Dr. Akshay. B. K.
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Generally, in cholesteatoma surgery, surgeons put a cotton ball in the eustachian orifice area while exploring the middle ear. It is usually taken out before packing the ear. However, in my case, the surgeon did not take the cotton ball out even after the procedure. As a result, I have recurrent cholesteatoma and negative pressure issues while swallowing. Can we remove it from the eustachian orifice?
Hello,
Welcome to icliniq.com.
I agree that a cotton plug is put in while exploring the middle ear, but it will be removed after the procedure. In your case, how did you get to know there is a cotton plug in the eustachian tube? Also, recurrent cholesteatoma might occur due to inadequate clearance during the first surgery. Do you have a temporal scan or any other relevant material?
Patient's Query
Thank you doctor for the reply,
I know that I had negative pressure issues while swallowing. I thought it would get clear in six months, but still, the issue is there after eight years. Recently I got operated on again after cholesteatoma surgery. Unfortunately, they just cleared granulation tissue. Still, obstruction is there in the eustachian tube. They also mentioned severe adhesions because of negative pressure in my middle ear. I have undergone CTscan, but I do not know how to see.
Hello,
Welcome back to icliniq.com.
Please do not worry. I will try to help you out to the best of my abilities. As you mentioned, granulation tissue in the eustachian tube might be due to many reasons. A small nest of cholesteatoma or a cholesterol granuloma can also cause granulations in the eustachian tube. Have you tried doing the Valsalva maneuver? It helps a lot in overcoming this eustachian tube dysfunction. So, I suggest you do these exercises 15 to 20 times a day. I agree that negative middle ear pressure causes adhesions around the foot, which will lead to hearing loss. The pain that you are experiencing is because of your eustachian tube dysfunction. You will need a eustachian tube function test to see whether the dysfunction is due to organic pathology. Take steam inhalation two to three times a day. Also, I suggest you take nasal steroids. Consult a specialist doctor, discuss with them, and take medications with their consent.
Patient's Query
Thank you doctor for the reply,
I have tried everything. I observed that the discharge got accumulated in the middle ear cavity. Can we unblock the eustachian tube at the isthmus? Please save my life. If the same cycle repeats, I will die some day.
Hello,
Welcome back to icliniq.com.
I understand your concern. What is the opinion of your ENT (ear, nose, and throat) surgeon on this? Did he advise any balloon dilatation of the eustachian tube? This can clear the eustachian tube. An alternative could be placing a grommet tube in the tympanic membrane, which would have been formed after the recent surgery. But, again, what did your surgeon advise?
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Otolaryngology (E.N.T)
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