“I have chronic sinusitis, eustachian tube dysfunction, tinnitus, pulsatile tinnitus, and cholesteatoma?”
My symptoms have been going on for a long time and I would like to give as much detail as I can. I am a 36 year old white female with a long history of chronic sinusitis and sinus headaches since my teens. In August 2020 I woke up with a blocked left ear but I wasn't experiencing any pain. I waited about a week then went to a walk-in clinic to get it checked out. They took a look at my ear and stated that they couldn't see anything wrong with my ear, I didn't have an ear infection but that I had a small piece of wax up against my eardrum. However, they stated they didn't see that causing my problem. They sent me on my way with I believe some Sudafed and Flonase and my ear resolved itself a week later. I didn't think much more about it until it happened again about a month in a half to two months later.
I again didn't have any pain, just felt like my hearing was muffled/blocked so I didn't go to the Dr until a month later after I started experiencing tinnitus. Again I was told the same thing, the ear looks fine, no infection, and brought up this piece of wax that shouldn't be causing me any problems. However, this time I was referred to an ENT. I went to the ENT and was immediately told I have a deviated septum on the left side of my nose. He tried to flush the wax out of my ear, unsuccessfully, ordered a CT, and sent me on my way with some antibiotics, Flonase, and ear drops to soften the wax. I returned to do the CT scan and saw the Dr right after. He informed me that my septum deviation was pretty bad and I required sinus surgery.
He stated that my eustachian tube dysfunction could be directly attributed to my septum deviation since they are both on the left side and we could try to mitigate the worst of the symptoms with meds but ultimately surgery was going to be the only way to get any real results. I was not able to take off work at that time for surgery so I decided to hold off. The ENT told me to call or schedule for any sinus infections and to let them know when I was ready for surgery but there wasn't anything he could do to help my ear in its current state besides the surgery. I want to say this was sometime in Jan maybe Feb 2021 It is worth noting that from the time the blocked ear started I was unable to pop my ear at all. Sometime between that appt and May 2021 I was able to pop my ear. Though when I would pop my left ear, I would be able to "hear again" for a few seconds. I would pop it then a few seconds later I would feel air bubbles in the left side of my nose and hear the pop from my eardrum retracting causing my ear to feel blocked again. I also started experiencing pulsatile tinnitus.
This caused me an enormous amount of anxiety and was the ultimate driving factor in proceeding with the surgery. I had the surgery on June 10th, 2021. Supposedly, the ENT came out after and told my husband that the septum deviation came to an almost 90-degree angle. I attended all my debridement and follow-up appts, each time bringing up my ear. The ENT urged me to give it some time to heal and stated that ears are typically the last thing to feel better. It made sense especially since I was still feeling that strange air bubbling up through the left side of my nose when I would pop my ear. A few months ago I order an at-home otoscope for other reasons but was able to get a look inside my ear for myself. I immediately saw the wax everyone had spoken of, though it didn't really look like wax to me. To be honest my first thought was that it looked like a scab. It was perfectly circular and didn't appear to have any edges at all. It looked like it was fused to the eardrum.
I purchased some debrox and the first night it bubbled and fizzled in my ear, the next two nights....nothing. It further made me question if it really was wax. I requested my GP to send a referral to another ENT, one that I know specializes more in the hearing side of things. The wax/scab is actually a cholesteatoma. I've done a lot of research about what could possibly be going on with my ear as this has been going on for a really long time, but I discounted a cholesteatoma as I hadn't experienced chronic ear infections, nor any smelly discharge. My last ear infection was about 14 years ago and I ruptured my right eardrum. The only issue I can think of with my ears in between that time is occasional itchiness deep in the ear during a cold or sinus infection.
The new ENT suctioned out the wax/scab and a big chunk of white gunk. Suctioning out that gunk has gotten rid of the pulsatile tinnitus and my eardrum doesn't feel retracted anymore. I can pop that ear and I hear a little crackle but it doesn't pop back in and I don't feel the air pressure bubbles in my nose. The regular tinnitus is still there and my ear does still feel blocked but I'm extremely happy to have the blood pumping sound gone. I am currently awaiting the CT to be scheduled to find out how big the Cholesteatoma is and if it is going to require a two-part surgery. So after all that......My question is which is most likely?
Is it possible that I've had poor eustachian tube function and retracted eardrum for quite a while with no symptoms and the cholesteatoma itself is what brought on the clogged ear, tinnitus, and pulsatile tinnitus?
Or is the cholesteatoma a result of the eustachian tube dysfunction and retracted eardrum going on since August 2020? If the cholesteatoma is a result of the ETD going on so long, finding the cause to the ETD would still be necessary to prevent another cholesteatoma from forming right.
