Hi,

Thank you for your query.

1. The ear behind the eardrum contains an air space called the middle ear. There is a connection between the middle ear and the back of the nose known as the Eustachian Tube. The Eustachian tube is normally in a collapsed state. It opens during yawning, burping, hiccups, swallowing, chewing gum, or performing the valsalva maneuver.

2. Burping and hiccups cause sudden opening of the Eustachian tube causing sharp pressure changes in the middle ear leading to your symptoms. A Tympanogram (Impedance Audiogram) will be useful. Has a nasal endoscopy been done to check the inner end of the Eustachian tube? This may explain why only one side hurts.

3. I would like to review your audiograms and detailed eardrum findings (clinical notes), if possible. Images of the eardrums may be obtained by an endoscope or video-oto-endoscope. If possible, please upload the reports using “Upload your reports” section on the right.
As I believe that more information can help a physician help a patient better, please answer the following questions:
• Do you hear any sounds (Tinnitus) or have any dizziness?
• Is your hearing fluctuating at times or is it distorted at times?
• Do you hear 'double' (diplacusis)?
• Do you hear yourself talking or eating?
• Do you have any family history of ear problems?
• Did you have adenoid related problems in childhood?
• Have you suddenly lost weight? (Patulous Eustachian Tube)

5. If there is a proven middle ear pressure differential or fluid, it can be relieved by a myringotomy and grommet insertion.

6. Sinusitis may cause Eustachian Tube Dysfunction. However sinusitis will show up on a computerised tomography scan of the Para Nasal Sinuses (CT PNS). This may also explain why one side is worse.

7. Acidity and acid reflux may cause this discomfort. GERD (Gastro Esophageal Reflux Disease) and LPR (Laryngo Pharyngeal Reflux) are common causes of discomfort in the throat and ear.

8. Your ear sensation may be a referred sensation due to irritation of your throat. Recently, acid reflux has also been found to be capable of reaching into the middle ear and sinuses.

9. There may be other symptoms of GERD or LPR such as dryness of the throat, frequent throat clearing, bitter taste in the mouth, choking, dry cough, change in voice and so on. Do you have any other symptoms?

10. You need a trial with anti reflux medication including Mucaine gel for two weeks. Meanwhile you may get an ENT examination and videolaryngoscopy done. You should also consult a gastro-enterologist for the h. pylori infection and a general medicine specialist to rule out cardiac or chest related causes.

11. An abdominal ultrasound (USG) will help rule out a sliding hiatus hernia. There are newer esophageal pressure and pH monitoring devices available. This may help find the cause of your burping and hiccups.

I hope I have answered your query. If you have any further questions I will be available to answer them.

Regards

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Hi,

Thank you for writing back.

1. From your reports, there is no major cause.

2. You should get a Tympanometry done. You may also get the above mentioned tests done.

3. Anti-reflux medication will help. You may also start steam inhalation and get a prescription for an anti-allergic and a steroid nasal spray such as mometasone , ciclesonide or fluticasone.

4. Occasional Tinnitus is of no harm.

5. Kindly let me know the results of your Tympanometry. This will help in suggesting further treatment.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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