EpistemisSensation of tympanic bubbling
Specialty: Otolaryngology.
Why it occurs
- Presence of serous or mucous fluid effusion in the middle ear after an upper respiratory infection
- Fluctuating tubal dysfunction with sudden and intermittent opening of the Eustachian tube
- Myoclonus of the stapes muscle or the tensor tympani muscle that produce rhythmic contractions of the eardrum
- Small tympanic perforation with remnants of serous secretion in the middle ear subjected to atmospheric pressure
Initial workup
High resolution otoscopy to visualize air-fluid levels or bubbles behind the tympanic membrane, tympanometry with type B or C curve that detects severe tubal dysfunction or the presence of fluid, tonal audiometry, and impedanciometry with monitoring of tympanic compliance to rule out myoclonus of the middle ear muscles.
red flags
Presence of unilateral persistent progressive hearing loss, episodes of acute vertigo associated with swallowing movements or pressure changes, facial paralysis of sudden onset, or intense stabbing nocturnal otalgia refractory to common analgesics.
Standard management
- Topical nasal corticosteroids such as mometasone furoate — 50 mcg, 2 sprays in each nostril every 12 hours to reduce inflammation of the mucosa of the Eustachian tube
- Oral mucolytics such as erdosteine — 300 mg orally every 12 hours to reduce the viscosity of middle ear secretions
- Second generation antihistamines such as levocetirizine — 5 mg orally every 24 hours only if a seasonal allergic background is confirmed
- Controlled tubal insufflation maneuvers, such as the Valsalva maneuver, if the tympanic membrane is intact and the patient is instructed.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4