Around 8 months ago I had an acute middle ear infection that
unfortunately was not promptly treated correctly. I had several
antibiotic treatments, yet 3 months after the onset a Cat scan showed
marked changes in the middle ear and mastoid and presence of middle ear
otitis. A month later, a myringotomy was performed, yet my symptoms of
autophony, sense of fullness in the infected ear and moderate hearing
loss continued. I then tried ear inflating, and most recently
tympanostomy tubes were placed following another myringotomy. My doctor
seems to think that my symptoms may clear up after a few months of the
tubes, but I am still concerned about the results of a more recent Cat
scan that indicated that I have pathological tissue growth in the middle
ear and mastoid, and referred the condition to "chronic mastoiditis".
To conclude, decisive in this situation seems to be the fact that 18
years ago (I am now 32) I had a tympanoplasty done.
I have a hard time understanding clearly this situation, and my frequent
headaches and ear pain, especially when it is cold or there is a change
in temperature, cause me to worry. Help!
Reply: ---------------------------
You are describing persistent mucosal thickening in the middle ear and mastoid despite having had a ventilating tube placed. This is occasionally seen in individuals who have had a prolonged period of eustachian tube dysfunction, a history of a middle ear infection with a particularly virulent (or perhaps resistant) virus or bacteria, a history of chronic or recurrent ear infections, a persistent ear infection, or certain unusual conditions such as granulomatous disease etc. When initial empiric antibiotic treatment fails and ear disease (without fever or systemic illness) persists behind an intact ear drum for a couple of months or more, it is then appropriate to do a myringotomy with or without a ventilating tube placement. (Certain clinical circumstances may warrant doing this earlier - such as immune compromised states.) When mucosal disease persists despite tube placement, particularly if otorrhea (drainage) is present then more prolonged, preferrably culture-directed, antibiotic therapy (possibly intravenous) combined with topical application of antibiotic-steroid ear drops is indicated. If this fails to resolve significant mucosal disease in the middle ear and mastoid after 6-8 weeks (providing clinical circumstances do not prompt earlier action) mastoid surgery may be appropriate. A thorough assessment of the entire upper respiratory and digestive tract is also warranted to ensure that the problem is not a manifestation of more widespread mucosal disease beyond the ear.
--
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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