Nasal septum deviation - difficulty equalizing left ear

[LVFT]

I'm hoping someone might be able to shed some light on my situation. Perhaps someone has been in the same predicament. My left ear is definitely slower to equalize/more difficult to equalize in comparison to my right ear. I've read conflicting information stating that a deviated septum might be to blame for this. Some say a deviated septum may be to blame and some say a deviated septum has no bearing on the Eustachian tubes being able to equalize.

I do have allergies (grass, weed, mold, and oak) according to recent blood work. I have implemented an allergy regiment consisting of Neilmed sinus rinse, Flonase, and Aller-tec pill daily. I have also started to slowly cut dairy.

The results of my CT scan are as follows:

Indication: Sinusitis

Comparison: None

Technique: Multiple axial CT images of the facial bones without IV contrast were obtained, followed by 2D coronal reformats.

Findings: There are small retention cyst within the inferior maxillary sinuses greater on the left. There is no evidence of sinusitis. Patent ostiomeatal complexes. No significant nasal septal deviation.

Impression: No evidence of acute sinusitis. Small retention cysts within the maxillary sinuses.

So my question is, could the following deviated septum be to blame? Would getting this corrected solve my problem? Again, my left ear is the one that is troublesome. I've never had issues with my right ear which leads me to believe that it might not be technique.... Appreciate any help/suggestion you guys can provide!

 

[PACKRMAN]

I am not a ENT. I can tell you that my ENT, who is a diver, corrected my deviated septum, and it helped. I suggest you talk to a doctor with a diving background.

 

[LVFT]

I am not a ENT. I can tell you that my ENT, who is a diver, corrected my deviated septum, and it helped. I suggest you talk to a doctor with a diving background.

Appreciate the response! Could you please elaborate when you say, "it helped." Did you always have issues equalizing and noticed a significant difference equalizing after the procedure? Did you have one ear that was more stubborn than the other and the procedure resolved it?

I spoke with an ENT a little while back and actually reached out to Dr. Mike here on the forums. I also scheduled a 2nd opinion consultation in the coming weeks.

 

[doctormike]

Hey, nice looking sinuses! I took the liberty of drawing on your scan. Black is air, white is bone, grey is everything else in between. In general, the more black in the ears and sinuses, the better.

To equalize your ears, you need to raise the pressure in the nasopharynx, the area in the back of the nose. As you can see, this area is very far from the septum, and even farther from the part of the septum that isn't straight. While a severe deviated septum might make it difficult to breathe through the nose and even hard to raise pressure in the nasopharynx, the NP is one large space, so it's not like a deviated septum to the left will cause more issues with the left ear than the right ear. Also, if you can breathe well through the other side, you should be able to ventilate the NP through that side and equalize.

Now, I am only seeing one slice of the scan, so I can't speak to whatever else is going on, but I hope that helps explain how equalization works.

 

[LVFT]

Now, I am only seeing one slice of the scan, so I can't speak to whatever else is going on, but I hope that helps explain how equalization works.

Thanks, Dr. Mike. I guess I'm just a little confused b/c the information can be so conflicting. Take the following excerpt from DAN:

Other recognizable factors in equalizing problems are:

• a history of childhood ear infections or even one severe infection that may leave the eustachian tube scarred and partially occluded;
• a history of a broken nose or a deviated septum that prevents one ear or set of sinuses from clearing as fast as the opposite side;
• hay fever, which may produce swelling of the mucous membranes or cause nasal polyps that can partially or completely occlude a sinus cavity or airway.

Guide to Avoiding Ear & Sinus Injuries in Scuba Diving

Could a broken nose be at fault or would this fall into the category of being too far from the ET to have an impact? I know that I had tubes as a child. Is there a way for the ENT to view the tubes to ensure they aren't scarred or occluded? I just want to be certain I'm armed with information and can better understand when speaking with my ENT during my 2nd opinion consultation.

Lastly, I wanted to provide a few more images in hopes something jumps out at you! :d Thanks again for your help!!

Bone Images

 

[LVFT]

Unenhanced

 

[LVFT]

Coronals

 

[LVFT]

Sagittals

I really hope this was helpful in some way! Please let me know if you need to see more images of a certain area!!

 

[Bratface]

I have always had issues with my ears and sinuses from back when I was a kid. I began having trouble again last year during allergy season with my ears so I went to my local ENT doctor. I had a turbinate reduction and another procedure on my nose (under local in the office--I don't recommend local for most people and the nasal packing was pretty miserable). I also had a relatively new procedure done at another time called a balloon tuboplasty. The doctor numbed me up (just like for the first surgery) and then put the endoscope waaaay up my nose into my Eustachian tube, inflated the balloon for two minutes and took it out. It didn't hurt, just felt really weird. I coped by staring at the ceiling or closing my eyes and wishing I was any place but there.

Both surgeries have helped tremendously. I still have a slightly deviated septum on the left (which is my problem side), but I am able to equalize very easily. I'm an RN in the operating room and don't want to have the septum fixed (it's a curse to know too much). The other two procedures helped me 85%. I still take nasal sprays and use the netibottle daily.

 

[doctormike]

Thanks, Dr. Mike. I guess I'm just a little confused b/c the information can be so conflicting. Take the following excerpt from DAN:

...

• a history of a broken nose or a deviated septum that prevents one ear or set of sinuses from clearing as fast as the opposite side

Two doctors, three opinions! Hah...

Seriously, I am not supposed to give you specific advice online, but I don't mind making some general comments.

All I can say is that I don't understand how that would happen from a physiological point of view, although it is a commonly held assumption. A deviated septum can definitely interfere with sinus equalization, but not really with ear equalization.

I know that I had tubes as a child. Is there a way for the ENT to view the tubes to ensure they aren't scarred or occluded?

This is more likely to be relevant than the septum. You can image the Eustachian tubes by MRI or CT, but apart from something like a tumor, there really isn't anything in the appearance on a scan that correlates with function.

Lastly, I wanted to provide a few more images in hopes something jumps out at you! :d Thanks again for your help!!

Sure... you have pretty well ventilated sinuses, with only a small retention cyst or polyp in the bottom of the left maxillary sinus (I usually ignore something like that, not really clinically relevant). Your tooth roots are going up into the sinus - any dental issues? Sometimes that can cause issues with diving, especially if there is a potential or partial fistula between the mouth and sinuses.

---------- Post added May 21st, 2015 at 10:52 PM ----------

I have always had issues with my ears and sinuses from back when I was a kid. I began having trouble again last year during allergy season with my ears so I went to my local ENT doctor. I had a turbinate reduction and another procedure on my nose (under local in the office--I don't recommend local for most people and the nasal packing was pretty miserable). I also had a relatively new procedure done at another time called a balloon tuboplasty. The doctor numbed me up (just like for the first surgery) and then put the endoscope waaaay up my nose into my Eustachian tube, inflated the balloon for two minutes and took it out. It didn't hurt, just felt really weird. I coped by staring at the ceiling or closing my eyes and wishing I was any place but there.

Both surgeries have helped tremendously. I still have a slightly deviated septum on the left (which is my problem side), but I am able to equalize very easily. I'm an RN in the operating room and don't want to have the septum fixed (it's a curse to know too much). The other two procedures helped me 85%. I still take nasal sprays and use the netibottle daily.

I do the turbinate reduction procedure on kids frequently, it's really helpful and has minimal risks. The balloon tuboplasty is much newer, and not really done in children at this point, so I have no experience with it. I know that it's controversial and has some risks, but I understand that there may be some people who will get long term benefit from it. Unlike nasal surgery, this one does actually address the structure that ventilates the ears (the ET).