I have been having trouble for months with my Eustachian tubes in my ears getting blocked and not draining properly. This results in ear infections. I have been given three rounds of antibiotics and steroids, But my right ear has blocked up again. My doctors say the next step will be surgery, Do you have any suggestions as to how to keep my ears draining properly. Thank you for your time. K.B., Australia

 Prof Ronen Perez, director of the otology unit and cochlear implant center at Jerusalem’s Shaare Zedek Medical Center and chairman of the Israel Otoneurology, replies:

Thank you for your question. It’s a bit difficult to specifically answer your question, as many details are missing such as your age; is your ear problem on one side or both sides or alternating; and if you have a full-blown middle ear infection of fluid in your middle ear, a condition named serous otitis media or fluid in the middle ear.

In general, fluid in the middle ear (SOM) or recurrent middle ear infection as a result of Eustachian tube dysfunction is common in children but can also occasionally occur in adults. In adults, the nose and especially the nasopharynx (an area behind the nasal cavity) should be carefully examined to rule out anything that may physically obstruct the opening of the Eustachian tube. In many cases the fluid is absorbed without treatment. In other cases, the use of nasal steroid spray may be helpful in resolving the problem.

When there is a full-blown, middle-ear infection, oral antibiotics should be prescribed. In a condition, such as our reader describes, in which all conservative treatment was not effective, surgical intervention may be warranted. Examples of such an intervention include making a hole in the eardrum (myringotomy) or insertion of a ventilation tube.

Can you help me find information about successful hair-cell regeneration of the cochlea of the ear? I was born deaf and am profoundly deaf. I am 56 years old.  I believe healing will come from the Land of Israel. I appreciate any thoughts or references. Pat, Australia

Prof. Perez answers this question as well:

I’m not aware of successful cochlear hair-cell regeneration to date. There are a few groups worldwide that are working on this, but as far as I know that there is still a lot to be done before this becomes practical.

My 47-year-old daughter who lives in San Antonio, Texas, was diagnosed four or five years ago with a condition called erythromelalgia after she complained about her symptoms, which are so distressing that some patients hopes for death  by suicide as a way out. The symptoms are the feeling of burning from the inside out, burning hands and feet, numbness in the mouth, tongue and lips and difficulty sleeping. She was not given any effective relief from the pain.

Prof. Elyad Davidson, director of the pain relief unit and researchers at the Multidisciplinary Center for Cannabinoid Research at Hadassah University Medical Center; member of the board of directors of the, Hebrew University Center for Research on Pain; and chairman of the acute pain section of the Israel Society of Anesthesiology, answers:

I am sorry to hear about your daughter’s suffering. Erythromelalgia, formerly known as Mitchell’s disease (after Silas Weir Mitchell), is a rare vascular peripheral pain disorder in which blood vessels – usually in the lower extremities or hands – are periodically blocked (frequently on and off daily), then become hyperemic and inflamed. The specific underlying cause of erythromelalgia remains unknown.

Erythromelalgia is thought to result from vasomotor abnormalities or dysfunction in the normal narrowing and widening of the diameter of certain blood vessels, leading to abnormalities of blood flow to the extremities. There is severe burning pain in the small fiber sensory nerves and skin redness. The attacks are periodic and are commonly triggered by heat, pressure, mild activity, exertion, insomnia or stress.

As you know, it is rare and unfortunately has no specific therapy.

At Hadassah, we have treated a patient with this diagnosis in the past.  

Since the pain is scattered, specific local treatment like spinal cord stimulators would probably not be effective. I’m sure she has already tried anti-neuropathic pain medications such as anti-epileptic and anti-depressants, but they have obviously not helped.

 I would suggest a trial of methadone or medical cannabis, which could relieve her pain.

I am a 67-year-old man who works out and does strenuous activities. My pulse never goes above 120 when I’m active. At times, I get heart palpitations that go to 200 beats per minute. It happened five times in the last year. I had an electrocardiogram, an echo cardiogram, a Holter monitor for 24 hours and everything checked out OK.

Last Sunday, it happened again. Instead of lying there with my pulse beating 185 to 200 for eight hours, I went to the hospital emergency room. The doctors gave me adenosine (Adenocard) intravenously and brought my pulse down. After they performed comprehensive metabolic blood tests, which all came out in normal range, and my troponin levels were fine without any heart damage, they discharged me.

 My question is what do you think causes this, and what can I do about it? These palpitations just happen when I am sitting doing nothing for no apparent reason. Shalom. J.R., New York, USA

Prof. Michael Glikson, director of the Jesselson Integrated Heart Center in Jerusalem, immediate past president of the Israel Heart Society and an expert in cardiac rhythm, comments:

Your condition sounds like something that we call supraventricular tachycardia (SVT), which is an abnormally fast heartbeat. It’s a broad term that includes many forms of heart rhythm problems (heart arrhythmias) that originate above the ventricles (supraventricular) in the atria or AV node.

SVT that can be easily treated by ablation therapy. I recommend that you see an electrophysiologist (heart rhythm specialist )

 If you want an Israeli expert to answer your medical questions, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at judy@israel365.com with your initials, age, gender and place of residence and details of the medical condition, if any.