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How can ear be cleaned from outside after MRM or petrosectomy?

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Hi, I have been suffering from pain near my mastoid and ear from a long time. I had undergone 2 mastoidectomies (both cortical). I don't have any ear discharge. I have the following problem: - Pain in the region marked with red colour in the two attached pictures. - The pain is of burning type - There is a continuous dull pain. - Sometimes the pain gets very severe. Doctors are suspecting osteomyelitis as my bone scan is positive. I have the following questions - 1. Doctor has suggested me modified petrosectomy. He told he will create a drainage link between the mastoid and petrous and flush the petrous but will not do a blind sac closure with fat so he will not do a conventional sub total petrosectomy. How much will such a procedure help me? 2. How can the ear be cleaned from outside after MRM or petrosectomy? Will it require cutting of ear drum everytime? 3. Can MRM clear all cell tracts till petrous so that only MRM can solve the purpose? 4. Is it possible to know whether infection has gone to the petrous while doing a mastoidectomy without drilling the petrous? 5. If the petrous contains fibrosis is it possible to clear that up? 6. How long nerve pain and giddiness stays after petrosectomy? Thanks, XXXX
Posted Sun, 16 Feb 2014 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Raju A.T 3 hours later
Brief Answer: below are the answers Detailed Answer: Hi, Thanks for your query. I have seen the image attached. Answers to your questions are as below. 1. Doctor has suggested me modified petrosectomy. He told he will create a drainage link between the mastoid and petrous and flush the petrous but will not do a blind sac closure with fat so he will not do a conventional sub total petrosectomy. How much will such a procedure help me? ---Yes, the procedure does help. Considering your symptoms I suspect the cause for the pain you have could be infection. Unless the infective focus is been completely cured and cleaned blind closure is not advised. Blind closure can lea to entrapment of the infection. A drainage procedure is the best to remove all the sequestrum and the infection. 2. How can the ear be cleaned from outside after MRM or petrosectomy? Will it require cutting of ear drum everytime? --No, Ear drum is left intact. The ear canal and the middle ear is accessed through the mastoid cavity which forms the roof of the middle ear. 3. Can MRM clear all cell tracts till petrous so that only MRM can solve the purpose? -- May not clear all the air cells but for cure helps to drain all the infection. 4. Is it possible to know whether infection has gone to the petrous while doing a mastoidectomy without drilling the petrous? -- Yes, but incomplete. Petrous is a solid bone, only active inflammation can me made out. 5. If the petrous contains fibrosis is it possible to clear that up? -- Yes, with drilling but not completely. Necessity is decided on the operation table. 6. How long nerve pain and giddiness stays after petrosectomy? -- Its subjective. Multivitamin and better drainage helps to heal faster. May be a week or two. Regards,
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Follow-up: How can ear be cleaned from outside after MRM or petrosectomy? 35 hours later
Hi again... Some more questions... 1. Can there be only inflammation without infection? If so how long? 2. I am on oral levoflaxacin 500 mg once and clindamycin 300 mg twice. I have taken this for a month now and still continuing. Had two surgeries (cortical mastoidectomies) which did not cure the problem. Culture did not yield anything. Is medicine best or should I go for major petrosectomy surgery? 3. My doctor who did my last cortical mastoidectomy said there is bone inflammation but the whole bone can't be removed. Also culture did not yield anything. In such a case how what to do? No proper culture guided antibiotic. 4. I had taken pipercillin for 3 weeks but got limited relief. Now is it advisable to go for imepenum or anything higher as culture did not reveal anything? 5. What are the complications of petrous apex surgery? 6. Is it possible that if infection is not there in petrous and if petrous is drilled, infection might enter there from any residual infection in mastoid? 7. Kindly state the differences between - Cortical, MRM and petrosectomy? 8. Sorry I did not understand how mastoid can be cleaned without opening it after MRM? Do I need to undergo small surgeries every year after MRM to clear my mastoid? Thanks... XXXX
 
