How to fix the repeated accumulation of fluid in ears?

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 recently, a few years ago.

After the tubes were removed, both eardrums 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 performed another tympanoplasty with cartilage backup, 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 for the last three months, but 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), wants to put a hole in the right ear.

The neurotologist was for putting a tube in right after surgery, as there was fluid behind the eardrum, but he has left the country, so my choices are limited to going back to him, or I have been traveling back and forth 12 hours each way for the last few months, and driving after the barotrauma is getting painful in the left ear.

Now, the second doctor's opinion: he said that he would not recommend tubes as both eardrums are intact. He recommended 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, based on 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 led 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 daytime splint made. All the problems in the left ear started three months ago.

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 get tubes in both ears and not do any more reconstructive surgery.

Please help.

Thank you.

Hello doctor,

Thank you for the reply.

I have been diagnosed with eustachian tube dysfunction since I was a child, and adenoids were 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 with 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 a hole in the ear to improve 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 were to move forward with the surgery of grommets, would there be any long-term complications besides the possibility of ear infections to worry about?

Please help.

Thank you.