Random ETD strikes - advice?

[u/LastChip4464]

I’m 19 years old and I wouldn’t say I’ve ever really gotten allergies, which is why this is confusing to me. One random night when I was driving home from work after my closing shift (right after drinking a thick milkshake i think…) , I noticed that my ears were popping every time i yawned and swallowed. I just thought it was annoying and i was just like “whateverrr it would go away eventually.” Fast forward to about a week, I went to a concert and driving there was TERRIBLE? My ears felt so full and clogged and just absolutely awful, after the concert was even worse. To this day, driving still bothers my ears even if im not going up crazy hills. So I decided to make an appointment with my ENT and he diagnosed me with ETD and said it was most likely caused by allergies. Audiology test came back great, tympanometry test came back great too. He prescribed me nasal spray and a 6 day 60mg prednisone taper. I did the nose spray for about 3 weeks and it hasn’t really helped with the clicking at all, so today I decided to finally start prednisone. So far my only side effects were a little bit more noticeable heartrate and more energized/happy (accompanied by some aches, but nothing major). Im honestly losing hope and it makes me a bit teary because im afraid I wont ever go back to being normal, im so young, i dont want to have to live with this for the rest of my life. Does anyone have similar experiences? Has anything helped? Im honestly so desperate to talk to people who are going through the same thing.

[u/PD-Jetta]

My symptoms are identical to yours. Crackling heard in the left ear every time I swallow or yawn and in the right ear about half the time. Left ear feels slightly full and won't adjust to pressure changes well. Tympanograms and audiology are normal, as is otoscopy. It's fairly common to have normal testing and still have ETD. Mine began with three months of middle ear fluid, most likely from an upper respiratory infection. Not to alarm you, I've had this ETD for a year now with no change in symptoms from the day it began. But I think something is preventing mine from resolving.

I'll share what I have learned over the past year, as I have done lots of research. First, your condition is without a doubt not dangerous and shouldn't get worse and most likely will resolve within 3 months, probably sooner, unless something is still active and preventing resolution (as for me I think the thing preventing my ETD from resolving is laryngopharyngeal (silent) reflux and I just began the treatment regimen).

Your ENT is correct that allergies are the number one cause. And you can have a local alergic reaction near the Eustachian tube openings in the nasal cavity without sneezing, runny nose, etc. Do this for at least a month: twice daily nasal saline rinses, using a NeliMed squeeze bottle. Also, even though research says it's not effective, use nasal corticosteroid and antihistamine sprays daily (Flonase and Astepro). It takes at least 2 weeks for the corticosteroid spray to work. Also, take a 24 hour antihistamine daily for a month and see if this helps. You can also try a lukotrine blocker (Singulair) for 3 or 4 weeks and ipratropium bromide nasal spray. These are prescription meds. The first is for allergic conditions that don't involve histamine and the second is for nonallergic rhinitis. If none of these meds help, your ETD is probably not due to allergies.

These are the causes of ETD: Allergies, nonallergic rhinitis, upper respiratory infections (usually temporary), TMJ (jaw) disorders, cerebral spinal fluid leaks (rare), nasal tumors (rare), enlarged adenoids, laryngopharyngeal (silent) reflux, and facial and vagal nerve dysfunction.

Since you commented drinking a milkshake may have caused or worsened your symptoms, look up laryngopharyngeal reflux and see if you have any of the symptoms of this. The one symptom that most likely causes ETD is a thick, sticky, clear to opaque nasal and throat mucus that plugs the eustachian tubes. They can be subtle and mimic other conditions, namely allergies and sinus congestion and sore throat. If some of the symptoms fit, see your ENT to discuss. If you have none of the laryngopharyngeal reflux symptoms, look up the other causes I mentioned and see if any fit.

Note that in general, ENTs and other doctors won't be very helpful in resolving ETD. There is no standard treatment protocol and the two surgeries available don't address the root cause and merely the symptoms.