My Ear Feels Full (Cochlear Hydrops)

by Dr. Christopher Chang, last modified on 4/13/21.

Introduction

Eustachian tube dysfunction, fluid collection in the middle ear, and sensorineural hearing loss are THE most common causes of ear fullness or clogged sensation in the ear.

HOWEVER, in rare situations, each of these more common causes of ear fullness ends up being not the true problem.

Rather, it is a rare condition called Cochlear Hydrops.

It is an atypical form of Meniere's Disease, but without the dizziness. Symptoms may include some or all of the following:

ear fullness/clogged
roaring sound in the ear
hearing fluctuation
sound/speech distortion
noise sensitivity, especiually to high frequencies

To reiterate, if spinning dizziness IS also present, you do not have cochlear hydrops, but rather Meniere's Disease.

Watch Video on Meniere's Disease

So what IS cochlear hydrops? No one really quiteknows the answer, but the best hypothesis is an excessive amount of fluid pressure built up WITHIN the cochlea (purple in diagram). This condition is different from the fluid in the middle ear (yellow in the diagram) that can be seen and measured.

There is no "test" that will diagnose cochlear hydrops. It is a diagnosis of exclusion which often leads to frustration for both physician and patient.

SO, how does one diagnose cochlear hydrops?

Given it is a diagnosis of exclusion (given there's no specific test for it), this is the typical scenario of how this rare and frustrating condition is diagnosed in our clinic:

Day 1: Initial Consultation with ENT
- Ear is examined to ensure no earwax in the ear canal or fluid in the middle ear.
- Audiogram is obtained and reveals no unusual nerve hearing loss.
- Treatment initiated with suspicion for eustachian tube dysfunction with nasal sprays combined with deliberate ear popping.

Week 3: Follow-Up #1
- Failure to respond to nasal sprays and ear still not clearing with ear popping
- Nasal endoscopy performed to ensure no nasopharyngeal pathology
- Treatment started with singulair and oral steroids
Week 5: Follow-Up #2
- Failure to respond to medical management.
- Trial myringotomy (hole made in eardrum) in an attempt to "release" any pressure that may be present
Week 9: Post-Procedure Follow-Up

Patient reports myringotomy made no difference whatsoever.
Suspicion for cochlear hydrops made. Treatment started.

As can be seen, the possibility for cochlear hydrops is not typically raised until over 2 months have passed from initial ENT consultation.

Treatment

Once it is felt that cochlear hydrops is a possibility, treatment is immediately started with dietary restrictions:

Complete alcohol elimination
Complete caffiene elimination. That means NO decaffeinated coffee, soda pop, tea, chocolate, etc.
Complete salt avoidance (ideally less than 1.2 gram sodium total). That means no adding salt, no canned foods, no microwave dinners, no soy sauce, etc which contains a lot of salt.

Additionally, auditory tests including ABR, ECoG, and VEMPs can be obtained which if abnormal does provide helpful information.

Depending on the response to dietary restrictions, prescription diuretics can also be tried.

Links

My Ear Feels Full (Cochlear Hydrops)

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