Why does ear discharge occur?
The ear is actually composed of three parts - the external ear, the middle ear, and the inner ear. When a disease strikes external ear or middle ear, it usually shows up with ear discharge. These diseases can be simple or complicated. Some common ear conditions leading to ear discharge can be otitis externa and otomycosis for the outer ear, and acute otitis media and safe/unsafe types of chronic otitis media for the middle ear. A complicated outer ear condition causing discharge could be malignant otitis externa.
Yes, you should definitely visit an ENT physician as ear discharge indicates that your ear has been infected and needs treatment at the earliest. Your ENT physician will examine your ear, take a detailed case history and will make a suitable diagnosis and may prescribe oral medicines and/or topical ear drops accordingly to heal the condition and to bring relief from pain and itching you are feeling. However, if the condition is diagnosed as chronic, recurrent or serious, the ENT physician may prescribe tests to pinpoint the cause. Surgery may be advised in serious cases.
I have been getting ear discharge that stops for a while on taking medicines but returns within a few days of stopping the treatment. How do I get permanent relief?
What’s needed in recurring ear discharge is correct and accurate diagnosis of the problem. Once the underlying cause is known, permanent cure is highly possible. Do note that some (not all) conditions can be treated effectively only through surgery. Plus your ENT physician will also have to rule out diabetes or any immunosuppressant conditions.
In some cases, the patient can take a few easy precautions to get longer-lasting relief from ear discharge. For example, if you have an ear condition called otitis externa, do not use ear buds or safety pins or hair pins at all to clean your ears. Actually, you should never clean your ears using these anyways as these are unsafe things that can damage ear canal and provide a fertile space for disease-causing germs to grow. Similarly if you have been diagnosed as suffering from otomycosis or fungal infection in ear, ensure that water does not enter your ears. This is especially recommended if your bathing water (think ponds!) could be harbouring germs.
What is usually called a hole in the ear is most often a hole in the ear drum (tympanic membrane, to use medical terminology). Both safe and unsafe type of chronic otitis media (COM) can cause these holes. Either way, your best option for relief is through surgical procedures. The difference is that if your condition is due to safe chronic otitis media, you can opt for your surgery on an elective basis i.e. schedule in advance as there is no emergency situation that needs immediate response. However, if your chronic otitis media condition is of the unsafe type, you must get it operated upon to avoid more complications.
In safe chronic otitis media cases, you will be advised to undergo a surgical procedure involving a myringoplasty and a cortical mastoidectomy. In some cases, an additional procedure called ossiculoplasty may also have to be undertaken. For the unsafe type, you will have to undergo a mastoid exploration along with cavity obliteration and myringoplasty. Like in safe chronic ostitis media, ossiculoplasty may also have to be undertaken.
I have a hole in my ear but my ENT surgeon recommends that I first undergo a nose surgery or an adenotonsillectomy, and only then opt for ear surgery. Why do I need a nose surgery as well?
Your ENT surgeon is recommending an adenotonsillectomy/ nasal surgery first because to get long lasting relief, you need to tackle the issues that caused a hole in the ear in the first place. Many a times, a hole in the tympanic membrane of ear occurs due to an infection in the nose, tonsils or adenoids. Actually, most middle ear infections spring from germs that travel from throat or nose to ear through a small tube-like organ called the Eustachian tube. This can happen due to many factors – deviated nasal septum, chronic sinusitis (symptoms: facial heaviness, the need to clear the throat again and again, trickling sensation in nose, headaches etc), chronic adenoitidis (nasal obstruction), or chronic tonsillitis (symptoms: recurring throat pain). These underlying ailments can send microorganisms zooming through the Eustachian tube to the ear which can then cause a hole in the ear. Of course, the actual cause will need to be confirmed as it will differ from case to case. The simple fact is that if you treat only the hole and the not what it caused in the first place, you run grave risk of getting a hole in your ear all over again, especially so if you have holes in both ears!
