1b. A patient with popping or crackling sound in ears.
Case history- A 45 year’s patient presents to you with popping or crackling sound in ears for 6days.
What is the diagnosis striking in your mind?
Eustachian Tube Dysfunction.
What key questions would you ask?
A sense of fullness in the ear
Mild to moderate fluctuating impairment of hearing
Time of popping or crackling sound- particularly during swallowing or yawning History of common cold / allergic rhinitis(The most common causes of Eustachian tube dysfunction are diseases associated with edema of the tubal lining, such as viral upper respiratory tract infections(common cold) and allergy.)
What will you examine?
Ear examination may reveal retraction of the tympanic membrane. But diagnosis is clinical.
Forced expiration against closed nostrils and mouth will reproduce the sound.
Treatment-
- Reassurance and explanation.
- Treatment with systemic and intranasal decongestants (e.g. pseudoephedrine 60 mg orally every 4 hours; oxymetazoline 0.05% spray every 8–12 hours)
Combined with
- Autoinflation by forced exhalation against closed nostrils may hasten relief.
(Autoinflation should not be recommended to patients with active intranasal infection, since this maneuver may precipitate middle ear infection.)
- Allergic patients may also benefit from desensitization or intranasal corticosteroids (e.g., beclomethasone dipropionate, two sprays in each nostril twice daily for 2–6 weeks).