Ask the Doctors

Dear Doctor: I have recently experienced severe vertigo due to fluid pressing against my eardrum, which happened after a sinus infection. What was going on? How can I avoid a repeat?

Dear Reader: What you're describing falls into a collection of conditions known as otitis media, a somewhat general term that refers to inflammation of the middle ear. This is the small, air-filled chamber behind the ear drum where the tiny vibrating bones that are a crucial part of our hearing apparatus are located. Otitis media can develop any time something prevents fluid in the area from draining. Congestion arising from a cold, the flu, allergies or a respiratory infection can all lead to inflammation of the middle ear.

There are several types of otitis media. When an infection develops, this is known as acute otitis media, or AOM. The cause is most often viral or bacterial. Symptoms include pain in one or both ears, a feeling of fullness in the affected ear, muffled hearing, a sore throat or drainage from the ear. In some cases, AOM can progress into a condition known as chronic suppurative otitis media. Characterized by the persistent discharge of fluid from the middle ear through a rupture in the ear drum, this is a serious condition that can lead to hearing loss.

When fluid collects in the middle ear but is not infected, this is known as otitis media with effusion, which means fluid. As with acute otitis media, there is often a feeling of fullness in the ear, and a loss of hearing acuity. In some cases, the condition can cause the dizziness and vertigo that you described. Unlike AOM, however, symptoms typically don't include pain or fever. Acute otitis media with effusion can last anywhere from a few weeks to several months. If the condition persists beyond three months, or if it recurs, the diagnosis becomes chronic otitis media with effusion.

The culprit here is the Eustachian tube, a narrow passage between the middle ear and the rear of the nose, near the soft palate. Its functions are to equalize air pressure between the middle ear and pressure outside of the body, and to drain fluids from within the ear. But upper respiratory tract infections can cause the Eustachian tubes to become congested, which means fluids will remain trapped in the middle ear. Children's Eustachian tubes are narrower than those in adults, which is why they account for the lion's share -- at least 80 percent -- of otitis media diagnoses.

When it comes to prevention, the options are somewhat limited. It's a good idea to take a decongestant before you fly, so your ears have a better shot at equalizing pressure. When you have a cold, be sure to blow your nose gently so as not to inadvertently overcome the pressure differential of the Eustachian tubes and thus force mucus in the wrong direction. In that same vein, never hold or close off your nose when you sneeze.

Finally, other conditions can have symptoms that are very similar to otitis media. With your complaint of extreme vertigo, we think it's important to see your family doctor for a definitive diagnosis.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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