Ongoing Ear Problems Since Starting CPAP

I was diagnosed with OSA about 18 months ago, and have 100% compliance since starting CPAP treatment (well, except for the one night I got less than four hours' sleep due to insomnia). My AHI has gone from 96 untreated to ~3.5 with treatment (about half of which is SWJ). I have more energy, think clearer, and wouldn't give up my Autoset for anything.

My only problem is that since starting PAP therapy I have developed several severe ear infections. After my first ear infection, I was diagnosed with sensorineural hearing loss and have had to start wearing hearing aids. I am currently on my second course of Augmentin in six weeks, both times for an ear infection in my Left ear. My ENT tells me that PAP treatment can cause or contribute to Eustachian tube disfunction, but in his words (which I thoroughly agree with) "Stopping your CPAP is not an option." He seems resigned to just treating these infections when they occur.

So, I have a few questions:

1) Has anyone else developed Eustachian tube problems with CPAP?

2) Has anyone found anything that relieves these problems, even partially?

3) Does anyone have any experience with CPAP and myringotomy/tympanostomy/PE tubes? They did wonders for my son's recurrent ear infections, but I'm not sure whether they are contraindicated with PAP treatment.

I'm not a doctor, higher internal air pressure created by Xpap would put a little extra pressure on internal organs.
You might be more prone to this around your ear canals.
Do you get vertigo at all?
What are your pressures settings on the machine?

My experience has been the exact opposite. My ears have been much better with cpap.
I never had tubes; as I was a child many years before this was done.
I am not aware of tubes being offered for an adult.
Repeated infections could be a sign of a more serious systemic disorder.
I would dismiss this ENT. He sounds lazy and ignorant, but that's my opinion.

Ear issues in conjunction with cpap use do get reported but it isn't something that is very common.
What pressure(s) are you using?
Sometimes a reduction in pressure can less the ear issues and not compromise the therapy too much.

I got an inner-ear infection, with vertigo, which I suspect was caused by failing to wash my CPAP mask. Since then I clean the mask regularly, and that hasn't happened again.

Cannuck 1 wrote:Do you get vertigo at all?What are your pressures settings on the machine?

Sometimes vertigo accompanies my ear infections, but not always. My pressures are in my signature.

chunkyfrog wrote:I am not aware of tubes being offered for an adult.

Tubes are used at any age for Eustachian tube disfunction. Such disfunction is more common in children for anatomical reasons involving the shallow angle of children's Eustachian tubes. For adults it's a simple office procedure under local anaesthetic.

Repeated infections could be a sign of a more serious systemic disorder.
I would dismiss this ENT. He sounds lazy and ignorant, but that's my opinion.

Oh, he did his due diligence. I've had plenty of tests (everything short of an MRI/CT Scan) to rule out everything from anatomical issues to tumors. There is no evidence that there is any issue other than Eustachian tube disfunction with secondary infection.

Pugsy wrote:Ear issues in conjunction with cpap use do get reported but it isn't something that is very common. What pressure(s) are you using? Sometimes a reduction in pressure can less the ear issues and not compromise the therapy too much.

My pressures are in my signature. I have tried reducing pressure a couple of times, but it has always led to an increased AHI.

I don't know if increasing the EPR will help the ear situation without compromising the AHI too much.
Might be worth a try.
If the pressure is the culprit you might be forced to either accept it or make a compromise with maybe a little more AHI if lower pressures eliminate the ear issues....that is of course if the pressure is the culprit.

I am just being curious here. I am a chronic sinusitis sufferer and I was very concerned with the pressure of the treatments and what would be the side effects. Knowing that congestion (also have allergic rhinitis) can lead to sinus infections, I use a sinus rinse almost every night, and have had no adverse side effects from the CPAP treatments.

Have you done this as well? It would seem that if you are having blocked tubes and infections, then there is an issue with your sinuses getting impacted by the treatment and causing infections. I notice a marked clearing of my tubes and sinuses after rinsing, so maybe this could be helpful to you.

ALSO, since I have been rinsing my sinuses out, I have stopped all sinus / rhinitis medications, which (for me) caused significant vertigo issues. My symptoms have been almost non - existent

That might be something you should really consider.