I again didn't have any pain, just felt like my hearing was muffled/blocked so I didn't go to the Dr until a month later after I started experiencing tinnitus. Again I was told the same thing, the ear looks fine, no infection, and brought up this piece of wax that shouldn't be causing me any problems. However, this time I was referred to an ENT. I went to the ENT and was immediately told I have a deviated septum on the left side of my nose. He tried to flush the wax out of my ear, unsuccessfully, ordered a CT, and sent me on my way with some antibiotics, Flonase, and ear drops to soften the wax. I returned to do the CT scan and saw the Dr right after. He informed me that my septum deviation was pretty bad and I required sinus surgery.
He stated that my eustachian tube dysfunction could be directly attributed to my septum deviation since they are both on the left side and we could try to mitigate the worst of the symptoms with meds but ultimately surgery was going to be the only way to get any real results. I was not able to take off work at that time for surgery so I decided to hold off. The ENT told me to call or schedule for any sinus infections and to let them know when I was ready for surgery but there wasn't anything he could do to help my ear in its current state besides the surgery. I want to say this was sometime in Jan maybe Feb 2021 It is worth noting that from the time the blocked ear started I was unable to pop my ear at all. Sometime between that appt and May 2021 I was able to pop my ear. Though when I would pop my left ear, I would be able to "hear again" for a few seconds. I would pop it then a few seconds later I would feel air bubbles in the left side of my nose and hear the pop from my eardrum retracting causing my ear to feel blocked again. I also started experiencing pulsatile tinnitus.
This caused me an enormous amount of anxiety and was the ultimate driving factor in proceeding with the surgery. I had the surgery on June 10th, 2021. Supposedly, the ENT came out after and told my husband that the septum deviation came to an almost 90-degree angle. I attended all my debridement and follow-up appts, each time bringing up my ear. The ENT urged me to give it some time to heal and stated that ears are typically the last thing to feel better. It made sense especially since I was still feeling that strange air bubbling up through the left side of my nose when I would pop my ear. A few months ago I order an at-home otoscope for other reasons but was able to get a look inside my ear for myself. I immediately saw the wax everyone had spoken of, though it didn't really look like wax to me. To be honest my first thought was that it looked like a scab. It was perfectly circular and didn't appear to have any edges at all. It looked like it was fused to the eardrum.
I purchased some debrox and the first night it bubbled and fizzled in my ear, the next two nights....nothing. It further made me question if it really was wax. I requested my GP to send a referral to another ENT, one that I know specializes more in the hearing side of things. The wax/scab is actually a cholesteatoma. I've done a lot of research about what could possibly be going on with my ear as this has been going on for a really long time, but I discounted a cholesteatoma as I hadn't experienced chronic ear infections, nor any smelly discharge. My last ear infection was about 14 years ago and I ruptured my right eardrum. The only issue I can think of with my ears in between that time is occasional itchiness deep in the ear during a cold or sinus infection.
The new ENT suctioned out the wax/scab and a big chunk of white gunk. Suctioning out that gunk has gotten rid of the pulsatile tinnitus and my eardrum doesn't feel retracted anymore. I can pop that ear and I hear a little crackle but it doesn't pop back in and I don't feel the air pressure bubbles in my nose. The regular tinnitus is still there and my ear does still feel blocked but I'm extremely happy to have the blood pumping sound gone. I am currently awaiting the CT to be scheduled to find out how big the Cholesteatoma is and if it is going to require a two-part surgery. So after all that......My question is which is most likely?
Is it possible that I've had poor eustachian tube function and retracted eardrum for quite a while with no symptoms and the cholesteatoma itself is what brought on the clogged ear, tinnitus, and pulsatile tinnitus?
Or is the cholesteatoma a result of the eustachian tube dysfunction and retracted eardrum going on since August 2020? If the cholesteatoma is a result of the ETD going on so long, finding the cause to the ETD would still be necessary to prevent another cholesteatoma from forming right.
Female | 36 years old
Complaint duration: 14 months
Medications: ramipril, crestor, claritin D, Linzess, flonase
Conditions: hypertension, chronic sinusitis, eustachian tube dysfunction
3 Answers
Eustatisl tube dysfunction
Eustachian tube dysfunction is the pathological cause of a cholesteatoma. The cholesteatoma forms because there is too much negative pressure constantly pulling on the ear drum (the middle ear pressure is not being regulated properly do to eustachian tube dysfunction. Honestly, Septal deviation does not "cause" eustachian tube dysfunction. So no doubt he straightened your nasal septum... but this did not have anything to do with your ears. It can take months to years for a cholesteatoma to form. So likely it's been going on for a while and you just started to feel the symptoms recently. You doctor should also get an audiogram. It would be helpful to perform a eustachian tube dilation at the time of your ear surgery, known as a tympanomastoidectomy. The dilation will help to address the origin of the whole problem, the eustachian tube.
Was the surgery just septoplasty or this plus a sinus procedure? Do you (or did you) have medically prove chronic sinusitis? If you have untreated sinus disease, this could have been present for many years and caused a “retraction-pocket cholesteoma. It should be addressed to lessen chance of eustachian tube problems in the future. Also, the size of the cholesteotoma on CT, your hearing level, and the status of the ossicles?? Many variables here.
