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Steven Y Park, MD  
Male, 47
New York, NY

Specialties: Sleep-breathing disorders

Interests: Running, Baking, origami
Private Practice
212-315-9058
New York, NY
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Ear Mystery, Solved

Nov 11, 2008 - 26 comments
Tags:

eustachian tube dysfunction

,

Ear Fullness

,

Acid reflux

,

sleep position



In many cases, taking a good history and asking some pointed questions can solve a medical problem without resorting to medications. For example, I saw a man in his late 30’s who came to see me with 3 days of left ear sound distortion and reverberation with mild fullness. He had no other problems, including hearing loss. His exam was completely normal. Most doctors at this point will give a diagnosis of Eustachian tube dysfunction, where due to mild nasal inflammation, the tube that connects to the ear is partially blocked, leading to pressure changes that can cause ear problems. Many patients will walk out the door with prescription allergy mediations or over-the-counter decongestants.

After going through my standard list of questions addressing what changes or lifestyle issues that he’s been going through, it turns out that his wife delivered their first child 2 weeks ago. Obviously, this can be detrimental to sleep. Upon further probing, he admitted to working later the last few days, coming home late, and eating just before going to bed. He also had some alcohol late at night as well. To top it off, he normally likes to sleep on his left side.

The history alone solved the puzzle: He normally likes to sleep on his side to partially compensate for his tongue falling back during deep sleep (due to muscle relaxation). When he ate late the last few days, every time he stops breathing even temporarily he suctioned up small amounts of stomach juices into his throat, and since he’s lying on his left side, it can easily travel to his left Eustachian tube, causing mild swelling and partial blockage. He also noted afterwards that he has post-nasal drip and mild throat clearing, which is consistent with reflux in the throat.

He was advised to eat dinner much earlier and avoid alcohol close to bedtime. This should be a life-long habit. Another great example of using my sleep-breathing paradigm to solve a medical problem without the need to give to medications.

____________________________________________
Steven Y. Park, M.D., author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Endorsed by New York Times best-selling authors Dr. Christiane Northrup, Dr. Dean Ornish, Dr. Mark Liponis, and Mary Shomon.

www.doctorstevenpark.com


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by stevejosie5125, Nov 13, 2008
Impressive work.  Can those same habits cause ringing in the ears?

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by Steven Y Park, MDBlank, Nov 13, 2008
Interesting you ask that question. In my experience, people with tinnitus (chronic ringing in the ears) all tend to have poor quality sleep. If you are anatomically predisposed to your tongue falling back and you either eat late or drink alcohol before bedtime, or both, then by definition, you'll sleep less effectively. Chronic low-grade deep sleep deprivation can cause a stress response, which can heighten your senses, so that even a very mild case of ringing can be aggravated or exaggerated. If you have ringing, and you tend to eat late or drink alcohol close to bedtime, try avoiding this for a few weeks and see what happens. You may be pleasantly surprised. I talk about these concepts in more detail in my book, Sleep, Interrupted.

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by redheadaussie, Nov 13, 2008
I like investigative doctoring, and yours is very impressive!

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by kittyma, Nov 16, 2008
I have tinnitus, have had it since my teens and am now 46, and sleep very well, very soundly.  Always have, no complaints.  What about me?

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by Steven Y Park, MDBlank, Nov 18, 2008
Kiiyma,

There are many other reasons for tinnitus. If you have no other problems, then nothing more needs to be done.

BTW, do you like to sleep on your back, side or stomach? Are you ever refreshed when you wake up in the morning?

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by Rosie3, Nov 26, 2008
Thanks for your Medical Advised which is very enlightening. I have sleep apnea and have problems with tinnitus which makes me go crazy ay times. My doctor advised me to sleep on my right or left side to reduce my loud snoring caused by my tongue falling back during my sleep.But tinnitus is louder at night time, the reason why I can't sleep and scared of not waking up due to sleep apnea. Any advise ?


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by Steven Y Park, MDBlank, Nov 26, 2008
The first thing you should do is to treat your sleep apnea. Positional therapy works for some people but not completely for most people. If you sleep better, then you won't be as bothered by your ringing. Poor sleep causes your nervous system to become heightened, and makes your senses much more hypersensitive, so even a little ringing may be magnified. In addition, you should probably undergo a basic ENT evaluation and testing to make sure it's nothing more serious.

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by phil62, Jan 25, 2009
I had a ear drum rupture over 5 weeks ago . Iam still having problems , I'm  having a lot of preasure on my head and my ears , preasure on my sinuses and alot of preasure on the front and back of my head ..