The only other piece advice I can think of, you will have to keep your equipment clean, could be your immune system is weak and bacteria, virus could be the issue.
I posted on "clean mask etiquette" it could help.
Best to you

You have probably had problems all along with your Eustachian tubes, these problems are causing the complications with your CPAP. 4 to 5 inches of water pressure is equivalent to dunking your head 4-5 inches under water, so as you can imagine, most people won't have a problem with CPAP pressure and their ears.

Has your ENT suggested any surgical options? I don't know if they do it for adults, but they will often implant tubes to keep the Eustachian tubes open in children in order to get rid of chronic ear infections.

WindCpap wrote: 4 to 5 inches of water pressure is equivalent to dunking your head 4-5 inches under water, so as you can imagine, most people won't have a problem with CPAP pressure and their ears.

Cpap pressure is measured in cm H2O not inches. With 2.5 cm to 1 in, the pressure would be less than half of your example.

OkyDoky wrote:

WindCpap wrote: 4 to 5 inches of water pressure is equivalent to dunking your head 4-5 inches under water, so as you can imagine, most people won't have a problem with CPAP pressure and their ears.

Cpap pressure is measured in cm H2O not inches. With 2.5 cm to 1 in, the pressure would be less than half of your example.

Aren't you argumentative today. CPAP pressure can be measured in inches if you set it that way. 4-5 inches is approximately 10-12 cmH20. I was using inches, because that is how most people think, and CPAP pressure for most people is generally somewhere around 9-12 cmH20

Some sort of acid reflux? Your ENT probably already ruled that out. I'm going to the ENT on Wednesday to see about a persistent infection near the right e-tube (my main sleeping side before I roll to my back) and reflux is a suspicion. Tough to tell what is going on with this prolonged Florida summer, allergies, sick co-workers. I have never associated xpap use with inner ear infections which have been rare for me since I've been on a xpap, and I used to have a lot of them.

WindCpap wrote:Has your ENT suggested any surgical options? I don't know if they do it for adults, but they will often implant tubes to keep the Eustachian tubes open in children in order to get rid of chronic ear infections.

I mentioned that in my original post, and indeed my primary motivation for posting this thread was to find out if anyone had experience with PE-tubes and PAP therapy.

So...I take it that nobody has any experience with PE-tubes and CPAP?

Pugsy wrote:I don't know if increasing the EPR will help the ear situation without compromising the AHI too much.
Might be worth a try.
If the pressure is the culprit you might be forced to either accept it or make a compromise with maybe a little more AHI if lower pressures eliminate the ear issues....that is of course if the pressure is the culprit.

I don't know if the pressure is the culprit; it may just be a confounding factor or may be irrelevant. I might try increasing EPR and seeing what happens; I hadn't thought about that.

OkyDoky wrote:

WindCpap wrote: 4 to 5 inches of water pressure is equivalent to dunking your head 4-5 inches under water, so as you can imagine, most people won't have a problem with CPAP pressure and their ears.

Cpap pressure is measured in cm H2O not inches. With 2.5 cm to 1 in, the pressure would be less than half of your example.

Since my pressures are 12-16 cm H20, that's equivalent to 4.7 to 6.3 in H20, isn't it? Still, I think the comparison is flawed, since what we're talking about here is not external pressure on the ear drum but internal pressure on the Eustachian tubes and, indeed, air and fluid potentially being blown into the middle ear.

klv329 wrote:Some sort of acid reflux? Your ENT probably already ruled that out. I'm going to the ENT on Wednesday to see about a persistent infection near the right e-tube (my main sleeping side before I roll to my back) and reflux is a suspicion. Tough to tell what is going on with this prolonged Florida summer, allergies, sick co-workers. I have never associated xpap use with inner ear infections which have been rare for me since I've been on a xpap, and I used to have a lot of them.

I was not aware of a connection between GERD and ear infections. Indeed, I have been treated in the past for GERD and it runs in my family. I will ask my ENT at my next visit.

The comparison is actually fairly accurate. Your middle ear links your outer ear and your inner ear. The pressure is equalized through your Eustachian tubes. 6 inches of pressure on the inside will feel the same as 6 inches on the outside. The whole point was that the pressure from the CPAP is fairly benign considering how one would feel with one's ears six inches under the water, but with plugged Eustachian tubes, it could it could cause complications like possibly forcing infectious agents into your middle ear, just like you said. You are supposed to have air in your middle ear.