patulous Eustachian tube＆Tinnitus

Where do you feel the sound?
・Clearly feels like it is coming from the ear
・Is it from the left ear or the right ear?
・Is it heard in both ears? Are the sounds in both ears different, or exactly the same? Are there common sounds and different sounds?
②2. Heard outside the ear: head noise (atamanari)
・Felt in a part of the head, especially the brain: buzzing, ringing, cicada-like sound
・Around the head: felt in the body down to the neck; does it change or get induced by body movement or neck movement?

① Continuous sound in the ear: buzzing, ringing
②Sensed in the ear as something other than continuous sound
・Rhythmic sound: pulsating like a heartbeat, could be physiological or pathological blood flow
・Clicking like a spasm
・Muscle spasms connected to the eardrum and ear bones: the muscles connected to the eardrum and the eustachian tube (the tubular organ connecting the middle ear, which is the space behind the eardrum, to the back of the nasal cavity)

One person mentioned, “I started to notice it two months ago.” Upon checking, “I suddenly stopped the exercise I had been doing consistently around that time for no reason. That’s also when my snoring started to get worse.” In many cases, when tinnitus is suddenly noticed or worsens, there is some underlying cause. It requires exploration from various angles. In cases of stress or fatigue, people often push through while they are trying hard, but once they relax and feel relieved, they start to notice the tinnitus.

Ear fullness (jihikan: a feeling of the ears being blocked, a sensation like being underwater, a roaring sound) The term “ear fullness” is a technical term, but in practice, people express it differently, so caution is needed. Some people describe it as ear fullness when they have tinnitus or hearing loss. In otolaryngology, when there is no hearing loss and no earwax blockage, there are mainly two conditions where people complain of ear fullness:
1. Eustachian tube dysfunction: The mucous membrane of the eustachian tube is continuous with the mucous membranes at the back of the nasal cavity and the pharynx. When the mucous membranes swell due to allergic rhinitis or pharyngitis caused by a cold, the mucous membrane of the eustachian tube also swells. As a result, the eustachian tube narrows, creating negative pressure in the middle ear, limiting the mobility of the eardrum, which results in a blocked feeling. In mild or temporary cases, swallowing can alleviate it (ear popping).
2. Patulous eustachian tube: When in a state of stress, exhaustion, or sleep disturbance, the activity of the muscles regulating the eustachian tube can decrease, causing the eustachian tube to remain open. This results in the pressure in the middle ear being the same as the pressure in the nasal cavity or the external environment. Normally, the eustachian tube should be closed to maintain a constant pressure in the middle ear. When this pressure is lost, it creates a feeling of discomfort in the ear, such as a blocked sensation or a feeling of being underwater.

First, you need to identify if there is tinnitus. Then, determine how bothersome it is. These are the key points. Many people suddenly become aware of it one day, though it likely existed before they noticed it. As mentioned earlier, tinnitus itself is often a physiological sensation and not pathological. In such cases, you can either wait and see or, if you want to be sure, have a hearing test at an ENT clinic. If there are no abnormalities, that is the end of it. However, if the symptoms are severe, highly bothersome, or causing significant anxiety, they themselves become the target of treatment.

①If you experience ringing in the ears along with a noticeable loss of hearing. If it recovers quickly, it is likely a temporary physiological response and not a concern. However, if the sound subsides and the hearing loss continues for more than a day, it is necessary to check for sudden hearing loss, such as sudden sensorineural hearing loss.
②If the symptoms are intense and severe. Many pulsatile tinnitus cases are physiological. However, in the more severe cases of patulous eustachian tube, individuals may be acutely aware of it. In rare instances, it can be related to cerebrovascular issues.
③If sudden hearing loss in one ear was treated but did not improve, worsened over time, or deteriorated again after treatment. In rare cases, an acoustic neuroma might be present. This tumor grows very slowly, so caution is necessary.

The following conditions often overlap, and tinnitus or ear fullness frequently co-occur. Ear disorders involve the entire related apparatus and can create imbalances in the brain’s sensory systems. Additionally, overall bodily imbalances manifest as various ear symptoms. In this sense, the ears function as an alarm system for bodily imbalances.
1.Gender-Related Conditions
Ａ：Common in Women:
①1. As a symptom of menopause: In Japanese individuals, common symptoms include stiff shoulders, easy fatigue, headaches, hot flashes, back pain, and abnormal sweating. Tinnitus is closely related to these symptoms
②Hormonal imbalances specific to women: Some women experience tinnitus, dizziness, and headaches as menstrual symptoms. Young people taking birth control pills have increased rapidly. This resembles the “chicken or the egg” situation. Birth control is used to treat menstrual symptoms, but sometimes this treatment overlooks and potentially worsens the underlying imbalance of mind, body, and lifestyle.
③Iron deficiency anemia: This is often overlooked in general health check-ups. If experiencing fatigue or shortness of breath with minor exertion, check the blood ferritin level. Ferritin reflects stored iron in the body. If the level is below 50, iron supplements are necessary. Conversely, high levels may indicate inflammation or conditions like cancer.
④Autonomic nervous system disorder: Symptoms include headaches, dizziness, stiff shoulders, and insomnia. It involves an imbalance between the sympathetic (arousal) and parasympathetic (relaxation) nervous systems. Prolonged stress can lead to a state where the sympathetic nervous system is dominant, contributing to the cycle of tinnitus
⑤Sensitivity to cold: People with unstable autonomic balance are often prone to stress and poor peripheral blood flow, feeling cold, having shallow sleep, and low energy.
⑥6. Weather-related symptoms: Changes in atmospheric pressure and weather can cause tinnitus or ear fullness. The body has homeostasis, like maintaining body temperature despite external temperature changes. Similarly, healthy bodies maintain internal pressure and humidity despite weather changes. When vitality is low or imbalanced, these external changes can affect the body, leading to weather-related symptoms.
B．Common in Men
①Loss of purpose: People often seek a sense of purpose. After retirement, those who lived for their jobs may feel lost. Not paying attention to their emotions previously, they can become quite distressed. In some cases, it might require psychiatric help for depression, but often, proper approaches can help overcome this without relying on medication
②Lack of exercise: Increased remote work due to COVID-19 has led to a lack of exercise. This can result in shallow sleep, slower metabolism, and various sensory issues, including worsened tinnitus. Severe snoring might indicate sleep apnea
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③Energy imbalance: Losing a sense of purpose after retirement can lead to unspent energy causing anxiety and fear, pushing one into a destructive cycle. COVID-19 has also isolated many elderly, exacerbating this issue.
④Temporary tinnitus after eating: Sudden tinnitus and hearing loss that quickly subsides often relate to food intake. The onset can vary from minutes to half a day after eating. Sensitive individuals might identify a specific food trigger, like fried foods or additives.
2.Age-related hearing loss and tinnitus
Hearing loss progresses with age, particularly in high-frequency sounds. As the inner ear’s function declines, more people become aware of tinnitus. The brain’s auditory center becomes confused with reduced sound input, and anxiety or fear of hearing loss can exacerbate tinnitus. Hearing aids can often help by increasing sound input to the brain, reducing tinnitus discomfort
3.Sleep disorders:
Many with tinnitus also have sleep disorders. The saying “chicken or the egg” applies. Many claim tinnitus prevents sleep, but often, the underlying cause is a state of exhaustion leading to heightened awareness of pre-existing tinnitus. Severe snoring might indicate sleep apnea
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