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Problem with left ear/possibly enlarged lymph node/pulsatile tinnutis
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KLB1974 posted:
I am a 38 year old female and have had a problem with my left ear for over 2.5 years now.

It started when I was pregnant in early 2010. I had a very bad cold where I sneezed many times over the course of a day. After one particularly hard sneeze, I could hear a pulsating sensation in both ears (like I could actually hear my pulse). I felt dizzy and had to lay down.

A few days later, my family doc put me on antibiotics for a sinus infection. I told him about the weird noise I was experiencing in both ears but he sort of waved it off as nothing.

After I finished the antibiotics, I felt there was alot of fluid trapped in my ears and still had the noise. I visited an ENT for further eval. He told me neither eardrum was moving at all and that I probably had eustachian tube dysfunction and that it would likely return to normal after several weeks. He said steroids could be prescribed but I did not want to take them during my pregnancy and also have had past bad reactions to them. He also said that it was very possible the noise was related to a "venous hum" due to my pregnancy. My OB agreed and said it would resolve itself after delivery.

My right ear got better over time but since then, but my left ear has never been the same. I still have the pulsating noise and still feel like something (like fluid) is trapped in there. I went back to the same ENTa year after this all began (I put it off as I was dealing with twin newborns) and he pretty much wrote it off as my family doc had done previously. He said my eardrums both looked good this time. I did mention to him that a few times over the course of the last several years, my family doc had noted that my left lymph node in my neck was a little swollen and could this be related. He had been telling me this for years but it generally coincided with an illness like a sinus infection or cold so he waved it off as nothing. I brought it up to the ENT thinking maybe it was related to my ear problem. He examined my neck and listened to my arteries with a stethescope. After he was done examining me, he said he thought my lymph node was fine but that I had an enlarged carotiod artery. We decided it was best to get a scan done to rule out anything serious so I had a MRI of the blood vessels in my neck. The MRI did indeed show that my left carotiod is larger than the right but the report was normal. The radiologist said it was uniformly large and they did not detect any abnormalities that would indicate an aneurysm or something serious.

This was over a year ago and I have still been dealing with this pulsating noise. I also have an aching sensation that occurs under my jawline near my left ear that seems to occur on occassion and is worse when I have a cold/allergy flare-ups. That has been going on for awhile now as well.

At this point, I don't know what to do. I feel like the possible lymph node enlargement/carotiod artery enlargement/pulsatile tinnutis/aching sensation/feeling of pressure and fullness all have to be related somehow.

If I am being told my ears look normal upon examination, is there another test that can be done that can actually look behind my eardrum to see if there is fluid trapped back there or possibly some type of nerve damage? Is it even possible to have fluid trapped back there for this long without it causing an infection?

And my biggest fear is that I have a tumor causing all of these symptoms. Would the MRI have shown a tumor if I had one (I just had images taken of the vessels in my neck)? Lymph node enlargment makes me concerned but then again I have one doctor saying it's enlarged and another telling me it's the carotiod and not the lymph node.
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Rod Moser, PA, PhD responded:
I don't think you could have a medical condition any more complicated than what you have described. While reading your posting about the sudden onset of your symptoms after sneezing, I thought of a rupture of the round window -- an area leading into the inner ear, a place that cannot be seen on a routine examination. But later, as your symptoms developed into a more pulsatitle problem I begin the grasp at the complexity of what youa are dealing with.....

Pulsatile tinnitus can be caused by many medical conditions. There are several different medical conditions that can cause pulsatile symptoms:

  • Vascular abnormalities -- a problem with an adjacent artery or vein (the jugular vein has a pulsation is high on the list of causes). It is not just the carotid.
  • Glomus tumors (a non-cancerous growth in or near the blood vessels) are occasionally found.
  • Carotid stenosis (closing or narrowing of this neck artery) can cause pulsatile symptoms.
There are other causes, including hypertension (high blood pressure), patulous Eustachian tubes (open tubes leading from throat to ear), palatomyoclonus (spasms of muscles in the soft palate) and stapedial muscle spasm (the tiny muscle attached to the stapes bone in the middle ear).

In order for you to be properly evaluated, it would be best for you to see an ENT associated with a large, university-based medical center. Usually, the collaborative resources at these large institutions are better for these more difficult to diagnose (and treat) disorders. I cannot provide you with any names or institutions (against WebMD policies), but even if you have to fly/drive to one near you for a high-level diagnostic evaluation, it may be worth it to solve this 2.5 year long mystery.

I do not handle this type of problem in my primary care practice. I refer all of the cases out to sub-specialists at the university. As much as I would like to help you further, this is well beyond my primary care expertise.

I can't really comment on the significance of your lymph node (0r whatever it is) based soley on your description. Sorry.
 
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KLB1974 replied to Rod Moser, PA, PhD's response:
Thanks for your reply. I do think the pulsating is related to that cold I had a few years ago due to the sudden onset. I would think that if it were a vascular cause, the MRI would have picked it up as the imaged all of the vessels on both sides of my neck and didn't pick up anything with the exception of the enlarged carotid which they said was not abnormal looking.

Fortunately, I live very close to a large university based medical center so I will definitely look into it.

Thanks for your time.
 
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Rod Moser, PA, PhD replied to KLB1974's response:
The MRI...no, but an MRA may show it. If the jugular system is causing the pulsatile symptoms ,this vein will need to be imaged. So, a normal MRI does not rule out all of the cause.

Good luck.
 
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KLB1974 replied to Rod Moser, PA, PhD's response:
It was a MRA actually. I did not realize they were not the same thing.
 
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Rod Moser, PA, PhD replied to KLB1974's response:
Great. Then, you were properly evaluated.

Not all ENTs like treating PT. This can be a very, very difficult problem to manage.
 
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rseneta responded:
Well I just about cried when I read this post. I actually thought I wrote it. Your post is exactly what happened to me (minus the being pregnant when it did). I sneezed one day and almost passed right out of my chair I got so light headed and heard my heart and blood beating in my ear. From that point on I have the discomfort in jawline/neck, swollen lymph node, and pulsing in ear (only when I sneeze and not all the time). Went to ENT, had CAT Scan...all normal. I think they wrote me off as crazy. My question to you is (if you ever read this) do you have your tonsils? I am 42 and still have my tonsils-they are extremely cryptic- and I get tonsiliths or tonsil stones, which in turn they might be causing the swollen lymph node, which in turn could be pressuring my Eustachian tube. Sounds far out but it is the only thing that they could come up with. If you ever do see this I would love to hear if you have had any success. This has been 5 years for me. I just sneezed today and got that scary rush sound in my ear and almost passed out-which made me Google it again. At least I found the term Pulsatile Tinnitus-which I had never heard before. I get nervous because I know that carotoid artery is right there too. He told me I could have the lymph node removed just incase...or my tonsils out, neither of which I wanted to do as I don't care to have surgery that isn't absolutely necessary. I try to take extra care of my tonsils to reduce the stones and it seems to help, but its a lot work-netipot, gargling, water pik etc....


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