I'm seem to have a consistent discharge coming out of my ear now. It is very gucky. Additionally my sinus's seem to generate alot of mucus. I have seen an ENT doctor for three years and am growing very discouraged over the lack of any resolution.
He performed two operations, one for sinus polyps. I've always had them since I was 15, currently 40. Another for removing a "growth" on the back of my ear drum. The ear drum operation resulted in the loss of my middle ear and subsequently significant hearing loss in the ear.The operation were performed two years ago. The growth was believe to be caused by a prior tube in my ear. That tube was placed thier during a previous operation (6 years ago) for sinus polyps performed by a different ENT guy. After that surgury my ear was excellant with the subsequent developement of the minor growth.
A year and 1/2 ago I had him put in a tube, he was very hesistant to do this. I continously reported to him stuff was "draining" out the tube. The tube was small and its purpose was for "ventilation". He didn't seem to believe me on the amount of drainage. The tube has recently come out and now my ear seems to be "congested" with "yucky stuff" coming out my ear.
I then recently developed Sciatica of my left leg. A GP gave me some steriods (10 days) initially. This did nothing for my Sciatica but immediately had effects on my ear. Within hours I could feel the ear trying to drain thru the Eustacian tube. Which as far as I can tell hasn't been functional for years. Within days it seem to clear up very well. After finishing the steriods my ear actually seem quite good. However it then slowly started to deteriorate back to its original condition. My Sciatica is slowly improving, seems the more exercise (walking) the more improvement.
He's given me some common antibiotics years ago. I smoke about 1 1/2 packs a day. This seems to initially have started when a moron at work coughed in my ear. Immediatelly an outer ear infection developed. The GP prescribed some antibiotics which seem to clear it up. However my inside ear then seemed to stay "congested".
I'm concerned thier is still some sort of infection (for 3+ years ????). What can be done to determine if there is or isn't an infection. Why is my ear acting so goofy? What's going on?
Help, me please.
Answer ----------------
The above description of symptoms is consistent with a diagnosis of chronic otitis media. Chronic otitis media refers to a condition affecting the middle ear (behind the ear drum) and the mastoid air cell system where there is perisistent or recurrent infection which becomes manifest as purulent (pus) discharge usually through a hole in the ear drum. The condition can develop after a discrete single episode of ear infection or it may develop more insidiously. Occasionally the condition may develop after prior ear surgery.
The condition may have its origins in eustachian tube dysfunction whereby normal ventilation and pressure equilibration inside the air chambers of the ear become chronically disturbed. When the eustachian tube fails to properly ventilate the ear, the normal gases in the ear are absorbed and may be replaced with fluid. The fluid can act as a nutrient base fostering the growth of bacteria leading to infection. Eustachian tube dysfunction may be the result of cigarette smoking, sinus or nasal disease, adenoid disease, as well as a number of other conditions. Generally, chronic eustachian tube dysfunction resulting in middle ear fluid that fails to resolve with medication is treated with placement of tympanostomy tubes in the ear drum. In most cases temporary tube placement restores normal function to the middle ear and eustachian tube such that when the tube extrudes on its own, the problem is resolved. However, in some patients other factors cause middle ear and mastoid disease to persist despite placement of a tympanostomy tube.
Chronic otitis media may follow or precede the development of a growth of skin inside the middle ear and mastoid known as a cholesteatoma. A cholesteatoma expands inside the ear eroding bone and can destroy the ossicles (bones) of the middle ear which conduct sound. Untreated, cholesteatomas can lead to even more serious complications. Generally, cholesteatomas require surgery - a tympanomastoidectomy.
In many cases, however, chronic otitis media can be successfully treated to resolution, prior to development of cholesteatoma, or other complications, without surgery. First of all a thorough assessment of all potential causative factors must be addressed and those factors must be eliminated. Examples include cigarette smoke - a well-established factor associated with the development of chronic otitis media, sinus or nasal disease, adenoid disease, allergy, etc. A proper examination of the ear requires microscopic assessment with debridement of all purulent matter and debris from the ear - this usually can be done in the office but may occasionally require an examination under anesthesia, for example in children. If purulent matter is seen a culture should be obtained to attempt to identify the organisms present to allow for focused antibiotic therapy. Occasionally a gentle irrigation of the ear with a mixture of lukewarm water or saline and vinegar may be helpful in cleansing the ear for examination. The examination of the ear will allow identification of cholesteatoma which is generally an indication for surgery. The examination can also occasionally determine the integrity of the ossicular chain which conducts sound from the ear drum to the inner ear. The examination is usually accompanied by a measurement of hearing after the ear is properly debrided, which can also reflect the integrity of the ossicular chain. In some cases, an x-ray such as a CT scan of the mastoid may be recommended, but most otolaryngologists will obtain one only if cholesteatoma is seen or suspected, or in cases where non-surgical treatment of chronic infection has failed.
The elimination of chronic infection is generally the next step, unless findings are present that suggest early surgical intervention is necessary - such as the presence of a cholesteatoma (particularly if complications such as abscess have developed). The non-surgical means of eradicating chronic infection involve periodic debridement of the ear, topical antibiotic medications, and systemic antibiotics. Debridement of the ear might involve weekly visits to the physicians office for microscopic debridement in more difficult cases, or it might be something that can be accomplished at home - boil tap water, then allow to cool to body temperature. Mix with white vinegar (half and half) and irrigate the ear with a bulb syringe daily. Topical antibiotic ear drops are usually necessary (cortisporin otic, tobramycin, gentamicin, etc.). Finally systemic antibiotics are often helpful particularly if the offending organism can be identified by culture.
Once the ear is "dry", surgery might still be considered to restore hearing - this requires a thorough discussion with your otolaryngologist regarding the chances of success. If after many weeks of appropriate continuous medical therapy, drainage persists, then surgery may be the only alternative to eradicate the chronic infection - a tympanomastoidectomy.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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