I have had a feeling of fullness in my left ear for two weeks. I went to a general physician. He examined the ear, saw no apparent infection, and suggested taking Sudafed to relieve any fluid buildup behind the eardrum. I experienced some relief, but now sounds in that ear have a tinny echo to them. What do you suggest?

N.F.

The symptom you describe, "aural fullness," can be due to several different problems. The most obvious possibilities are fluid in the middle ear, ear infection and eustachian-tube dysfunction. The eustachian tubes are tubes of muscle and cartilage that extend from each middle-ear space to the top of the throat. The tubes are normally closed, but they can "pop" open as needed to ventilate your middle-ear spaces. Problems may result if the tubes do not function properly.

Less obvious causes of aural fullness include hearing loss and a "referred" sensation of fullness. A sensation is called referred when a problem in one region is misinterpreted by the brain as coming from a different region. The classic example of this is left shoulder and arm pain during a heart attack. The arm pain is "referred pain" from the heart. In the case of aural fullness, the sensation may be referred from the nasopharynx (the area behind the nasal cavity and above the soft palate). Infection or a tumor in the nasopharynx could cause a referred sense of fullness in the ear.

The fact that Sudafed (a decongestant) gave you some relief suggests that you may have had a problem with an eustachian tube. (In my experience, however, Sudafed does a poor job of treating such problems. If that is what you had, you probably improved due to "tincture of time" -- in other words, your symptoms were going to get better with time anyway.) Your "tinny echo" worries me in that you may have had hearing loss and are still experiencing some auditory distortion as a result. The "tinny echo" could also be a result of continued eustachian tube problems.

I suggest you see an ENT (ear, nose and throat) specialist to differentiate among these various possibilities. (ENTs undergo an additional four to five years of training after medical school. During this time, the ENT-in-training is focused entirely upon the medical and surgical treatment of diseases of the head and neck.) An ENT would examine your ears, nasopharynx, throat and neck to look for other possible explanations of your symptoms. He or she might use a slender fiberoptic camera to examine your nasopharynx directly. A binocular microscope can provide a much better view of your eardrum than the hand-held scope that your general physician used. Finally, ENTs work closely with audiologists, and audiologic testing would determine whether your hearing is normal or decreased, whether you have fluid behind your ear drum and whether your eustachian tubes are working appropriately.

Your general physician was a good starting point. If you continue to have problems, you definitely need the services of an ENT specialist. Good luck.