Q. What could be the reason for an earache, tinnitus, and redness despite using an anti-fungal drop?

Hello doctor,

I applied antifungal drops, for a week but my ears are still sore. I am attaching an image of the ear canal. I am experiencing pain, tinnitus, hyperacusis as well as clogged sensation. There is a feeling of pressure in the ears, for 12 months ever since a loud noise exposure led to acoustic trauma. Is the redness normal, or could it indicate a bacterial infection?

Thank you.

Hello doctor,

My hearing and ear problems started about a year ago following a loud noise exposure. Initially, I had severe pain in both ears and a clogged sensation, as well as muffled hearing. My ears were super sensitive to any sound. The muffled hearing has improved a lot, but I still have all the other symptoms. I saw the doctor, and upon looking at the ear canal with an otoscope, they thought there might be some evidence of infection, so suggested trying Clotrimazole drops for a week. I did that and also did another week of Acetic acid drops, but no improvement in symptoms. The images I shared are the otoscope images of the external ear canal. There is redness in the canal and also on the tympanic membrane. I am wondering if that could indicate some infection of the external ear, or like you said, if there might be otitis media, or if the continued pain and discomfort is just due to damage to the inner ear structures, due to the noise exposure. I am wondering if I should try some empirical treatment for otitis media, in the hope, that the pain is due to those issues. If it is not it is probably permanent damage from the noise exposure. Is that level of redness in the ear canal normal, or do you think it would indicate otitis? I have been prescribed Ciprofloxacin drops a few months ago, but with no improvement. How about Amoxicillin and Clavulanic acid tablets for otitis media, some other antibiotic, or antifungal medicines? Maybe there could be some type of eczema of the external ear? I do not know. Let me know what you think. I have already been to an ENT and a local doctor but would like to take another opinion, as I am in constant pain. The worst symptom is hyperacusis, which is hypersensitivity to normal sounds. Even the sound of traffic, or sounds that do not bother other people, can leave my ears feeling sore and inflamed.

Thank you.

Hello doctor,

Thank you for your advice. I will send a message later.

Thank you.

Hello doctor,

There is not any discharge or fever. There is mostly a sensation of pressure, tension, and a feeling that the ear is clogged. The clogged sensation has decreased a bit recently. The pain sensation and feeling of tension are greatly aggravated by noise. I cannot use a hair dryer or electric shaver without earplugs anymore, as otherwise I would feel physical pain and discomfort in my ears, and the clogged feeling would become aggravated. It almost feels like fluid begins to accumulate in the ear, but the audiologist said that the tympanometry measurement did not show fluid in the middle ear, and the otoscope did not show any either. Nevertheless, I think they are looking for large amounts of fluid like in occlusion, and that smaller amounts of fluid may be released when triggered by some noise, and these might not show up. This has been going on for a year now. Would you suggest any particular antibiotic for empirical treatment of potential otitis media? I read that they use Amoxicillin, or Amoxicillin and Clavulanic acid for more stubborn cases. Or would I need something stronger? I think it would be a good idea to try something, to see if that had any impact.

Thanks again for your advice.