ear at the slightest noise (such as biting into a pumpkin seed or clicking the deodarant stick). I, like so many others, have had doctors tell me there's nothing they can do and try to live with it. My case is unusal, however, because it is a direct result of the surgery, as I did not have this prior to surgery.

My doctor told me that once the tube comes out the hearing should come back and the sensitivity will go down. Well, the tube has since come out about 7 weeks ago. The pouding has gone down a lot and the sensitivity seems to be getting some better. What was 25% hearing loss is down to !5%. The most agonizing time for me still is when I work out. My question is, do you think this is something that will clear up on its own in time? How long will it take? Doc has me on a nasal spray to try to get my Eustachian tube functioning properly. Is that necessary, really? I appreciate your time and comments. Thank you.
3 Replies |Watch This Discussion | Report This| Share this:Pulsatile Tinnitus after surgeryHi Dr. Moser, I developed pulsatile tinnitus about six weeks after Tympanoplasty surgery in June, 2011 to fix a retracted eardrum. Then I had a tube put in a couple months later. The pounding was really bad during the holidays into spring, 2012. My ear was also very sensitive to sounds, like a gong going off in my ear at the slightest noise (such as biting into a pumpkin seed or clicking the deodarant stick). I, like so many others, have had doctors tell me there's nothing they can do and try to live with it. My case is unusal, however, because it is a direct result of the surgery, as I did not have this prior to surgery. <br /> <br />My doctor told me that once the tube comes out the hearing should come back and the sensitivity will go down. Well, the tube has since come out about 7 weeks ago. The pouding has gone down a lot and the sensitivity seems to be getting some better. What was 25% hearing loss is down to !5%. The most agonizing time for me still is when I work out. My question is, do you think this is something that will clear up on its own in time? How long will it take? Doc has me on a nasal spray to try to get my Eustachian tube functioning properly. Is that necessary, really? I appreciate your time and comments. Thank you.
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Rod Moser, PA, PhD responded:
Pulsatile tinnitus, just by definition, mean that there is blood vessel involvement somewhere....it could be an adjacent artery, or even a branch of the jugular vein (this vein has a puslation). The vessel could be somewhat remote from the ear if there is still inflammation in this area, or fluid in the middle ear. PT is a very difficult condition to evaluate and manage. Some people end up going to a high-level evaluation at a University-medical center. Obviously, when you work out, your heart rate increases and blood pressure changes...this just proves it is pulsatile.

I have no way of predicting if your PT will resolve in time, but you could be encouraged knowing that you seem to be improving. Some cases of PT end up in the operating room if a source is identified; some do resolve. Did your ENT tell you what he thought was the cause?

I don't know what KIND of nasal spray you are taking, but if you feel it is not necessary, you will need to address this with the prescriber. I suspect it may be a nasal corticosteroid, but that is just a guess.
Report This| Share this:Pulsatile Tinnitus after surgeryPulsatile tinnitus, just by definition, mean that there is blood vessel involvement somewhere....it could be an adjacent artery, or even a branch of the jugular vein (this vein has a puslation). The vessel could be somewhat remote from the ear if there is still inflammation in this area, or fluid in the middle ear. PT is a very difficult condition to evaluate and manage. Some people end up going to a high-level evaluation at a University-medical center. Obviously, when you work out, your heart rate increases and blood pressure changes...this just proves it is pulsatile.<br /> <br />I have no way of predicting if your PT will resolve in time, but you could be encouraged knowing that you seem to be improving. Some cases of PT end up in the operating room if a source is identified; some do resolve. Did your ENT tell you what he thought was the cause?<br /> <br /> I don't know what KIND of nasal spray you are taking, but if you feel it is not necessary, you will need to address this with the prescriber. I suspect it may be a nasal corticosteroid, but that is just a guess.
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Mitzi57 replied to Rod Moser, PA, PhD's response:
Dear Dr. Moser,
Thank you for your quick reply. The improvement has been small changes but very, very gradual. My ENT doctor, I have to be honest, never really acknowledged the condition as being a result of surgery. He kept telling me there wasn't a "darn thing that could be done about it" and that I had to try to live with it. When I told him I didn't have PT before surgery, he would somehow dodge to statement and during one visit he simply ignored me regarding the subject. Needless to say, he hasn't been much help and has not told me what he thought the cause was.

The nasal spray he prescribed is called Fluticasone Propionate. I'll try it for a couple weeks and see how it helps. In the meantime, I will give it some more time to see if it clears up on its own. If not, I have already found another ear doctor that I would return to if necessary. He recommeneded an MRI as the next step. That would catch any blood vessel abnormalities. Is it possible to have inflammation but not experience any pain, drainage, or anything? I appreciate your comments.
Thank you.
Report This| Share this:Pulsatile Tinnitus after surgeryDear Dr. Moser, <br />Thank you for your quick reply. The improvement has been small changes but very, very gradual. My ENT doctor, I have to be honest, never really acknowledged the condition as being a result of surgery. He kept telling me there wasn't a "darn thing that could be done about it" and that I had to try to live with it. When I told him I didn't have PT before surgery, he would somehow dodge to statement and during one visit he simply ignored me regarding the subject. Needless to say, he hasn't been much help and has not told me what he thought the cause was. <br /> <br />The nasal spray he prescribed is called Fluticasone Propionate. I'll try it for a couple weeks and see how it helps. In the meantime, I will give it some more time to see if it clears up on its own. If not, I have already found another ear doctor that I would return to if necessary. He recommeneded an MRI as the next step. That would catch any blood vessel abnormalities. Is it possible to have inflammation but not experience any pain, drainage, or anything? I appreciate your comments. <br />Thank you.
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Rod Moser, PA, PhD replied to Mitzi57's response:
Fluticasone is a nasal corticosteroid usually used for allergies, but has been used for Eustachian tube issues. It is not a specific treatment for pulstatile tinnitus, as you know, but perhaps the mild, anti-inflammatory effect may be beneficial.

You may need a special type of MRI - sone that can visualized the blood vessels...this is called an MRA. Most of these tests end up to be normal, but it is a part of the diagnostic work-up.

Since your current ENT is not responsive, you may want to consider getting a second opinion from another ENT -- one that treats PT (may be difficult to find), so a university-based medical center ENT department would be recommended. Ask your next ENT if they follow or treat PT, or do they refer you to others.
Report This| Share this:Pulsatile Tinnitus after surgeryFluticasone is a nasal corticosteroid usually used for allergies, but has been used for Eustachian tube issues. It is not a specific treatment for pulstatile tinnitus, as you know, but perhaps the mild, anti-inflammatory effect may be beneficial.<br /> <br />You may need a special type of MRI - sone that can visualized the blood vessels...this is called an MRA. Most of these tests end up to be normal, but it is a part of the diagnostic work-up.<br /> <br />Since your current ENT is not responsive, you may want to consider getting a second opinion from another ENT -- one that treats PT (may be difficult to find), so a university-based medical center ENT department would be recommended. Ask your next ENT if they follow or treat PT, or do they refer you to others.
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