by Neil Bauman, Ph.D.
A mother-to-be wrote,
After stumbling across your website today, I was wondering if you could give me some advice.
Three years ago I perforated my eardrum free diving. This wasn’t picked up until 9 months after the incident, and the ENT suggested that I would need a graft put over the hole as it hadn’t healed. On the day of the surgery, another consultant who was to perform the operation, canceled, and advised that my eardrum would heal, but would take time.
My eardrum never healed. I know this as I never feel pressure in my left ear when going through a tunnel, or on a plane. It hasn’t caused me too much of a problem, until recently.
I am 6 months pregnant—not sure if this is a factor, but over the past 3 months my hearing has been impaired daily, on and off. Sometimes it is both ears. Noise sounds muffled and my breathing sounds very loud. Sometimes I can ‘clear’ the right ear by holding my right nostril and breathing in. But for the left ear—the air just blows straight out the drum. It also doesn’t work for very long. As soon as I swallow, the hearing loss is back and sometimes with pain. When I go to sleep, by the next morning, my hearing is back to normal—but only for so long.
This problem is becoming more frequent and more difficult to resolve by myself. By chance, last night I found that if I tip my head forward (as if I’m touching my toes) for about 30 seconds, this also seems to relieve the hearing loss.
I wondered if you had any advice for me on what’s wrong? What’s the treatment?
The hole in your eardrum is not related to your present condition. However, having said that, it could be a good idea to see another doctor about getting the hole closed. A hole in your eardrum causes a certain degree of conductive hearing loss, but more importantly, it is an avenue for infection. So there are two good reasons to have it closed.
Now, to address your current problem.
When you hear your own breathing very loud, typically it’s because your Eustachian tubes are not closing properly. Normally, they are closed except when you yawn or swallow—at which point they momentarily open to equalize the air pressure in your middle ears. If they don’t close properly, then you hear breathy sounds all the time they are open. This is called Patulous Eustachian Tubes. “Patulous” is just a fancy Latin word that means “open”.
Your muffled hearing, breath sounds, intermittent occurrence, etc. all point to patulous Eustachian tubes. So does your pregnancy. You see, pregnancy can cause patulous Eustachian tubes due to the effects of pregnancy hormones on surface tension and mucous in the respiratory system. So, if pregnancy is the cause, then you could expect things to revert to normal once your baby is born and your hormones settle down again.
Rapid weight loss (or less commonly—weight gain) can cause patulous Eustachian tubes—and you are gaining weight fast at this point.
When you swallow, your Eustachian tubes momentarily open—and in your case—forget to close again.
I don’t know why the pain. That’s something to discuss with your ear specialist.
You’ve noticed that after a night’s sleep, your hearing is back to normal but only stays that way for a bit. Here’s why.
Your Eustachian tubes close as you sleep and then open when you become active again. It is known that laying your head down can help since it increases venous blood pressure and congestion of the mucosa which helps close the open Eustachian tube.
You note, “By chance, last night I found that if I tip my head forward (as if I’m touching my toes) for about 30 seconds, this also seems to relieve the hearing loss.”
You’ve found a trick that also forces your Eustachian tubes to close. Actually, this is one of the ways to “treat” your condition. “Historically, to temporarily alleviate symptoms, patients have tried positional maneuvers, such as tilting their head to one side or upside down, lie down on their backs, or sit in a chair with their head between their knees. Similarly, a routine of lying down four times per day with legs elevated to around 20 inches for at least two weeks has been attempted as well.”
How much caffeine (from coffee, cola drinks, chocolate, etc.) do you ingest daily? For some people caffeine makes this condition worse so you might try cutting back on the above and see whether it makes a difference.
From everything you’ve said, I’m certain you have patulous Eustachian tubes. You can talk to your ear specialist about it, but I think it will go away in a few months. Doctors have medical solutions (surgery or drugs) but I don’t think that is the best way for you to proceed at this point.