I understand that I need an adenotonsillectomy or a nasal surgery before I can get my ear surgery. How much time should separate these two surgeries?
You need at least a month’s gap between your nose surgery and your ear surgery for effective healing to occur.
Unfortunately not. As your ENT surgeon cannot operate on both the ears together, you will have to undergo two separate surgeries. However, first an audiologic test will be conducted to determine which ear is in worse shape and that will be operated upon first. Then you will need at least three months’ rest before your other ear can be operated upon as well.
Let’s assume that I do not opt to undergo any surgery for the hole in my ear. What can happen to me?
If you have safe chronic otitis media, recurring infections and ear discharge resulting from them will gradually destroy the three very small but very critical bones present in your middle ear which will then have a gross negative effect on your hearing ability. While an expert and super specialist ENT surgeon (known as an otologist) can reconstruct the sound conducting mechanism to restore your hearing, it will require another surgery called ossicuplasty. Our advice would be to not expose yourself and your hearing to so much damage. As they say, a stitch in time saves nine. It is certainly true in this case.
I will be undergoing an ear surgery in the coming days. Are there any precautions that I can take in the meanwhile to ensure that my condition does not deteriorate?
Yes, of course. It would be very sensible to not allow any water into your ear. You can either put greased cotton ball in the ear or use ear plugs. You should also avoid intake of cold/cough causing eatables.
My doctor has diagnosed me as suffering from cholestetoma and has advised a surgery at the earliest. Do I really need to undergo a surgery without any delay?
Yes, you do need to undergo surgery as an emergency procedure. Cholestetoma is a condition also known as unsafe chronic otitis media. It is indeed unsafe as it causes your ear bones to decay. Any delay in surgery can bring fresh complications like face paralysis, meningitis, brain infections, body imbalance and/or severe hearing loss.
I have been diagnosed with a hole in my ear or cholestetoma and my hearing ability has weakened. Will a surgery restore my hearing to normal levels?
Your hearing depends on many factors including two background mechanisms occurring inside the ear. These are conduction of sound, and conversion of conducted sound impulses into electrical current that are then conducted to your brain for hearing to take place. A hole in the ear and uncomplicated cholestetoma have an adverse effect on the sound conduction which is brought about by your ear drum and the ossicles (the three tiny bones in the middle ear). For recovery to take place, your ENT surgeon needs to repair your eardrum through a surgical procedure called myringoplasty. On the other hand, the damage to the ear bones is rectified through a procedure called ossiculoplasty. Performed by an expert otologist, these surgeries can indeed restore your hearing. The extent of hearing restoration can be measured very well by taking hearing tests called PTA (pure tone audiometry) before surgery and again, three months after it.
When a skilled ENT surgeon reconstructs your perforated ear drum with microsurgery, it is called a myringoplasty. As we have explained earlier, your ear drum (or tympanic membrane) plays a key role along with the three tiny bones called ossicles present in your middle ear. It is the vibration of your ear drum and these ossicles that carries sound signals to your inner ear.
In myringoplasty, the surgeon harvests an extremely thin, sheet-like and fibrous graft called temporalis fascia and uses it to repair the hole in your ear. At times, the surgeon may also use the patient’s own cartilage to strengthen the reconstructed ear drum. If that is done, the procedure becomes a cartilage myringoplasty.
If your ear is suffering from decayed ossicles (the three tiny bones present in middle ear that vibrate along with the ear drum for hearing to occur), your ENT surgeon will undertake a microsurgical procedure called ossiculoplasty to reshape and reposition the damaged bones as required so that sound vibration (and hearing) can take place. However, if the patient’s ossicles are damaged beyond repair, the surgeon also has the option of implanting either harvested and disease-free ossicles from a donor, or put in place artificial prosthetics made of titanium, hydroxyapatite, or silastic, to restore hearing.
When ossiculoplasty and myringoplasty are combined, the procedure is often referred to as a tympanoplasty.