Ruptured eardrum? Ruptured eardrum? - Page 3

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Thread: Ruptured eardrum?

  1. #21
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    Quote Originally Posted by Mark Rippetoe View Post
    Got it. You're a prednisone doc. Lots of you guys here in North Texas.
    Not just there.

    Quote Originally Posted by Mark Rippetoe View Post
    What about this presentation would lead you to believe that Eric is dealing with an inflammatory situation? And if for some odd reason you really believe he is, why not an NSAID?
    NSAIDs can be hard on the ear. I would say they're contraindicated here. The more important question remains unaddressed: What is the aetiology of the hearing loss? The differential includes a wide range of conditions, spanning from genetic to acquired, from toxicologic to neurologic, from the benign to...not benign. Can you say "cerebellopontine angle tumor?"

    FFS. If it were me, I wouldn't be satisfied until somebody gave enough minimal fucks to put me in an MRI. And if it were my patient in the ED (and this presentation is not unknown to me) I'd get a same-day MRI precisely to prevent a delay in diagnosis while some generalist just massaged the patient with corticosteroids without knowing what they were treating.

    This is not rocket science. Rule out serious shit first. If you come up with bupkis, then you can throw the holy water prednisone at it.

  2. #22
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    Feb 2019
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    The reason pred is used at onset of symptoms is because cranial nerve pathologies, especially acute onset, could be down to herpes simplex or zoster infection and the associated inflammation. Of course the list of differentials is huge, and imaging is mandatory, and if you can get an MRI immediately and then consider treatment then that would be the best course of action. But the neurological consequences of untreated herpes infections of the cranial nerves can be ameliorated with prompt corticosteroid use (and antiviral use, especially in Ramsay Hunt syndrome). I cannot think of a differential that would be made worse by initiating prednisolone whilst you wait for the MRI.
    And Sully, shame on you for insulting generalists! I would be mad except you're a hero of mine for your pioneering work with the old folk and I'm secretly pleased to have been involved in a forum discussion with you and Rip. Keep up the good work!

    Eric I hope things are settling down. Most of the time this isn't anything serious. But I agree in this day and age a scan is probably reasonable.

  3. #23
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    Feb 2018
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    Quote Originally Posted by Jdcuth View Post
    I cannot think of a differential that would be made worse by initiating prednisolone whilst you wait for the MRI.
    Diabetic cranial neuropathy?

    Assuming OP is not diabetic, I agree with you. And with the MRI.

    Jfsully (not that Sully)

  4. #24
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    Apr 2018
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    Thanks Everyone for continuing to follow up.

    Someone asked if I clench my teeth, and actually this has been a big problem for me over the last year or so. I hadnít considered it, but this might be one thing I can look into.

    The second doctor (a top ENT in the country) agreed with the cortisone. He said that the acute problem is that inflammation is keeping blood from getting into the middle ear and healing it. One thing he told me is that flying is absolutely contraindicated, since a sudden change in pressure is the most dangerous thing for the ear right now. At this point, Iíve taken the cortisone for about a week, reduced my carbohydrate intake, and have improved my sleep hygiene. Things are improving somewhat, and Iím focusing on recovery first.

    Of course, that still leaves a huge blind spot in what actually happened and how I can prevent it from happening again, so it looks like I need to find a way to get a MRI. It wonít be cheap or easy, I think, but this is my ear. Iíve got to get it done.

  5. #25
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    Nov 2013
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    Hi mate,

    Have a look at the symptoms of a perilmph fistula (PLF)

    Perilymph Fistula: Symptoms, Causes, Diagnosis, and Treatment

    I did this whilst lifting, feels a bit like water in your inner ear and mildly affects balance (room spinning when lying down etc) When the GP looks at your ear drum it looks fine. Symptoms get worse the heavier the weight and settles down after 24 hours. Took a while to heal up for me, mostly because I kept training heavy. Eventually I went a bit lighter for a while and it got better.

    James

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