Air escapes from my ear when I blow my nose. I can even blow out bubbles when I’m underwater. It’s not painful, but it can’t be right? I am 67
Carol Lawrence, Morecambe, Lancashire.
Air leaking from the ear is a classic sign of a perforated ear drum. The eardrum (or eardrum) is a wafer-thin structure that separates the outer ear from the middle ear.
The external ear canal, where wax accumulates, is only 2.5 cm long and the eardrum, which is only 8 mm in diameter, can be easily perforated or ruptured.
Possible causes include untreated otitis media and physical injuries, including those caused by cotton swabs (one reason you shouldn’t use them to clean your ears).
In your lengthy letter you say that many years ago you burst your eardrum in the same ear in a swimming accident. Being able to blow air out of your ear as you describe it indicates that the healed perforation has collapsed.
Air leaking from the ear is a classic sign of a perforated eardrum. The eardrum (or eardrum) is a wafer-thin structure that separates the outer ear from the middle ear
This has disrupted the normal process by which air pressure in the head is “regulated” by the Eustachian tube.
Usually, the Eustachian tube, which connects the middle ear to the area behind the nose, balances air pressure in the head with the outside. For example, if you blow your nose or descend on a plane, the internal pressure increases
The Eustachian tube opens to regulate the air pressure. It also opens naturally when we chew, yawn, or swallow (you may hear a click that makes the valve close again).
In your case, however, the eardrum is torn. The scar on it meant that it would never have been as strong as the original structure, and at some point you must have sneezed or put pressure on the eardrum that broke it again.
When you blow your nose, the pressure pushes air into the Eustachian tube, into the middle ear cavity, and through the perforation (normally the nasal bladder would just increase the pressure in the middle ear cavity and stretch the eardrum).
The concern is that if you swim or shower, water can get into the middle ear cavity and you get an infection that can lead to complications.
For this reason, you should see your GP and be referred to an ear, nose and throat specialist for surgically repairing the eardrum (usually under general anesthesia, but as a diurnal case).
I have a fairly large goiter that gives me problems with clearing the throat, acid reflux and coughing, mostly at night. I’ve been taking omeprazole but it doesn’t seem to be helping. What else would you recommend?
Michael Symons, Penzance.
The term goiter means abnormal growth of the thyroid gland, a butterfly-shaped gland at the front of the neck that spans the windpipe, with a flap on either side. An enlarged thyroid gland can affect the gullet (gullet), which is behind the windpipe, or move or even compress blood vessels in the neck.
In the UK, goiter is usually linked to autoimmune diseases – typically Graves’ disease, in which the thyroid gland becomes overactive.
This affects hormone levels and I am confident that your doctor has checked these, suggesting that you have something called a multinodular goiter.
Here the thyroid slowly enlarges over many years without causing symptoms, although the windpipe can eventually become compressed and cause shortness of breath when exerted (this occurs more than 30 percent of the time).
Some patients find that breathlessness occurs in certain positions, such as when leaning forward. Around 10 percent of patients experience coughing and choking, and this, too, may be related to their position.
Difficulty swallowing is reported less frequently – acid reflux is not a recognized symptom, but it could simply coincide with the goiter.
So is your cough due to acid reflux or compression of your windpipe by your enlarged thyroid?
Omeprazole suppresses acid production and therefore relieves coughs due to reflux. But you haven’t found it effective, which suggests that the thyroid is the problem.
Options include surgically removing the gland or “shrinking” the gland with a single oral dose of radioactive iodine – this will reduce the gland by 30 to 60 percent over several weeks.
I would recommend an ultrasound to check the amount of trachea compression. A specialist thyroid surgeon can then advise you.
Acid reflux can persist, but there are other medical options that could suppress it.
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The answers should be given in a general context and should always consult your own general practitioner if you have any health concerns.
IN MY VIEW: Don’t worry about waiting for your second Covid shock
Are you one of those people waiting to hear of your second burst with the watch heading towards the promised 12 week timeframe?
After almost 11 weeks, I just got mine, but I know some readers have waited longer and are concerned about the delay.
Personally, I don’t think waiting any longer between the two doses is cause for concern. But I’m afraid the government has poorly explained why (and not for the first time).
When it was announced that the second shot (a booster for better immune protection) would be given after 12 weeks instead of four weeks, it seemed arbitrary rather than evidence-based – which only has the confidence of those unsure of the vaccine further impaired.
Are you one of those people who are still waiting to hear about your second burst while the clock is ticking on the promised 12 week timeframe?
The fact is, the immune system isn’t looking at the clock. In the past, we have given injections to infants at three, six, and nine months. Then it was changed to two months, with boosters after three and four months.
The evidence showed that compressing vaccination times didn’t make them less effective or less safe. The same applies to the extension of the schedule for Covid-19 immunization. The first impact offers excellent protection; The booster amplifies this regardless of the timing.
Research shows that with the AstraZeneca burst, immunity is much higher with a dose of 12 weeks or more (up to 91.7 percent effective) than with a dose of less than six weeks (69.7 percent).
We don’t yet know if this is the case for the Pfizer push, but in my opinion this is a fair assumption. Those who are concerned about a slightly longer wait should be reassured.
My bigger concern remains with those who are eligible but not yet first encountered and what can be done to turn the heads of anti-vaxxers. Statistics that are screaming louder and louder are not the answer: we need clear explanations from our incomparable chief physicians.