DEAR DR. ROACH: I think I have a middle ear infection. I noticed it last night. It doesn’t hurt except when I swallow. Otherwise, I feel fine. Should I wait 24 hours before seeing my doctor, or should I try to see him today? — J.B.
ANSWER: First, let’s review the anatomy. The ear has three components: the inner ear where the organs of balance and hearing are; the outer ear that includes the ear canal all the way to the eardrum; and the middle ear, which contains the three bones that transmit sound waves from the outer ear to the inner ear.
The middle ear is normally filled with air, and the air pressure is kept equalized by the Eustachian tube, which connects the middle ear with the back of the throat. The Eustachian tube can be blocked when there is congestion in the ear, most commonly from allergies or infection.
When it is blocked, the sounds can’t be transmitted well, and the ear feels plugged up. The middle ear can fill up with fluid, exacerbating the problem. This condition is called otitis media with effusion (fluid) and may be misdiagnosed as acute otitis media due to infection.
Your primary care doctor can usually tell otitis media with effusion from acute otitis media by an exam. Acute otitis media is most commonly treated with antibiotics, while otitis media with effusion will go away on its own after a few weeks.
Otitis media can be relieved by antihistamines, nasal steroids or decongestants. “Congestion,” in this sense, is caused by increased blood flow causing swelling. A decongestant, such as pseudoephedrine (Sudafed), works by constricting blood vessels. These can cause problems in people with poorly controlled blood pressure and in men with enlarged prostates.
You can try these at home now if you have none of those medical conditions, as they are all over-the-counter. Antihistamines and decongestants help right away, while nasal steroids take at least a week to start working. Unless you are in a ton of pain, it’s OK to wait a day or two to be seen.
Sometimes, we general doctors just can’t see well enough to be sure of the diagnosis, and we may try symptomatic treatment. But if things aren’t working, an ENT doctor has tools and expertise that are not available to us. Rarely, there are some dangerous conditions that can look like a simple ear infection, so a consultation is appropriate.
DEAR DR. ROACH: Do supplements for tinnitus work? I have seen websites for various pills and supplements. Have you read anything that shows the success of these products, or is it snake oil? Should I save my money? — D.J.R.
ANSWER: I wish I could say that they worked, but there is no good evidence that any supplements, such as ginkgo biloba, zinc, magnesium, melatonin, lipo-flavinoids, bioflavinoids or vitamins, have any benefit on tinnitus.
Tinnitus retraining therapy and treatment of insomnia and depression, which often accompanies tinnitus, remain the most effective treatments. People who have tinnitus associated with severe hearing loss (due to nerve damage) may benefit from a cochlear implant.
Interestingly, actual snake oil may have some health benefits, due to its high amount of omega-3 acids. Snake oil has been used in traditional Chinese medicine for centuries. The origin of the term “snake oil” was due to the unscrupulous salesmen of purported snake oil who sold other oils such as mineral oil that had no real snake oil in it, which is why the term is now synonymous with fraud.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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