This letter originally appeared in Dr. Hoffman's column on allHealth.com. |
Q: I have had a problem with my ears since I was 18, but the last eight months, I have been on antibiotics and eardrops and every morning I wake up with drainage and sometimes even blood coming out of my ears. It is a chronic problem and has not gone away despite treatment. Can you give me some advice on what to do with it? I am lost and I am afraid of having an infection that long that I will lose my hearing soon. Even when I am up it is a constant draining coming out and when it gets to where it would drain out it just sits there and forms a crusty substance and it hurts. Sometimes at night I wake up with such severe pain in the ears and on the side of my face, that I just sit there and cry. Finally, my doctor gave me some drops to numb it when it gets bad but I can’t keep going on like this! Please, I could use any suggestion that you have.
A: From your description, I suspect that you suffer from chronic otitis media, a chronic inflammation (usually with bacterial infection) of the middle ear. It is also possible that you have chronic otitis externa, which is a chronic inflammation/infection of ear canal skin. The only good way to tell the difference between these two conditions is to have an ear examination by an ear, nose and throat specialist.
You may want to read my previous columns on acute otitis externa. Chronic otitis externa is similar to acute otitis externa, except that itching tends to be a more common complaint than pain. For this reason, I suspect that you actually have chronic otitis media.
The middle ear is the space behind the ear drum. It is lined with respiratory mucosa, the same tissue that lines your nasal cavity and sinuses. This tissue contains microscopic mucus-secreting glands which, when inflamed, produce much more mucus than usual. (This inflamed mucosa can also bleed with little provocation.) If your middle ears are chronically infected, there will also be a large number of dead white blood cells and bacteria draining from your ears. The latter combination is more commonly known as PUS, and so the whole mixture is fondly called, "mucopus." Yummy.
If the middle ear is the space behind the ear drum, how then does this stuff drain from your ears? You probably have a non-healing hole in each ear drum. An ENT could suction the mucopus from your ear canal and determine whether or not you have holes in your ear drums. Any other doctor looking into your ear with an otoscope would probably only see mucopus.
Now for a bit more anatomy: the bone immediately behind each ear is called the mastoid. The mastoid is not solid bone; it is riddled with a honeycomb of "air cells." ("Cell" is an unfortunate term, since it suggests something very tiny, like a red blood cell. The air cells are much larger than that; they vary in size, but are about the size of a grain of rice.) The air cells are lined with mucosa, and they are all interconnected, with one another and with the middle ear. You may have guessed it already: the air cells may also be chronically infected and may be the source of much of the junk that is draining from your ears.
How is this condition treated? First of all, as noted above, you need to be examined by an ear, nose and throat specialist. An ENT specialist can tell whether you have chronic otitis media or chronic otitis externa, he/she can thoroughly clean your ear canals (which may make you feel much better, at least for a short time), and he/she can also obtain a sample (an ear culture) of the mucopus to send to a microbiology lab, in order to determine what types of bacteria are growing in your ear and what antibiotics will be effective in killing these bacteria.
I suspect that you have not had an ear culture. Treatment of chronic otitis media with empirically-chosen ("best guess") oral antibiotics and ear drops can often lead to the emergence of multidrug-resistant strains of bacteria. If you are infected with one of these superbugs, it is no small wonder that you have had no response to the medications your doctor has given you.
Depending upon the extent of your infection, treatment will involve antibiotics (appropriately chosen, based upon your culture results) and may also involve surgery. Some patients only need an operation to repair the hole in the ear drum (tympanoplasty). In other cases, the ENT surgeon may also need to remove portions of the infected mastoid bone (mastoidectomy). A CT scan of the mastoid bone and ear is often obtained prior to such an operation. In any event, your ENT will inform you what treatment(s) will be necessary to stop the infection and restore your hearing.