1. Ear Pain
2. Discharging Ear
3. Tympanoplasty Surgeries for repair of ear drum



Ear Pain

Pain in the ear and in the tooth can disable the strongest and the most stoic.

So the saying goes.

How does the ear pain happen?
Why does it happen?
Who is more prone to it?
What are the emergency measures one can take for immediate relief?
And what must one NEVER do in case of a pain in the ear?

The ear pain can be so excruciating that it can keep you awake the whole night. Symptomatic relief is easy. A simple pain killer may be sufficient and allow you a few hours respite to reach your doctor safely.

Pain in the ear may be due to hard and impacted wax in the outer ea canal or due to an infection anywhere in the ear. It can also be due to injury to the ear.

There are some cases of pain in the ear when the ear is absolutely normal!

In these cases, the nerves that supply both the ear and the related structures may refer the pain from another area to the ear. The more common areas from which the pain can be referred to the ear are the teeth and the jaw. Sometimes the pain can also originate in the throat or the sinuses.

There is a tube that connects the back of the nose to the ear. This tube allows us to maintain the air pressure in the ear. When someone suffers frequent allergies or sore throats, the inner end of the tube can get swollen and blocked. This results in a feeling of heaviness in the ear. Sooner, or later, when not treated adequately, this can become a painful condition. If untreated, the fluid also accumulates in the ear and may eventually rupture the ear drum and flow out of the ear.

Another important cause of pain in the ear can be swelling and infection in the outer ear canal. This is more common but not restricted to diabetics with ubcontrolled sugar. The pain in this case can be intractable and requires dedicted and prolonged treatment. In cases where the patient keeps getting repeatetd episodes of pain in the ear, it is, thus, advisable to order blood sugar tests.

One thing is certain- never, never ignore an ear ache. It can be something that could be as simple as impacted wax. Or as complicated as the infection of surrounding bones. Even sudden changes of air pressure in flight can cause a pressure injury and subsequent pain in prone cases.

Also, it is important that ear does not normally require to be cleaned. It is a self-cleaning organ. Naturally. However, when this mechanism fails, and the ar needs to be cleaned, it MUST be done by a doctor or a nurse trained to do so under clear vision.

Certain easy steps can ensure the health of ears-

• Do not insert objects in the ears.
• Do not ignore episodes of cold or sore throat, especially if you are going to be travelling by air.
  Treat colds and coughs promptly.
• Seek medical advice if there is redness and swelling around the ear.
• Do keep blood sugar strictly under control. And if, you or someone you know is a diabetic, please do not put pins/ matchsticks/ pencils into the ear. It might relieve the momentary itch but can cause a severe bone penetrating infection.
• Old wives' recipe of putting heated oil in the ear can cause more harm than good. Taking a simple pain killer will be more effective till you can reach a doctor.

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Discharging Ear

Any fluid leaking from the ear is called ear discharge. This may be pus, mucus or even be blood or blood mixed with pus. Sometimes the ear discharges clear, watery fluid.

Any discharge from the ear may be alarming; however, blood stained discharge becomes particularly frightening for the patient or the parents.

Ear is a finely tuned organ bounded from the external world by the ear drum in the outer ear canal.

Yet, it is connected with the nose and the throat through a muscular tube- the Eustachian tube. In the children, this tube is loose and less inclined. Thus simple act of powerful blowing or sniffing can cause infection/ pressure changes in the ear. Repeated infections in the throat and the nose often travel to the ear through this highway. When the fuid is accumulating behind an intact drum, it gradually builds up in intensity of pain and the degree of hearing loss. Soon, however, the limit of stretch having been crossed, the ear drum ruptures, discharging the pus into the external ear canal. In fresh ruprures, this may even be mixed with blood. The pain and the blood can be frightening. This, however, releases the pressure and the pain subsides or decreases.

In a majority of patients, when treated timely and adequately, the ear heals very quickly. In some patients, the perforation may remain. The residual perforation, then requires sugery for the same. This is a simple surgery that can be done on a day care basis and the patient can have a near normal life from day one, albeit, with a bandage which may be there for up to 7 days till stitches rae removed.

Another important cause of ear discharge is infection of the bones surrounding the ear- mastoid. Mastoid disease cannot be treated conservatively. The only way to treat these infections is to plan surgery. The mastoid infections can erode the bone and cause potentially lethal infections involving the nerve of hearing, or of the face or even spread to the brain. This is the reason they are often dubbed "Unsafe" ear disease. Mastoidectomy is the operation that cleans all the infection and attempts to reconstruct the hearing from the left-over ossicles.

The infections in the nose and throat leading to ear discharge are the major cause of ear discharge. However, the discharge may start secondary to trauma or even by repeated scratching or probing of ears. This injures the skin and predisposes to infection. The road-side cleaners and instilling oil in the ear are age old grannny recipes that are best avoided for the health of this delicate organ.

A more sinister and potentially dangerous cause of ear discharge can be CSF ( fluid that surrounds the brain) leaking through the ear. This may occur spontaneously, apparently without a cause or due to head injury. These leaks create open pathway between the braina nd the exterior. Protecting the brain and its coverings to prevent meningitis is vital here. Some of these leaks may heal spontaneously while the rest may require operation to close the defect.

Thus, ear discharge is never normal. It may not always be possible to treat a discharging ear without an operation. The ear does become dry with medication but the perforation can begin to discharge any time in the future.

The ear is an organ often taken for granted and missed only when it is too late. It is advisable to see a specialist as soon as possible to deal with ear problems in a timely manner.

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Tympanoplasty

The ear is an organ of special senses and one to mature the first among all organs of special senses. It is a highly complex organ with a very fascinating and delicate functional anatomy.

The ear drum seals off the middle ear from the exterior at the External auditory canal. This membrane is extremely delicate and can be easily damaged by infections in the middle ear. The usual cold and cough that is often taken casually may cause the infection in the middle ear and when left untreated or incompletely treated, may cause build-up of pus and pressure in this area. The drum being the only boundary holding it in, gets stretched and eventually ruptures, quite like a water balloon filled beyond its capacity. As the pus builds up, it causes excruciating pain. The pain is relieved suddenly as the drum ruptures to release the pressure causing pus. I many cases, the ear drum heals with treatment. In several, however, after adequate control of infection, if the drum fails to heal, it may need to be repaired surgically.

The surgery (Tympanoplasty) involves a small incision in the groove behind the ear, and harvesting a drum like tissue from the covering of the muscle there ( Temporalis fascia). This is then used to graft the defect in the ear drum. At the time of the surgery, the bones of hearing can also be inspected and hearing mechanism adequately repaired. In some cases, the defect may not be possible to repair in a single surgery. In these cases, the bone repair ( Ossiculoplasty) can be done in the second stage after establishment of a safe, stable ear. This would usually be 6-12 months after the first operation, when needed.

This surgery takes about half an hour, is safe and effective in nearly all the cases. The patients can go back home the same day after surgery and come back for suture removal after a week. In many cases, we would advise the patients to follow a near normal life style from day 1 after surgery, albeit with an ear bandage.

The scar of the incision also is barely visible with in as little as a couple of months. The test for hearing is done again after a month to a month and a half, to document the hearing gain.

The risk of leaving the perforation is far greater than the usual risk involved in any surgery. The open perforation exposes the ear to repeated infections and can potentially cause irreversible and irrepairable hearing loss.

Thus, this is a simple surgery with a very good outcome.

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