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    Suggest remedy for ruptured eardrum and chronic ear pain

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Posted on Fri, 3 Jun 2016 in Ear, Nose and Throat Problems
Question: I have a ruptured eardrum and chronic ear pain. I've also had many ear infections. The pain has gotten worse recently and I'm considering surgery but I'd rather try other options before that. When I place a heating pad by my ear I star swallowing more and the pain decreases. I think it's because of fluid leaving down my eustachian tube. Are there other options for a ruptured ear drum and ear pain? Thank you!
doctor
Answered by Dr. Sumit Bhatti 5 hours later
Brief Answer:
Usually surgery is the best option for an eardrum perforation.

Detailed Answer:
Hi,

Thank you for your query.

1. A long standing ear drum rupture does not heal because of many reasons.

2. Frequent ear discharge, infections (including those in the nose, sinuses and mastoid bone), healed margins of the perforation, eustachian tube (ventilation) dysfunction, migration of outer canal skin into the middle ear and so on.

3. The middle ear is wet with normal secretions that drain out into the nasopharynx via the eustachian tube. Fomentation with application of heat bringing relief is suggestive of local inflammation and as you have think, the fluid draining out via the eustachian tube.

4. Usually, surgery is the best option for closing a ruptured ear drum. To settle the chronic ear pain, the chromic infection and ventilation issues must be addressed.

5. An HRCT and MRI Temporal Bones with a Sinus CT is recommended in your case. The CT Scan should be on a 128 slice machine and the MRI 3 Tesla. Upload these scan images and a Pure Tone Audiogram (PTA), including any reports from the past for an accurate assessment.

6. The ear should be dry (free of infection and discharge) for at least 3 weeks to 3 months before any attempt at surgery. This surgery can be done under local anaesthesia and sedation. Now endoscopic ear surgery is also possible. This is minimally invasive. Remember that a 100% success rate is not reported anywhere in the world.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Sumit Bhatti 19 hours later
When I have visited an ENT before because of the ear pain, he said I had no infection. But my ear is in constant discomfort. Could there be another explanation to this other than infection? It's been hurting for months. The pain is usually not very intense but at times it is. What do you mean by ventilation issues?

Also, when my ear hurts, it causes facial muscles on that side of the face to feel tense. It hurts behind my eye and the muscles going toward my eyebrow and mouth. Can that be reduced? I saw online that facial paralysis can be a rare complication of ear surgery. How likely is that to happen and how can it be prevented?

I should mention that I started getting infections after a doctor mistakenly broke my ear drum with hot water. He said I needed an ear wash and put hot, pressured water into my ear and it started bleeding. That happened when I was around 10. Since then I get several infections a year and now it's constant pain, sometimes a feeling of fullness, and facial muscle tightness.
doctor
Answered by Dr. Sumit Bhatti 8 hours later
Brief Answer:
There is no cause for worry.

Detailed Answer:
Hi,

Thank you for writing back.

1. The discomfort in the ear is usually due to some inflammation and sensitivity of the delicate mucosa ( inner lining of the ear ) as the middle ear is exposed to the outside (which is normally behind an intact ear drum).

2. The middle ear ( behind the ear drum) is ventilated or aerated via the Eustachian Tube and the nose. This helps equalise the air pressure on both sides of the eardrum.

3. Since you had a traumatic perforation in childhood, this a long standing perforation that will require surgery.

4. The fullness and the facial muscle tightness is due to referred sensations and the fact that the facial nerve passes through the ear.

5. Facial nerve paralysis after ear surgery is rare and usually transient. Your scan images will reveal the extent of surgery required and the possibility of complications.

6. There is a possibility of facial nerve paralysis even with repeated infections.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 6 hours later
Thank you! Would the surgery get rid of the pain and also the muscle tightness?

Also, before the surgery, should there be no pain/ tightness or just no infection in the area?

Do you think there could be something else causing the symptoms other than the perforation? What could they be and how could they be reduced?

Sorry for all the questions and thank you for the answers :)
doctor
Answered by Dr. Sumit Bhatti 14 hours later
Brief Answer:
You will be better after this routine surgery.

Detailed Answer:
Hi,

Thank you for writing back.

1. After successful ear surgery, your symptoms should subside.

2. Your ear should be free of any inflammation and infection before any surgery.

3. Usually, it is better to have the ear dry for at least 3 weeks or preferably 3 months before surgery.

4. The causes enumerated in point number 2 of my first answer can be underlying causes in addition to a ruptured ear drum. Follow the line of investigations and treatment explained in my previous answers.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 41 hours later
What should I do to make sure there is no inflammation in the area before surgery? If there is pain should I assume there is also inflammation?
Is there anything else you recommend doing in addition to the survey?
doctor
Answered by Dr. Sumit Bhatti 16 hours later
Brief Answer:
The surgery should be successful after the ear is treated.

Detailed Answer:
Hi,

Thank you for writing back.

1. Just following the standard medical treatment is enough to control the inflammation.

2. Pain will be one of the signs of underlying inflammation or infection.

3. The surgery should be the final step.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 2 hours later
I haven't been given any sort of medical treatment when I've gone to see doctors. They just said that I could do the surgery if I wanted to and take ibuprofen for the pain. But I'd rather not take ibuprofen everyday and I feel there are other options. What would be an example of a sample medical procedure on this case?

Also, if my ear starts to hurt while waiting for surgery should I then postpone the surgery? It hurts constantly so I can't imagine it going 3 whole weeks without hurting, much less 3 months.
doctor
Answered by Dr. Sumit Bhatti 20 hours later
Brief Answer:
Ideally, there should be no pain or ear discharge before surgery.

Detailed Answer:
Hi,

Thank you for writing back.

1. Its is odd. The world over, surgical sites are cleared of infection, inflammation and pain before attempting any elective or routine surgery.

2. The results of your hearing test and imaging tests (X-rays, Scans) and the ear drum examination will decide the extent of the surgery.

3. Routine surgery for a ear drum perforation can include myringoplasty, tympanoplasty, mastoidectomy and ossiculoplasty.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 34 hours later
He looked into my ear and said that he saw no infection or inflammation at all but I thought that was strange because I assumed that if I was in pain all the time then there must be inflammation somewhere? Or perhaps it's congestion?

I had a CT scan done and it showed that my eardrum was "dry and thicker than normal" but the 3 bones inside my ear are fine. Another doctor also told me that the perforation is about 1/4 of my eardrum.
doctor
Answered by Dr. Sumit Bhatti 3 hours later
Brief Answer:
The findings are favorable.

Detailed Answer:
Hi,

Thank you for writing back.

1. The above findings are good. You can proceed soon with the operation. The chances of success increase with a dry ear.

2. The pain is either due to myringitis (thickened ear drum) or a referred pain (from some where else in the head, neck, chest or abdomen - as some of these areas share a common nerve supply).

3. After 3 weeks of a dry ear, your doctor can proceed irrespective of the ear discomfort / pain.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2595 Questions

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