A Discussion of Chronic Ear Infections
Chronic ear infection is the result of an ear infection that has left a residual injury to the ear. This type of infection has been established as the cause of your ear problem. Chronic ear infection (the technical diagnosis is chronic otitis media) symptoms depend upon whether or not there is involvement of the mastoid bone and whether there is a hole in the eardrum. In addition, the hearing level depends on whether or not there has been injury to the middle ear bones as well as the eardrum. There may be drainage, hearing impairment, tinnitus (head noise), dizziness, pain, or rarely, weakness of the face. Most often there is simply hearing loss, an uncomfortable feeling and occasionally some discharge.
FUNCTION OF THE NORMAL EAR
The ear is divided into three parts the external ear, the middle ear, and the inner ear. Each part performs an important function in the process of hearing.
Sound waves pass through the canal of the external ear and vibrate the eardrum, which separate the external ear from the middle ear. The three small; bones in the middle ear (hammer or malleus, anvil or incus, and stirrup or stapes) act as a transformer to transmit energy of the sound vibrations to the fluids of the inner ear. Vibrations in this fluid stimulate the delicate nerve fibers. The hearing nerve then transmits impulses to the brain where they are interpreted as understandable sound.
TYPES OF HEARING IMPAIRMENT
The external ear and the middle ear conduct sound; the inner ear receives it. If there is some difficulty in the external or middle ear, a conductive hearing loss occurs. If the trouble lies in the inner ear, a sensorineural or hair cell loss is the result. When there is difficulty in both the middle and inner ear, a combination of conductive and sensorineural impairment exists.
THE DISEASED MIDDLE EAR
Any disease affecting the eardrum or the three small ear bones may cause a conductive hearing loss by interfering with the transmission of sound to the inner ear. Such a hearing impairment may be due to a perforation (hole) in the eardrum, partial or total destruction of one or all of the three little ear bones, or scar tissue.
When an acute infection develops in the middle ear (an abscessed ear), the eardrum may rupture, resulting in a perforation. This perforation usually heals. If it fails to do so a hearing loss occurs, often associated with head noise (tinnitus) and intermittent or constant ear drainage.
Occasionally after an infection in the healing process, skin from the ear canal may be stimulated to grow through a perforated eardrum, into the middle ear and into the mastoid. When this occurs, a skin-lined cyst known as a cholesteatoma is formed. This cyst will continue to expand over a period of time and progressively destroy the surrounding bone. It usually destroys the middle ear bones first, followed by the mastoid. Cholesteatoma presents a grave danger to the inner ear and event to the brain as meningitis may result. If a cholesteatoma is present, drainage tends to be more constant and frequently has a foul odor.
TREATMENT OF CHRONIC OTITIS MEDIA
Home Care of the Ear
If a perforation is present, you should not allow water to get into the ear canal. This may be avoided when showering or washing by placing cotton in the external ear canal and covering it with a layer of Vaseline. If you desire to swim, a custom made mold is helpful in keeping water out of the ear canal.
Avoid blowing your nose repeatedly in order to keep infection in the nose from spreading to the ear through the eustachian tube. If it is necessary to blow your nose, do not occlude or compress one nostril while blowing the other.
In the event of ear drainage, keep the ear clean by using a small cotton tipped applicator at the very outer portion of the canal. Medication should be used if discharge is present or when discharge occurs. Cotton may be placed in the outer ear canal to catch discharge, but should not be allowed to completely block the canal.
Medical Treatment
Medical treatment, including oral medications and ear drops, will frequently stop the ear drainage. In addition, careful cleaning of the canal and at times the application of antibiotic powder may be necessary.
Different antibiotics by mouth may be necessary in some cases.
If the ear is safe, that is, if there is not continuing destruction of the ear by scarring, infection, or by cholesteatoma, and there is minimal hearing loss, medical treatment may be all that is necessary for chronic otitis media. Otherwise, surgery will be necessary.
SURGICAL TREATMENT
For many years surgical treatment was instituted in chronic otitis media primarily to control infection and prevent serious complications, that is, to make the ear safe and dry. In recent years, it has often been possible with advances in surgical techniques to reconstruct the diseased hearing mechanism.
Various tissue grafts may be used to repair the eardrum. These include the covering of the muscle (fascia), vein, or the covering of cartilage (perichondrium).
A diseased ear bone may be replaced by a synthetic prosthesis and cartilage. Silastic may be used in the middle ear, behind the eardrum to prevent scar tissue from forming, to promote normal function of the ear and motion of the eardrum. When the ear is filled with scar tissue or cholesteatoma or when all the ear bones have been destroyed, it is usually necessary to perform the operation in two stages. In the first stage, the cholesteatoma is removed and silastic may be inserted to allow more normal healing without scar tissue. In the second operation, the silastic is removed and hearing may be reconstructed. In addition, at this time total cholesteatoma removal is assured. If it is not, it is removed at this time. Hearing improvement is rarely noted at or immediately following surgery.