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What can be done to treat recurrent bleeding from the ear with pus?

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ENT Specialist
Practicing since : 1991
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My daughter is 15 months old and at the age of 5 months we saw puss coming out from her ear. First doctors thought that its ear infection and gave her antibiotics for cure. But we started seeing puss with blood coming out from her ear almost once every two months since then. Doctors here in Atlanta predicted that it might be a cist that is getting infected. Doctors suggested a small surgery to remove the cist might help and are not 100 percent sure of the cure. Her ear swells for like two to three days and then puss mixed with blood comes out. With a dosage of oral antibiotic or ear drops it cures and comes back again. Now for past few months its more frequent and alteast once a month. Poor baby she suffers a lot with pain and no sleep because of pain. She barely eats or drinks during this period. Can you please please advise on what treatment would be the best for this problem. Appreciate your help
Posted Fri, 27 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 9 hours later

Thanks for your query.

The signs and symptoms are consistent with a Preauricular Cyst or Sinus. It would be of help if you could mail some photographs of her ear to YYYY@YYYY with 'Attn: Dr. Sumit Bhatti' in the subject line.

Get a culture & antibiotic sensitivity of her pus discharge done, whenever she has an active pus discharge.

When the infection has subsided, get an USG (UltraSonoGraphy) done. Sinograms, CT / MRI is required only in doubtful cases. A USG Abdomen should also be done to rule out kidney problems. I assume that other congenital problems have been ruled out. I assume that an ENT , eardrum examination and hearing tests are normal (OAE, BERA / ASSR).

Surgery is the best option. Recurrence can be avoided by complete excision, along with a small piece of auricular cartilage. It causes less scarring (even with removal of the overlying skin) than the scarring fr om repeated infections. It is a safe and effective procedure for permanent relief. I have done a lot of revision cases because of incomplete removal of the tract. The important points are to operate only after controlling the infection, carefully raising the overlying skin flap with delicate skin hooks, using magnification and methylene blue to identify the tract and it's branches, removing attached cartilage, removing the punctum (if present), overlying skin (if involved). The Facial nerve and adjacent blood vessels must be avoided.This condition is notorious for recurrence, which is why most surgeons will not guarantee 100% results, especially if it is located in an atypical area. However, with the above guidelines, the success rate is almost 100%.

Remember to send the removed tissue for HPE (Histo-Pathological Examination) because a few rare conditions can mimic this disease, for example, a first branchial cleft or arch cyst, epidermal inclusion cyst or dermoid cysts.

The surgery should be under a general anesthesia. If you are apprehensive about her surgery at this stage, you may delay the surgery and control the infection by appropriate antibiotics and ear drops as these conditions have no mortality and low morbidity. Radio frequency ablation assisted surgery is a new option. The prognosis is good.

Further discussion will be possible after seeing her photographs and test results.

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