My Ear Feels Full (Cochlear Hydrops)
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.
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
- 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.
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.
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