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| EAR DISORDERS & TREATMENTS > Chronic Ear Infection |
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Introduction
Chronic otitis media (infection of the middle ear) is the cause of your ear
problem. The symptoms depend on the severity of the disease, the
involvement of the mastoid bone and whether there is a hole in the
ear drum (perforation). These symptoms may include ear discharge
(drainage), hearing loss, dizziness, tinnitus (noise in the head)
and, rarely, weakness of the face.
Hearing loss and middle ear disease
The external and middle ear conduct the sound and the inner
ear is the receiver. A problem involving the external or middle ear
causes a conductive hearing loss. An inner ear or ear nerve problem
causes a sensorineural or nerve loss.
Any diseases affecting the ear drum or the three small bones
of hearing may cause a conductive hearing loss. The hearing loss may
be due to a hole in the ear drum (perforation), or destruction of
one or more of the three small bones of hearing (ossicles).
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The anatomy of the human ear, highlighting the ossicles
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An acute infection may develop in the middle ear with resultant
rupture and perforation of the ear drum. The perforation may fail to
heal and lead to intermittent or constant ear drainage and hearing
loss.
Non-surgical treatment
Medical or non-surgical treatment may be useful when a
perforation has been present for a short time with associated ear
discharge. The treatment involves ear drops, antibiotics, and
careful cleaning of the ear by an ear surgeon.
Water should be prevented from entering the ear in all cases
of perforation of the ear drum. This is avoided by placing an ear
plug such as "Blue Tak" or cotton wool mixed with Vaseline in the
outer ear canal. Swimming is possible with an earplug and bathing
cap, but diving must be avoided.
Surgery
Modern surgical techniques of the ear make possible the
reconstruction of the ear drum with resulting control of infection
and prevention of serious complications. The new techniques of
reconstruction can also lead to a marked improvement in hearing.
Tympanoplasty
A tympanoplasty is an operation that eliminates infection
from the middle ear lining and closes the perforation of the
eardrum. It may also include the repair of the small bones of
hearing if damage has occurred.
The operation may be performed under local anaesthetic
painlessly with the combination of intravenous sedation (the patient
is drowsy). A small incision is made near the top of the ear canal
and a graft is taken to repair the eardrum. The operation may also
be carried out under general anaesthesia (the patient is asleep). An
incision behind the ear may be performed if special techniques are
required to enlarge the ear canal in addition to the tympanoplasty.
The procedure often requires two operations to complete reconstruction of the
ear drum and sound transmitting mechanisms. The small bones of
hearing may be replaced by a synthetic prosthesis, your own
cartilage, or they may be repositioned. The patient is hospitalised
for one or two nights and may return to work in a week to ten days.
Antibiotic packing is placed in the ear canal and this is removed at
the first post-operative visit. Healing will not be complete for at
least six weeks and water should be prevented from entering the ear
canal during that time.
Tympanoplasty and mastoidectomy
In some cases the infection of the middle ear and mastoid
becomes chronic and persistent drainage occurs despite all measures.
Chronic infection may lead to permanent hearing loss, dizziness, or
even weakness of the face and brain infection. These situations
usually require the procedure of tympanoplasty with mastoidectomy.
When destruction by chronic infection is widespread in the mastoid
bone, the surgical elimination of this can be difficult and requires
meticulous surgery.
The tympanoplasty and mastoidectomy procedure removes the
diseased lining of the mastoid and middle ear and the eardrum is
reconstructed. This requires a general anaesthetic with an incision
behind the ear with one or two nights in hospital. The patient can
usually return to work in one or two weeks.
Cholesteatoma
A cholesteatoma is a skin-lined cyst or pouch that begins as
a perforation of the eardrum. The cyst continues to expand over a
period of time and destroys the surrounding ear bone.
Ear cholesteatoma can be dangerous and should never be
ignored. Bone erosion can cause the infection to spread into
surrounding areas, including the brain, inner ear, or cause
paralysis of the facial nerve leading to facial weakness.
Once a cholesteatoma has developed it is rarely possible to
eliminate the infection without surgery. Ear drops and antibiotics
reduce the discharge but recurrence is frequent after treatment has
stopped. The surgery is carried out under general anaesthesia, and
the primary purpose is to remove the cholesteatoma and infection.
The aim is to achieve a dry and safe ear that is free of the
complications of cholesteatoma spread. The surgery requires one to
three nights in hospital and one to two weeks off work. Hearing
preservation or reconstruction is the second goal of surgery and is
often performed as a second stage procedure, six to twelve months
later. Regular follow-up visits after surgical treatment are very
important to ensure healing. Antibiotic packing is placed in the ear
canal and removed in the first few weeks following surgery.
The information contained on this page is not meant to be a
substitute for the advice from the surgeon. This is not a complete
discussion of ear disease and is not a complete explanation of the
risks of surgery.
For more information see:
 Atlas MD, Eisenberg R (eds.) (2004) A Guide to Temporal Bone Dissection, 2nd edition, Perth, Lions Ear & Hearing Institute.
 O'Sullivan PG, Atlas MD (2004) The use of soft tissue vascular flaps for mastoid cavity obliteration. Laryngoscope 114, 957-959.
Vijayasekaran S, Golledge C, Atlas MD (2002) Topical Fluoroquinolones for treatment of infections. New Ethics Journal, October 2002, 55-57.
Becvarovski Z, Atlas MD (2001) Modified radical mastoidectomy: Techniques to Prevent Failure. Australian Journal of Otolaryngology 4(1): 11-15.
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