I wrote a week ago concerning an ear infection I had that was being stubborn. The infection resolved, though there was still some pain and inflamation as of last Tuesday. This morning I awoke with my ear making loud popping noises...especially when I blew my nose (which runs in cold weather). Upon blowing my nose I could also hear a squeaking...kind of like wir passing through cellophane. The pain wasn't any worse though, and my hearing seems okay. I think that I can say for sure that the eardrum is perforated, for I am still using auroto ear drops. When I put them in the ear, shortly thereafter my throat on that side began to sting, I began gagging, and There also was mucous production, I'm assuming from the irritation. I've not used the ear drops since, as from the reaction my throat had was not pleasant at all...I'm still gagging a little. I will be unable to see my regular doc until Monday at the earliest. From what information I could find I am assuming this can wait until then. I'm curious to hear what you do in these cases. I just want this to resolve completely.
Answer ------------------------
The symptoms you describe are most likely due to residual and persistent eustachian tube dysfunction due to mucosal edema following an ear infection, although a tympanic membrane perforation is possible. The ear drum cannot "pop" if there has been a perforation - most people are able to "pop" their ear drums with nose blowing which causes air to be forced through the eustachian tube inflating the middle ear causing the ear drum to snap outward with an audible and palpable "pop". With a perforation this does not occur, although in some cases an individual can force air through the perforation and hear it, however it is also possible to hear the air pass through a congested eustachian tube.
The only way to know which is the cause of your symptoms is to examine the ears. If the cause is residual eustachian dysfunction, the passage of time and frequent autoinflation (purposeful but gentle "popping" of the ear drums) is generally all that is required. Occasionally decongestant pills or topical nasal decongestants such as Afrin may be helpful but should be limited to very short-term (few days) usage. If the cause is a tympanic membrane rupture, no treatment is required for the time being other than observation since >95% will heal spontaneously within a few weeks at the most. Some doctors will advise avoidance of water in the ears during the period of healing but no medication is necessary as long as the infection is resolved. Spontaneous rupture of the ear drum amidst a middle ear infection is a protective mechanism that occurs particularly with virulent middle ear infections to prevent complications such as spread of the infection towards the brain or blood stream.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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