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dslocomb 01-09-2009 11:01 AM

Possible Perilymph fistula from blowing nose?
 
On Dec. 23 I woke up with nasal symptoms, blew nose really hard, there was negative pressure in my rt. sinus, and my ear plugged. Nasal passage released very slowly, like a "squeeze". In the morning, ear plugged felt full, never reopened. Went to ENT 4 days later, was Dx'd with Sudden Hearing Loss (Loss of high tones, no infection or fluids) and put on high dose Prednisone. By day 9 I was crazy from the steroids, was hearing "R2D2" sounds (tinny buzzy awful!) from that ear, especially women's voices. Went to Dr. Timothy Hain in CHGO, who is, I think a guru in this field.

He thinks because of my knowing the moment it "happened" it is a baratrauma type of thing, and possibly a tear of the round or oval window membrane. I have had minor, VERY minor unbalace issues, not really vertigo.

I'm to see him in 2 weeks for more tests, then on to a surgeon for evaluation.He took me OFF steroids (Said it's not SHL, thus won't help and I wasn't tolerating them).

I still have this terrible fullness, even down my neck....hearing is muffled greatly, altho the buzzy sounds have diminished.

Feeling so hopeless about this. How could I do this to myself just blowing my nose! Has anyone had a similar experience, and been diagnosed with a window tear?

Any opinions welcome.

xtine04 01-13-2009 12:02 PM

Re: Possible Perilymph fistula from blowing nose?
 
yup. that's how mine started and was made worse 2 months later from swimming and 2 weeks after that from a chiropractor. it's been 18 months for me, i've run around trying to find a doctor who actually believes that PLFs exist. i have surgery booked at the end of Feb. to fix it.

i can manage now if i don't increase cerebral pressure ie. blow nose, lift anything over 5 lbs, try not to sneeze etc.. etc... most PLFs will heal on their own 2 weeks to 6 months. i wasn't so lucky.

if i were you, i'd try bedrest and try to find a doctor who is familiar with PLFs... what area are you in? i might know of a good dr.

christine

Chele60 01-13-2009 02:43 PM

Re: Possible Perilymph fistula from blowing nose?
 
I've had this as well, but due to also having Meniere's I really wasn't aware of it. Meniere's causes a feeling of pressure to build in the ears, and I was in the habit of attempting to clear out my ears by holding my nose and blowing. I knew exactly when I really messed up when I heard a strange "giving" sound, but I got intensely dizzy.

When I went in for surgery to implant a shunt for the Meniere's, the surgeon also found the tear at that time and patched it. It may have healed on its own, but I have constant pressure in my ears, so I sort of doubt that.

But yes, though more rare, one can certainly tear a small hole in the ear canal by strong blowing of the nose, heavy lifting, straining, even intense air pressure in an airplane. They can heal on their own, but sometimes not. Hopefully, bedrest is all you will need. Ear surgery is not fun.

dslocomb 01-13-2009 09:09 PM

Re: Possible Perilymph fistula from blowing nose?
 
Thank you both for your response. I feel a bit hopeful that recovery is possible from this. Xtine I AM seeing Dr. Hain in Chicago, who seems to have written the book on a lot of this stuff. Interesting, even tho' his website says so and other sites do as well, he did not suggest bedrest for me...just to take it easy, no lifting, no exercise. So that's what I've been doing. My distorted, buzzy sounds are gone, and the pressure fullness is less today than it's been! It's always worse in the morning, then the more I'm up and walking around it improves...by this time of night it's pretty good. I strongly sense that it's fluid related...I've been trying to massage it all downwards to see if I can't facilitate moving the fluid a bit. The muffled hearing is still there, however, I don't have the vertigo that many people have.

I am taking Flavonoids, antihistimines, and Musinex....I feel that the virus I had that caused all the nose blowing is finally leaving my head and I'm getting a better idea of what I'm left with. Probably diminished hearing by about a third in that right ear. Do you think since all the symptoms are better that it's healing and I might get some of my hearing back?

I feel SO STUPID for having done this to myself. I'm 60, for heavens' sake, and should know not to blow so hard! I don't know what tests I'll have on Tues....but the next appt. after that is with a surgeon. I thought surgery had to be done fairly early on in order to help.

Thanks so much for responding...it's good not to feel so alone in this!

Chele60 01-14-2009 08:15 AM

Re: Possible Perilymph fistula from blowing nose?
 
Please don't beat yourself up over this. It doesn't do any good at this point, and it really isn't something a lot of people are aware of. Take things going forward.

