The patient had three tympanoplasty surgeries in the past, the most recent being a decade ago. She has 10 % hearing in one ear where surgery was performed. Recently, the patient developed an ear infection. Black and white fungus detected in the air. ENT used a micro-suction device to remove the fungus which was successful, but the suction device caused some bleeding in the ear. ENT prescribed Tobrex for the ear. This caused the patient extreme pain and was discontinued after three days. The ear canal became very inflamed. A yellow discharge started coming out of the ear. The new doctor prescribed Levofloxacin antibiotics, Prednisolone, and Naproxen for pain relief. The patient still continues to suffer from extreme pain in the ear.
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I need some details. Are the CT scan films those are attached (attachment removed to protect patient identity) taken after the development of the latest problem or are those taken during the tympanometry surgery in the perioperative period? Do you have the details of the surgery? Is it just a tympanoplasty or does it include mastoidectomy as well? Can you attach the hearing reports taken most recently? What medicines is the patient currently on? Is the course of Levofloxacin complete and does the patient feel any improvement? What are the complaints faced by the patient? Is the patient a diabetic and what is the age? Any medical condition for which the patient takes any medicines regularly? Otitis externa seems apparent but we need to find out the status of eardrum as well as sugar control. Kindly provide all details and we shall guide you on how to proceed further.
Thank you doctor,
CT scans have been recently taken. There are no details of the past surgeries. The only information I have is: Patient had 10 % hearing on the operated ear for the last 10 years. The patient said the doctor has mentioned that her inner ear bone was improperly placed. She feels pain if any fluid enters her ear and often uses an earplug if swimming at the beach. She has scar marks in her ear that may seem to indicate a perforated eardrum that was not fully healed in past surgeries.
Levofloxacin was started today. There seems to be a slight improvement, but I am not sure if that is attributed to an increase in pain medication prescribed. Before the patient took Esomeprazole for three days and there was no change in symptoms. The patient complains of ear pain, and pain in her bone by her jaw and under the ear. The patient is not diabetic and age is 29 years old. She takes medication for anxiety but not regularly. Eardrum seems to have lacerations from past surgeries that may not have fully healed. Is it possible the there may be small openings in her eardrums? Any fluids entering the patient's right ear causes severe pain.
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Now, let the patient be aware of and follow the instructions below:
1. I think, based on details that the drum is not intact. So, at all costs, the patient should not let water enter the said ear. While bathing they have to keep a cotton plug with a drop of vaseline inside the ear canal. The vaseline will act as a perfect seal for water to not enter. After bathing they should remove the cotton plug which may have got wet. Swimming needs special precautions as well. Plugs may help. If not helping consider not swimming.
2. Now, let the patient complete the course of Levofloxacin. I hope the frequency and dosage of the medicine have been checked by an appropriate doctor. If you have any doubt regarding that write to me and I shall guide you.
3. Esomeprazole helps in removing reflux related symptoms which indirectly worsen ear problems. Esomeprazole 40 mg tablet may be taken once daily in empty stomach, say half an hour before breakfast.
4. In the current scenario, in addition to Levofloxacin and Esomeprazole, the patient needs a good decongestant and antihistaminic. Something like Sudafed (Pseudoephedrine) and Allegra (Fexofenadine). These drugs produce sleep as the side effect and can be taken half a tablet twice daily. If you need something for pain relief, Sinarest LP and Recofast plus have an additional Tylenol (Paracetamol) component in their combination medicines. If you get these drugs where the patient is I can guide regarding the dosage and frequency.
5. An anti-inflammatory medicine like Chymoral forte (combination of Trypsin, Chymotrypsin, Bromelain, Rutopside) will be helpful in accentuating the healing and removal of dead cells and clearing out inflammatory products from the site of the problem. Other alternatives to this drug are Phlogam, Serratiopeptidase, etc.
6. The patient is advised to take rest. Once the condition subsides completely then the patient needs a full evaluation including ear under microscope and audiometry.
7. The antianxiety medicines need to be taken seriously if the doctor has prescribed and taken properly as per instructions.
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