 
Answered by Dr. Raju A.T 10 hours later
Brief Answer: Answers are below Detailed Answer: Hi, Thanks for writing back. 1. Can there be only inflammation without infection? If so how long? --Not usually unless its due to allergy. 2. I am on oral levoflaxacin 500 mg once and clindamycin 300 mg twice. I have taken this for a month now and still continuing. Had two surgeries (cortical mastoidectomies) which did not cure the problem. Culture did not yield anything. Is medicine best or should I go for major petrosectomy surgery? --Petrosectomy is advisable 3. My doctor who did my last cortical mastoidectomy said there is bone inflammation but the whole bone can't be removed. Also culture did not yield anything. In such a case how what to do? No proper culture guided antibiotic. --Culture could be negative due to incomplete suppression of the bacterial growth by antibiotics you have been on. Bone drilling and direct drainage of the infection is the best. 4. I had taken pipercillin for 3 weeks but got limited relief. Now is it advisable to go for imepenum or anything higher as culture did not reveal anything? --Yes, thats right. Meropenem or Imepenum would be good. 5. What are the complications of petrous apex surgery? -- Recurrence 6. Is it possible that if infection is not there in petrous and if petrous is drilled, infection might enter there from any residual infection in mastoid? --less likely 7. Kindly state the differences between - Cortical, MRM and petrosectomy? --Radical Mastoidectomy - Removal of posterior and superior canal wall, meatoplasty and exteriorisation of middle ear. Modified Radical Mastoidectomy - Diseased areas as well as portions of the adjacent superior and posterior canal are simply exteriorised without affecting the uninvolved middle ear. Petrosectomy- Petrous bone is explored through mastoid. 8. Sorry I did not understand how mastoid can be cleaned without opening it after MRM? Do I need to undergo small surgeries every year after MRM to clear my mastoid? --Mastoid must be opened in any of the above procedures. No repeat procedures are planned only when there is recurrence. Regards,
Above answer was peer-reviewed by
 
Follow-up: How can ear be cleaned from outside after MRM or petrosectomy? 11 hours later
Hi again... Some more questions - 1. My CRP is 16 and ESR is 6. My CRP is always high. Do these values suggest infection? 2. I have heard that all people do not have air cells in there pertous bone. If I too don't have will drilling the petrous have any bad effect? 3. What is the duration of Imepenem that a patient with osteomyelitis should take and in what dosage ? Just an approx duration. 4. Are oral antibiotics not helpful in a chronic infection? 5. Can there be trigemminal neuralgia even when the infection is gone? If so why? 6. I have been with pain for the last 2 years but without any other symptoms like ear discharge. But only thing which points to osteomyelitis is my bone scan is positive. But this all started with blisters on my ear drum and middle ear getting filled with bloody fluid. Can active infection stay so long with just pain? 7. After MRM cleaning the mastoid bowl can be done from outside. What does that mean? Does that mean doctor will cut my eardrum and clean my mastoid every 6 months? 8. The doctor said that whole temporal bone can't be removed. In such a case if there is remaining infection will it not spread in the wound and blood after surgery? Thanks, XXXX
 
 
Answered by Dr. Raju A.T 11 hours later
Brief Answer: Answers are below Detailed Answer: Hi, 1. My CRP is 16 and ESR is 6. My CRP is always high. Do these values suggest infection? --They indicate inflammation but not infection. 2. I have heard that all people do not have air cells in there pertous bone. If I too don't have will drilling the petrous have any bad effect? --no, 3. What is the duration of Imepenem that a patient with osteomyelitis should take and in what dosage ? Just an approx duration. --10 days approx, the course duration varies based on many clinical and lab parameteres. 4. Are oral antibiotics not helpful in a chronic infection? --no 5. Can there be trigemminal neuralgia even when the infection is gone? If so why? --Irreversible damage to the nerve can lead to symptoms even when the infection is gone. 6. I have been with pain for the last 2 years but without any other symptoms like ear discharge. But only thing which points to osteomyelitis is my bone scan is positive. But this all started with blisters on my ear drum and middle ear getting filled with bloody fluid. Can active infection stay so long with just pain? --yes, 7. After MRM cleaning the mastoid bowl can be done from outside. What does that mean? Does that mean doctor will cut my eardrum and clean my mastoid every 6 months? --In MRM the ear canal is enlarged to include the mastoid space through this defect regular cleaning is done. 8. The doctor said that whole temporal bone can't be removed. In such a case if there is remaining infection will it not spread in the wound and blood after surgery? --Drainage, regular cleaning and antibiotics will avoid such complications. Regards,
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