As far as your hearing is concerned, I can't really say. I have a hearing loss, but that is more due to the Meniere's than to anything else. Perhaps xtine can address that or your doctor.

Good luck and I wish you all the best - it sounds as if you have the best doctor in your area on this!

xtine04 01-18-2009 04:50 PM

Re: Possible Perilymph fistula from blowing nose?
 
[QUOTE=dslocomb;3848641]Thank you both for your response. I feel a bit hopeful that recovery is possible from this. Xtine I AM seeing Dr. Hain in Chicago, who seems to have written the book on a lot of this stuff. Interesting, even tho' his website says so and other sites do as well, he did not suggest bedrest for me...just to take it easy, no lifting, no exercise. So that's what I've been doing. My distorted, buzzy sounds are gone, and the pressure fullness is less today than it's been! It's always worse in the morning, then the more I'm up and walking around it improves...by this time of night it's pretty good. I strongly sense that it's fluid related...I've been trying to massage it all downwards to see if I can't facilitate moving the fluid a bit. The muffled hearing is still there, however, I don't have the vertigo that many people have.

I am taking Flavonoids, antihistimines, and Musinex....I feel that the virus I had that caused all the nose blowing is finally leaving my head and I'm getting a better idea of what I'm left with. Probably diminished hearing by about a third in that right ear. Do you think since all the symptoms are better that it's healing and I might get some of my hearing back?

I feel SO STUPID for having done this to myself. I'm 60, for heavens' sake, and should know not to blow so hard! I don't know what tests I'll have on Tues....but the next appt. after that is with a surgeon. I thought surgery had to be done fairly early on in order to help.

Thanks so much for responding...it's good not to feel so alone in this![/QUOTE]

yes some or all hearing can come back if the PLF heals. but please don't massage either... that builds up pressure thus causing more leaking and more symptoms. you might have compensated for the dizziness which is good however if you're still experiencing fullness chances are that it hasn't totally healed.

it's also possible to get secondary hydrops as a result of trauma. please just try to take it easy and learn from me! i didn't know what i had for almost a year so my healing is very slow.

it's strange that you're better in the AM. with PLFs it's usually opposite. you might have more high pressure now as a result of it healing... so i hope you're on your way to recovery.

there are some other things to do which might help the healing. i was low in iron and when i started taking that, i improved a lot. you might just want to get a basic blood test to make sure you vitamins and minerals are within normal ranges. keep blood sugar stable, low/no sugar diet and eat little meals throughout the day. keep a lower salt diet too.

i supplement with fish oils which help with inflamation as well as i'm taking a collagen supplement which is really, really helping! if you can find collagen i highly recommend it. make sure that you're eating or taking vitamin C too. all help with collagen production.

keep to the fistula protocols... i have some here for you: (see below)

Dr Hain is good however I know of a few other ENTs that are more PLF experts. Usually they recommend diuretics if symptoms are bad to help with healing. if you have a difficult time, you might want to ask about that.

You're lucky you saw Dr. Hain... most doctors don't believe in PLFs at all! I had to travel from Toronto to NYC just to get an accurate diagnosis. Now you can help me on my quest to show all the Doctors that this does indeed exist.

ask if you have any ?s...

best,
xtine

Fistula Precautions:
A perilymphatic fistula (PLF) is an abnormal opening somewhere around the inner ear. This is most commonly found a one of the natural weak spots to the inner ear, one of the inner ear windows---- the oval window or the round window. . In this condition, the fluid can shift out of the inner ear into another space, such as the middle ear. When this happens, this can tear delicate membranes in the inner ear and cause vertigo/dizziness, tinnitus (ringing in the ear) and hearing loss. Initial treatment of this is geared toward reducing any pressure directed toward the ear. Often we use dietary methods such as restricting caffeine or salt in the diet to reduce the fluid volume in the ear. Sometimes a diuretic or fluid pill will be used to reduce fluid pressure in the ear as well. In addition, there are a number of activities that you should refrain from in order to reduce pressure on the ear and reduce this from being a problem. Among these are the following:

1) Avoidance of nose blowing or sneezing through the nose. Sniffling is okay and does not seem to affect the pressure in the inner ear. If you have to sneeze, open your mouth to sneeze. Please do not stifle a sneeze since this is worse than actually sneezing through the nose.

2) Avoid any strenuous actitivity. In particular, any activity that increases the pressure in your abdomen or chest will get transmitted to the head and consequently to your inner ears. In general, any activity that requires more effort than lifting 10 pounds should be avoided.

