The Medical Consumer's Advocate
Q: 
After suffering for about 4 years
with what was diagnosed as a problem with my Eustachian
tube in my right ear, I finally couldn't stand the
plugged feeling and had my doctor put a tube in it. After
the tube was put in, it became worse. I feel like I have
suffered hearing loss and and the plugged feeling is
twice as bad. After a few weeks the feeling got a little
better but I was praying that the tube would help, but it
hasn't.......yet.
Do you think that if I leave it
in I have a chance that it may help or do you think if it
hasn't worked by now it won't, should I leave it in or
have it taken out. I am currently on a nose spray which
helps a little. If there is anything you can suggest I
would greatly appreciate it.........this ear is driving
me crazy.
A: I can't be certain of what's going on,
but I do have some theories. I'll leave the actual advice to
the end of the letter.
Possibility number 1: the plugged
sensation is due to swelling/inflammation of your right
Eustachian tube, and is NOT related to air pressure
differences between your middle ear and the external auditory
canal. This would explain why your nose spray (which I assume
is a steroid?) is helping a bit. It would not explain why
placement of the tube has apparently worsened your symptoms
of plugging and hearing loss. If this possibility is true,
anything that can be done to help remove the cause of the
inflammation would improve your symptoms (so, if you have
allergies, treat the allergies; if you have sinusitis, treat
the sinusitis, and so forth).
Possibility number 2: you did not
mention whether you have had a very long history (several
years) of problems with your right ear. In some individuals
with a long history of chronic ear infections, the ear drum
retracts (is sucked inward) to the point where
there is little or no space left in the middle ear. (Imagine
sucking in your cheeks so vigorously that you no longer had
any room left inside your mouth.) Frequently, there is often
significant degeneration of the middle ear bones which are
responsible for conducting sound. It is possible, in such
cases, that these three bones are no longer in complete
contact. The ear drum has retracted so far in that it makes
direct contact with the third (deepest) middle ear bone, the
stapes. So-- just to make this perfectly clear, in a normal
ear, sound follows the path:
ear drum...malleus (the
first bone)... incus (the second bone)... stapes...
inner ear.
In the "diseased" middle
ear described above, sound follows the path:
ear drum... stapes... inner
ear.
If such were the case, placement of
a tube could have the very unfortunate effect of causing the
ear drum to pull away from the stapes, leading to a rather
drastic drop in hearing. This would not be a subtle decrease
in hearing, mind you; you would certainly notice immediately
that something REALLY BAD had happened. Since you don't
mention this, I suspect that possibility #2 is not the case.
Possibility number 3: you may have
what is called "irreversible mucosal disease."
Mucosa is the tissue that lines the middle ear. People who
have had lots of ear infections develop mucosal problems to
one degree or another. Think of it as the middle ear
equivalent of irritable skin. In some cases, this mucosal
disease can become irreversible, i.e. no amount of ear drops,
antibiotics, or ventilation tubes help. This is not a
hopeless situation, but the treatment is beyond the scope of
this letter. In such a situation, tube placement may not
help, but I am not certain how your symptoms would have been
worsened by tube placement.
Possibility number 4: the plugged
sensation is due to a tumor high in your throat. Don't worry
about this -- such tumors are fairly rare -- but you should
certainly raise this issue with your doctor and let him/her
decide whether to pursue any further investigations.
I lean towards possibility number
1, since this is the most common problem, and as we say in
medicine, "common things are common."
My advice: if you haven't already
done so, talk this situation over with your doctor and see
what he/she has to say about it. Give your doctor a chance to
take care of this problem! If you are dissatisfied with your
doctor's response, find yourself an otologist (an ENT who has
had further training in the diagnosis and treatment of ear
disease). Most medical centers and all major metropolitan
areas will have an otologist, if not several.
Please let me know how things go.