Eustachian Tube Dysfunction

Dawn's suffering from eustachian tube dysfunction right now. It's an awfully painful condition where the middle ear fills up because the eustacian tube closes due to inflammation (see above image).

A healthy eustachian tube (named for Eustachius) opens to equalize pressure in the middle ear. That popping feeling when you gain or lose altitude? That's the eustachian tube opening to equalize pressure in your ear. See this EarDoc advertisement for an explanation of what happens: http://youtube.com/watch?v=XdqrGaUF5EQ (I love the duck).

Dawn tapered off of the anti-depressant Effexor on Wednesday, July 16th and began experiencing symptoms on Thursday, July 17th, with the pain gradually increasing in severity. Dawn experiences the ear pressure pain each time she tapers off Effexor, this being the third time. It's not listed as a common side-effect on the Effexor patient information leaflet. Since she's experiencing considerable, chronic pain, we visited her primary care physician on Friday, July 25. He assured her there's no danger of rupturing of the eardrum and noticed a bulge in her right eardrum (where most of the pain occurs).

Since we don't have a good track record with her primary care physician, we're switching doctors immediately to a highly-rated female doctor closer to home, Dr. Patricia Chen. On Saturday, July 26, we visited Med7 and got another opinion. He prescribed prednisone, a steroidal decongestant, and recommended seeing an ear-nose-throat specialist if it didn't work.

Well, it's not really working, two days in--though seven days remain, the bulk of the prednisone is taken in the first three days. So, we're guessing that we'll have to see an ENT specialist as soon as we can.

Our latest theory here takes into consideration the fact that Effexor acts as an SNRI (seratonin-norepinephrin reuptake inhibitor) boosting the levels of norepinephrin in the body.

Since pseudo-epinephrine aids in reducing swelling, we theorize that increased levels of norepinephrine (adrenaline, basically) possibly aided with reduction of swelling in Dawn's ears (caused by allergies, most likely, the Central Valley being the allergy capital of the world), thus keeping the eustachian tubes open and draining/equalizing the pressure in her middle ear. This theory has the support of some empirical evidence--each time Dawn goes back on Effexor (even temporarily) the pain diminishes immediately. Dawn's a bit skeptical, since she felt even worse pain when she tapered the first time--she thinks it might be a possible side-effect.

We guess that once the boosted levels of norepinephrin disappear (as Dawn ceases taking the SNRI), the swelling increases, shutting the eustachian tubes, filling the middle ear with fluid and causing the painful pressure on the eardrum.

Thoughts? I'm pretty ignorant in this area but have been reading as much as I can. We may be completely off-base. The doctors we've talked to have no clue about the correlation between Effexor discontinuation and the ear pain though, so perhaps our opinions make at least a bit of sense.

If worse comes to worse, an ENT can perform a myringotomy--but obviously we're hoping it doesn't have to go that far. There seem to be some devices on the market (like the EarDoc, http://eardoc.info, and the EarPopper) but they're expensive and we're skeptical without knowing more. On Monday we make an appointment (hopefully for as soon as possible) with Dr. Chen. We're hoping that we can get an immediate referral to see an ENT specialist ASAP.