The Medical Consumer's Advocate
Throbbing tinnitus and "tonsil
stones" (tonsilloliths)
Q: I am a 34-year old female. I
don't drink or smoke; I exercise regularly; and I eat
right. You might say I am generally in excellent health.
A year and a half ago I began hearing my heartbeat in my
ear and my voice would occasionally sound muffled in my
left ear, much like it would sound if it were plugged
with water. After four months of these symptoms, I
finally decided to have it checked. The ENT thought I had
a eustachian tube problem and gave me medicine as if to
treat allergies, even though I don't suffer from
allergies, nor have I been fighting a recent cold at the
time. Needless to say, the medicine didn't work and he
told me to "wait awhile". Six months later we
decided to do a CT scan which came out normal, so that
would rule out a tumor. Our next step would be an
arteriogram to see if I had AVM. But before we could do
it, we moved to XXXX. After we got settled in, I went to
another ENT who gave me an MRI and an MRA. They came out
normal. Do you have a clue as to what my problem could
be? Could it be a eustachian tube problem after all? The
heart beat gets louder when I'm lying on my left side and
while exercising. Which reminds me, when my body is
jarring up and down (i.e., on a treadmill), I can hear
something in my left ear moving up and down with me and
my "muffled voice" gets significantly worse.
What could this be? I am at a total loss and am getting
impatient and extrememly frustrated because, as I've
said, it's been a year and a half.
A: Let me reassure you that your
XXXX ENT seems pretty bright-- you don't have a diagnosis yet
primarily because your problem is very perplexing. Probably
not ETD, but I am not sure what it is, especially given a
negative CT, MRI and MRA. (I don't know if you know this, but
what did the tympanogram show?) You mention that your current
ENT is waiting for some advice from the school where he
trained. He is doing exactly what I would do: when baffled,
go back to the experts ("super-specialists," as we
like to call them) for fresh ideas.
Q: Also, I have been picking
out tonsil stones (left side) since August at an average
of three per week. I mentioned this to my ENT who looked
at my throat and said it looks "unsettled", but
didn't go any further with it. It is probably irrelevant
to my ear problem, but one never knows.
I have considered a tonsillectomy, but both ENTs I've
seen didn't seem too keen on the idea. The tonsil stones
are extremely annoying and I just don't understand why
they started up all of a sudden and why won't they stop?
My ENT in ZZZZ said I could expect my tonsils to settle
down after 3 or 4 tonsil stones, but they just keep
coming. How much longer will this go on?
I would appreciate ANYTHING at
all you could tell me. Thank you for your time.
A:
Regarding tonsil stones: these have a
medical name -- tonsilloliths, also known as tonsil stones.
Some folks find these things incredibly annoying. If you want
to do something about the stones, here are your options:
1. A long course of antibiotics (e.g., amoxicillin for 3
to 4 weeks) OCCASIONALLY helps.
2. Tonsillectomy would, of course, solve the problem, but
this is a painful operation for adults. You can count on
being in a lot of pain for 10 days, and you may not be back
to a regular diet for one month or more.
3. Some ENTs have begun treating this in the office by
"spraying" the surface of each tonsil with a laser.
Less painful than a tonsillectomy, and the docs who do this are, of course, claiming good results. (PLEASE NOTE: To
the best of my knowledge, this is an unproven technique!) If
you live near a big city, you ought to be able to find
someone who can do this for you.
I don't do the laser procedure, so I cannot address its
efficacy. This is a tough problem. I usually explain the
risks (including the definite expectation of pain) of
tonsillectomy, and if the stones are bothering the patient
enough, he/she will still insist on tonsillectomy.
If you are having ear pain, this could be due to your
tonsil stones... this is known as "referred pain",
in which pain in one area of the body is actually felt
elsewhere. (Very relevant example: many tonsillectomy
patients have only a mild sore throat, but complain bitterly
about ear pain.)
How much longer will this go on? About one month ago, I
did a tonsillectomy on a woman in her 30s who had had this
problem since she was a teenager. Bottom line: this is an
impossible question to answer, but the answer could be,
"a long, long time."