3) Avoid bending over at the waist. If you need to pick up something off the ground, bend at the knees.

4) Sexual activity is also restricted since this will place significant pressure on the inner ears as well

5) Straining can occur during times of constipation and should be avoided when having a bowel movement. Also because of this, we recommend a stool softener.

6) If at all possible we recommend the period of fistula precautions should begin with 5 days of bed rest with the head elevated above the heart. During this time period you should only get out of bed and go the bathroom.

7) If you have a chronic cough or problems with nasal congestion/chronic sneezing, you should contact your doctor for aggressive treatment of this since this will make the situation worse.

8) Do not use earplugs. You can use cotton with Vaseline to prevent water from getting in the ear.

9) It is also recommended that you not have any dental, chiropractic or physical therapy done, unless absolutely necessary, during this 6 week period.

The above mentioned restrictions generally apply for a 6 week period. If you develop any episodes of vertigo during this time period, please note which activities seem to provoke the spell and record them for later consultation. Many patients with PLF find that this will significantly improve their symptoms. However, if it does not, surgical repair may be required in order to treat your perilymphatic fistula.

ajay66 01-20-2009 09:44 AM

Re: Possible Perilymph fistula from blowing nose?
 
[QUOTE=dslocomb;3843508]On Dec. 23 I woke up with nasal symptoms, blew nose really hard, there was negative pressure in my rt. sinus, and my ear plugged. Nasal passage released very slowly, like a "squeeze". In the morning, ear plugged felt full, never reopened. Went to ENT 4 days later, was Dx'd with Sudden Hearing Loss (Loss of high tones, no infection or fluids) and put on high dose Prednisone. By day 9 I was crazy from the steroids, was hearing "R2D2" sounds (tinny buzzy awful!) from that ear, especially women's voices. Went to Dr. Timothy Hain in CHGO, who is, I think a guru in this field.

He thinks because of my knowing the moment it "happened" it is a baratrauma type of thing, and possibly a tear of the round or oval window membrane. I have had minor, VERY minor unbalace issues, not really vertigo.

I'm to see him in 2 weeks for more tests, then on to a surgeon for evaluation.He took me OFF steroids (Said it's not SHL, thus won't help and I wasn't tolerating them).

I still have this terrible fullness, even down my neck....hearing is muffled greatly, altho the buzzy sounds have diminished.

Feeling so hopeless about this. How could I do this to myself just blowing my nose! Has anyone had a similar experience, and been diagnosed with a window tear?

Any opinions welcome.[/QUOTE]

Hi There,

It is possible for PLF to occur by blowing your nose too hard.

Dr Hain is tops, hopefully he will be able to shed light on what your actual problem is. Inner ear problems are very complex, no one here can diagnose you, we can only share our personal experiences with you. Only a medical professional can help you figure out what your problem is.

I developed a PLF after I banged my head, I had the surgery done and thus far ALL my symptoms have resolved.

Good luck

AJ

xtine04 01-20-2009 11:49 AM

Re: Possible Perilymph fistula from blowing nose?
 
[QUOTE=ajay66;3855929]Hi There,

It is possible for PLF to occur by blowing your nose too hard.

Dr Hain is tops, hopefully he will be able to shed light on what your actual problem is. Inner ear problems are very complex, no one here can diagnose you, we can only share our personal experiences with you. Only a medical professional can help you figure out what your problem is.

I developed a PLF after I banged my head, I had the surgery done and thus far ALL my symptoms have resolved.

Good luck

AJ[/QUOTE]

Hi AJ,

you're certainly fortunate to have had things resolve post-surgery. how long has it been for you? were you on bedrest after surgery? or how long did you follow the precautions?

regards,
christine

ajay66 01-22-2009 11:57 AM

Re: Possible Perilymph fistula from blowing nose?
 
[QUOTE=xtine04;3856032]Hi AJ,

you're certainly fortunate to have had things resolve post-surgery. how long has it been for you? were you on bedrest after surgery? or how long did you follow the precautions?

regards,
christine[/QUOTE]

SHAWNA70 04-02-2009 02:49 PM

Re: Possible Perilymph fistula from blowing nose?
 
AJ,
May I ask how long it took for your post surgery to feel 100%
I am new at this posting board. I am suppose to have surgery on both ears the end of April. I have been very depressed for the last 4 1/2 months because of this.

Any positive feed back would really be great.
Shawna


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