Q. How to fix the problem of repeated collection of fluid in ears?

Answered by
Dr. Vinay S Bhat
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 12, 2020

Hi doctor,

I have a history of ear problems (seven surgeries as of right now). I had tubes placed in both ears when I was younger and more recent before few years. After the tubes were removed, both ear drums were left with holes in them which have been closed with surgery. In the left ear, there was only one tympanoplasty done. As for the right ear, there was a fat plug done and failed, next there was a tympanoplasty which also failed.

Finally, a neurotologist preformed another tympanoplasty with cartilage back up and it has taken. Within the last three months, I have had fluid in the left ear twice and Prednisone has been used. Once I was flying and caused barotrauma from being sick and flying. The other was just fluid sitting there, which is still there after 12 days of Prednisone. Also, I have been told to take Amoxicillin three times the last three months, only I did it with the barotrauma as there was blood sitting behind the ear.

Now, I have got three different opinions from ENT doctors and still, I am confused as to what to try. The normal ENT that has done all but the last surgery, where he made me go elsewhere because he was not comfortable trying again and said the hearing in my right ear has gotten worse from the last hearing test (I do not have a copy of the most recent hearing test), he wants to put a hole in the right ear. The neurotologist was for putting a tube in the right after surgery, as there was fluid behind the ear drum but he has left the country so my choices are limited to go back to him. I have been traveling back and forth 12 hours each way for the last few months and driving after the barotrauma is getting pain in the left ear.

Now, the second doctor's opinion, he said that he would not recommend tubes as both ear drums are intact. He recommended for an allergy test if it helps at all I have been using Flonase as well continuously (all three doctors said to do it). The third doctor told me he would leave the right ear alone and recommended a tube in my left ear with my travel schedule. He basically said I need to determine if I want to live with holes or leave them intact and have pain when it comes on.

Also, I have been diagnosed with TMJ after the first tube surgery, which I think that lead to the pain that made me go through with the tubes in the first place. I have had treatment for that, I hit all the limits I could with my dentist and am now having a day time splint made. All the problems in the left ear have started since three months back. I was placed on Prozac by a doctor, which is known for making clenching worse. I have done the botox in the masseter (for TMJ), which has helped in the past and we did 25 units this time (last time was 15 units).

Overall, I am wondering if it is in my best interest to try and pull off the Prozac (with the doctor's permission) or just getting tubes in both ears and not doing any more reconstructive surgery.

#

Hello,

Welcome to icliniq.com.

Thanks for the detailed history. I can understand that you have gone through a lot because of your repeated ear issues. Very clearly none of the conditions you have (either fluid in middle ear or hole in the eardrum) are painful conditions. Surgery for these conditions is done mainly to improve hearing.

Repeated collection of fluid in the middle ear can occur due to various reasons such as eustachian tube dysfunction, adenoids, allergy, etc. The most common being eustachian tube dysfunction.

Now, coming to the treatment of your condition. You can continue Flonase nasal spray for a few months and see if there is any improvement in fluid in the middle ear. If that is not working then the next option would be to undergo balloon dilatation of eustachian tubes which may work sometimes. Last option would be the insertion of grommet again. But an operated ear grommet can cause permanent perforation and you have to live with it all your life.

As far as pain is concerned, it is probably due to TMJ dysfunction. As you said Prozac worsens bruxism and you may need to stop it with your symptoms or doctor's consent.

These chronic conditions such as eustachian tube dysfunction are difficult to treat and eustachian tube balloon dilatation may be a good choice for you (as you are a frequent flyer).

Thank you doctor,

I have been diagnosed with eustachian tube dysfunction since I was a child, adenoids have been removed when I was younger. They have had me on Flonase for a while and the only way fluid clears from my middle ear is usually Prednisone. What is causing the pain back and forth with the driving/flying, as my ears are not pressurizing at all? I know that TMJ is a factor and I am working with a specialist in my area on that one. They are in the process of making a bite splint to wear during the day if needed and orthodontics have been done twice. Talking with two doctors, they are looking to put the hole in the ear to improve the hearing. The right ear would be to clear out the negative pressure and the left would be to prevent fluid from backing up. If I was to move forward with the surgery of grommets, would there be any long term complications besides possibility of ear infections to worry about?

#

Hi,

Welcome back to icliniq.com.

You clearly seem to be having severe eustachian tube dysfunction since childhood and not responding to steroid nasal sprays. If you can undergo eustachian tube balloon dilatation, it may be a good trail of treatment, if not the only option would be to get a grommet insertion. Long term issues with ear infection are expected. You need to be extremely careful after this procedure. Avoid swimming, and entry of water inside the ear. Make sure to use a cotton swab while taking bath or use earplugs all your life.

There is no alternative treatment for chronic eustachian tube dysfunction other than eustachian tube balloon dilatation or grommet insertion with life long care of the ear.


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