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by yollyt, Feb 07, 2009
I am a 45 y/o female who has ear fullness on the left ear associated with lightheadedness, mild ear buzzing for about 2 months aggravated by eatin/ chewin/ swallowing.Consulted an ENT, was given cinnarazine but symptoms still persisted. MRI of head &IAC, blood chems, hearing test normal. What's causing my problem?

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by Steven Y Park, MDBlank, Feb 07, 2009
From what you describe, it sounds like either TMJ or Eustachian tube dysfunction. These are common conditions which I'm sure your ENT considered.

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by stella5349, Feb 07, 2009
You rock

Dr. Park!

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by Alma214, Feb 12, 2009
I am a 57 year female, had sudden heaing loss on my right hear, since October 2008, I am still having much pressure and ringing on my right ear going down my throat, and into the other good ear, I've been to an ENT had the ear shots, MRI, with and without contrast, MRA, ECO, been to a neurologist, cardiologist, entomologist, Chiropractor, dentist, had X-rays  and no one seems to know what is going on, all the tests came back OK, blood, urnine, hair. This pressure in the ears and back of my neck and throat is driving me nuts!! I also have lost the balance on my right ear and I'm totaly deaf on my right ear.  
If anyone can help please reply, I'm desparate!!
Alma

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by Steven Y Park, MDBlank, Feb 12, 2009
Alma214,

Sorry to hear about all your problems. It sounds like you've undergone a lot. It sounds like you had every possible test and treatment, and from what you're telling me, you may have what's called sudden sensorineural hearing loss. If that's true, there's no cure for the hearing loss. The best thing to do is to go back to your ENT and he or she can hopefully take care of the dizziness.

Do you sleep on your right side? Are you tired when you wake up in the morning? Do you snore?

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by Heather3418, Feb 12, 2009
Dr. Park,

The world can only wish there were more doctor's of your caliber in the world of medicine.  You are a genuis....

Usually the best approach to medicine by physicians is common sense, along with their learned medical knowledge.  Alot of practicing doctor's today, have forgotten that.  Many doctor's have forgotten how important it is to ask questions; many questions and listen to the patient.  I truly believe that alot less prescriptions would be written, that seem to just mask the real problems.  Don't take that sentence wrong, Dr. Park; of course medicine has it's place and can be a life-saver....

I'm always on the edge of my seat, waiting for you to write more articles.  I thoroughly enoy them and always come away learning valuable lessons to apply to my own heath care.

Thank you kind sir,
Heather
MS Forum



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by Alma214, Feb 12, 2009
Dr.Park,
I am told by my husband that I do snore, and I do sleep on my right side  and keep turning most of the night from right to left. I never sleep on my stomach and I do fall asleep on my back ocasionally but I end up on my side. Oh and yes I do get up tired in the morning, I'm also on antidepressants have been for 20 years now, 30mg of flexotine, also harmones, estradol 0.5mg.
My biggest diconfort is the pressure! under each ear more close to my throat, I can deal with the off balance it's not a dizzy feeling only of balance.
Thank you so much
Alma

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by Steven Y Park, MDBlank, Feb 12, 2009
If you snore, that means that you may have a sleep-breathing problem. Since you like to sleep on your sides (especially the right side), there's even more reason to think this is the case. If you're not getting deep efficient sleep, then you'll never wake up refreshed in the morning. Think about what it can do with your mood if this happens for years of decades.

As for the pressure, you can take a decongestant like Afrin once or twice in case it's a sinus/ear pressure issue. Then switch to nasal saline irrigation as much as possible if the Afirn works.

One of the theories about sudden hearing loss is the vascular compromise theory. However, if you have a sleep-breathing problem, that means that your sympathetic nervous system is on overdrive (fight or flight response). This causes your nervous system to constrict blood vessels that go the "end-organs", such as your hands, feet, stomach and bowels, and your ears. It's almost like having a mini-stroke.

I'm assuming that you had a hearing test that showed nerve deafness. You can also have hearing loss from fluid behind the ear (which is reversible).

One other thing: if you're on estradiol only, that means that  you may have estrogen dominance, since your progesterone levels are lower (what naturally occurs during menopause). Lower levels of progesterone causes the your tongue to relax more, aggravating breathing pauses in deep sleep.

Also,try to avid eating late or drinking alcohol before bedtime (3-4 hours for both). Stomach juices can be actively suctioned up into your throat and irritate your throat and ear (especially on the right side since that's where yo spend most of your time sleeping).




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by Alma214, Feb 12, 2009
Thank you Dr. Park for you response.
I have had several hearing tests and I'm totaly deaf on my right ear and there is no fluid behind the ear as per the ENT, I will go back to my primary doctor as ask for a harmone test as for the sleep breathing problems I will seek a doctor that deals with this disorder, I live close to the Southeast Memorial Hospital in Houston Texas, do you have any recomendations?
Thank you again
and God Bless you !!
Alma

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by Steven Y Park, MDBlank, Feb 12, 2009
My pleasure.

