I recently had a very bad case of the flu. The flu is gone, but now I have a bad ear infection. I was on Biaxin for the flu. My internist changed it to Cipro for the ear infection. I had an allergic reaction (tiny, itchy hives all over my face, neck, chest & shoulders). I was told to stop the Cipro and was referred to an ENT specialist.
I went to the ENT on Tuesday. This was a fairly traumatic experience for me. After explaining to him that my right ear felt stopped up, I watched the doctor and his nurse pull out many unusual instruments from his drawer. Most seemed like dental instruments. (I didn't think it was possible to put these long, pointy things in my ear. At least not while I was conscious.)
He said I had a thin membrane covering my middle ear and he had to remove it. He used long thin instruments with a kind of handle and trigger as well as an item called a "hook". He also used some suction. He was annoyed by my flinching and told me that if I didn't sit still I would damage my ear drum. (No one held my head still or even let me lean against anything to keep me from flinching.) When he finally finished this uncomfortable procedure, he asked me how I felt. When I explained that I felt no different than when I walked in, he seemed surprised.
After he was done examining my ear, he looked in my nose. He told me I have a crushed (not deviated) septum and complete blockage of my left side. He said I needed surgery to correct it. He also seemed surprised that no one had diagnosed this before. He also said that I will probably stop snoring and begin breathing through my nose again after the surgery.
I have allergic reactions to almost every kind of decongestent. Therefore, he gave me no oral prescription. He did give me a prescription for ear drops, but it is giving me the same allergic reaction as the Cipro. I think this Doctor probably knows what he's doing, but I'm still very uncomfortable with what he did to my ear. Is this normal on a 1st visit? Should I trust his diagnosis of the "crushed septum"? Should I seek a 2nd opinion? Your comments would be much appreciated. Thanks you.
Reply: -------------------
As you know it is not possible for me to make a diagnosis through the medium of the internet. However, it is true that a pseudomembrane of dead skin and wax can form in the outer ear near the ear drum which can cause the symptom of a plugged ear. Such pseudomembranous formation can also interfere with hearing since it obstructs the transmission of sound waves to the ear drum. Office removal, usually with small hooks or tiny forceps is the most common method of treating the condition initially. The condition may be the result of an inflammation in the ear canal (external otitis) and therefore it is also common that topical drops be prescribed for 7-10 days. The drops are often not successful in eliminating outer ear inflammation if the pseudomembrane is not removed first.
Another cause of a plugged ear sensation following an upper respiratory condition like the flu, would be accumulation of fluid behind the ear drum which is called serous otitis media. This diagnosis can easily be made in the office. Treatment is usually with decongestants, topical nasal steroids, and/or frequent "popping" of the ears. A single course of antibiotics is usually recommended but if it fails to resolve with a single course, continued antibiotics are usually not felt to be indicated unless ear pain is present, fever is present, or if obvious pus can be seen behind the ear drum. Serous otitis media may persist for several weeks before resolving. If it doesn't resolve after 2-3 months, surgical drainage is often recommended.
Finally, yet another cause of a plugged ear following an upper respiratory condition, and perhaps the most common one, is eustachian tube dysfunction. In this situation the ear drum looks normal. A technique of examination known as pneumatic otoscopy in which air is blown into the ear canal through a scope used to simultaneously visualize the ear drum can be helpful in diagnosing this condition. Or an audiometric test known as a tympanogram can be used. Decongestants, topical nasal steroid sprays, or simply plugging your nose and frequently "popping" ones ears may be recommended for eustachian tube dysfunction. Eustachian tube dysfunction can persist for several weeks before resolving.
In regards to the question regarding your septum. I assume that what is meant by "crushed" is that you have a deviated nasal septum to the extent that the septum is in contact with the side wall of the nasal passage known as the turbinate possibly resulting in an indentation in the turbinate. The indication to perform surgery would be based upon the presence of chronic nasal symptoms - specifically constant obstruction to breathing through the nose, or chronic sinus symptoms. If you have no nasal or sinus symptoms of chronic nature it is probably not necessary to consider septal surgery. I have previously posted a number of responses to inquiries regarding deviated septums and septal surgery which may be accessed in the "review" section of the ENT clinic.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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