I have a ruptured eardrum that has not healed. Please help.

Hi,

Welcome to icliniq.com.

Thanks for the briefing regarding the problem in concern. I had a detailed look at the pictures (attachments removed to protect the patient's identity) you have sent. Before I speak about the treatment, let me first discuss the normal eardrum. Your ear is divided into three segments, the outer middle, and the inner ear. Our concern is pertaining to the middle ear component. The normal eardrum (which separates the outer ear and middle ear) is divided into two parts, pars tensa, and pars flaccida. Pars tensa is the area of the eardrum which has the perforation on both sides. Pars flaccida is that component which is the upper zone which, if you observe very closely, has a retraction pocket or a depressed area. This has happened over time due to constant negative pressure in the middle ear region secondary to faulty eustachian tube dysfunction. The eustachian tube ventilates the nose and ear, keeping the pressure between both areas equal. Any faulty function in the eustachian tube (due to nasal allergies or any nasal inflammation) can cause negative pressures to develop in the pars flaccida causing retraction pockets. These retraction pockets become zones that accumilate desquamated skin epithelium which we call cholesteatoma, and have the propensity to destroy underlying bones. The reason for your hearing loss could be due to this cholesteatoma causing destruction of the ossicles (which participate in the conduction of sound to the inner ear), and any discontinuity can lead to conductive deafness. So, to sum up, we have two issues here. 1. Perforation in the eardrum. 2. Retraction pockets developed due to eustachian tube dysfunction secondary to chronic nasal inflammation (which may or may not be symptomatic). How to manage this issue? 1. Through the photos you have sent, I can certainly say there is ongoing inflammation in the middle, which has to be treated with antibiotics. I would suggest you start tablet Ciplox TZ (Ciprofloxacin and Tinidazole) one tablet in the morning and evening after food for one week for this. 2. If there is an obvious nasal inflammation that is symptomatic, it has to be treated simultaneously, failing which the retraction pockets might deepen, progressing the disease further. 3. After the course of antibiotics, A HRCT (high-resolution computed tomography) of the temporal bone is a must to ascertain what extent of bone erosion is there and to also know the status of the ossicles. 4. A pure tone audiometry to ascertain the type of hearing loss and extent of hearing loss. 5. Surgery is the only answer to repair the eardrum, fix the ossicles (if there has been any erosion) and to remove any retraction pockets, and remove any cholesteatoma. I hope this answers your query in detail. If there are any further queries, you can revert back to us, and we will answer those queries as soon as possible. Warm regards.

Hi,

Welcome back to icliniq.com.

I am not sure if the tablet mentioned is available over the counter in your country. The surgery cost differs from institute to institute, and in my opinion, you should meet an ENT from where you want to get it operated on to get the details regarding the cost involved for this surgery. If the surgery is not done, the middle ear component might remain inflamed, causing foul-smelling discharge, which is very frustrating. In view of impending underlying complications associated with this disease (which slowly develop over the years or sometimes take even decades in a few), it is always best to fix the issue as soon as possible. We cannot give an exact time period as to when the complications will occur as each patient is different and the progression of the disease varies from patient to patient. The likelihood of losing your hearing depends on what rate the disease is progressing. I have seen patients who have taken decades before complications like a complete hearing loss have happened and also seen patients who have developed complications within a couple of years from the onset of the problem. This is the reason we cannot give a defined time frame for the onset of complications, such as the extent and progression of the sensorineural hearing loss (irreversible hearing loss). Please understand that the primary aim of the surgery is to prevent any further progression of bone erosion, while the secondary aim is to give the patient a serviceable hearing (whatever can be reversed). As time progresses, the tendency of developing irreversible hearing loss increases, and thats why surgery is recommended at the earliest. Warm regards.