Just to clarify, your progesterone levels diminishing is just a natural part of menopause. But adding an estrogen replacement only may suppress your progesterone levels even further. You may want a more balanced estrogen/progesterone combination. Of course you should talk to your doctor about your individual situation.

As for a sleep evaluation, you can go to any sleep center that's accredited by the American Academy of Sleep Medicine. Most large medical centers have this.

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by belleofball, Mar 31, 2009
I am a 42 year old female.  Off and on for about 3 weeks I have had a dull ache in my right ear and feels like it has pressure in it.  Last night and today I felt a little dizzy and have walked into the door twice tonight.  Is my equilibrium affected by the pressure in my ear?

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by Steven Y Park, MDBlank, Mar 31, 2009
Pressure in your ear caused by Eustachian tube dysfunction is the classic explanation for your condition. Another explanation is a migraine attack of your inner ear that gives you the same symptoms. This can also be associated with TMJ symptoms. Decongesting your nose is one option, but another option is to treat is like a migraine. If you grind or clench your teeth, you may want to have it evaluated by a dentist.

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by chief10rules, May 26, 2009
Dr. Park. I am a 41 year old healthy male. I had lost hearing in my right ear suddenly about a year ago. All the tests, scans by four different ENT specialists came out normal. But one thing which may give you a clue on what is wrong is: when I swallow (saliva or any thing) my right ear does pop, again pops and pops. So, no matter how many times I swallow, my right ear keeps popping! It may not pop fully but the sensation is deeply aggravating. Do you think I have  a eustachian tube dysfunction? I have tinnitus along with hearing loss, ear pressure but NO dizzines, or balance problems ever....What are your thoughts? I some times wake up perturbed complaining that I can't breath ( if it has to do any thing with my hearing loss).

Sanjay Sharma

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by coheefamily, Jul 31, 2009
Dr. York,

Please help us!  My husband is a dentist of 27 years and has suffered from Menier's symptoms; and recently had a loud dial tone sound in his ear for 36 hours, loss of hearing on one side and is really hearing nothing the first time said--he had a CAT scan done, but no one has offered any information on possible ETD or other information you have discussed on this site--should he pursue trying tubes to open his Eustachian tubes?  Thank you so much for your help; I'd fly him to NYC if necessary--we just are not finding anyone who will pursue treatment; this has been happening for years.

Sincerely grateful,
Carol C.

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by moshomo, Aug 29, 2009
Dr. York, i've had ringing in my ears off and on for the last 2yrs.
Dr. gave my xanax and it seems to help but makes me tired..
Its the worst in the morning and i seem to wake with anxiety and ringing every
day.....any suggestions... i find myself tearing up occasionally
i dont know if the depression is from my ears ringing or ear ringing
from depression...

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by nh105, Sep 18, 2009
Hello Dr. York, I just started taking an anti-depressant (bupropion SR) and just started getting the ringing in the ears (most severe at night or when its quiet).  In addition, about 2 days ago I now have a popping sound in both my ears (especially when i swallow).   I'm very worried and my doctor is brushing it off telling me to give it a month.  I'm worried this will be permanent-so I'm considering quitting taking the anti-depressant for frear it will be permanent.  Do you have any advice?  Should I be concerned?  Thank you!!

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by jhon79, Oct 27, 2013
For all you of out there diagnosied with SNHL . Thought of posting my story ...
Diagnoised with sudden hearing loss around April ..with no impovemnt in test results ..initially ..but after 6 months or so .. my results were almost close to normal ...
Being thru a lot of frustration with the Docs .. and carried out my own .. treatment plan .After all this i am writing this to let ppl know there is some hope out there ..when you do combination therapy one therapy will not work ..atleast in my case .

   Here is wot i did ... :
   1. Was able to take steriods within 3 days of onset symptoms .
   2. Presidisone + Ear Injections ....==== Did not help or see any imporvement for 1st month
    3. Then i started heavily on the Vitamins (B12) + Magnesium + Gingko + Antioxidant .. for 3-5 months continous .. Gingko showed great results atleast intially
   4. At last out of much frustation i have used Cinnazarine (anti histamine) for tinnitus .. this really helped my tinittus is almost softer now.

All in all my if you dont see a response in 1-2 months dont worry stick to you guts and follow your plan . **Only Combination Therapy Works **

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by Nikifm, Dec 17, 2013
I have tinnitus and feeling off balance for months now. I feel like I'm rocking on a boat. It's kept me from being able to drive or have a normal life. So frustrated about this.

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