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Author: admin, 23.08.2014. Category: Ring In The Ears

All information and advice on this website is of a general nature and may not apply to you. We can’t tell whether a discharging ear is simply otitis externa, or a more deep seated problem like cholesteatoma, until the whole of the eardrum has been seen. In established otitis externa, dead skin and infected material should be removed to give medications a proper chance to work.
The eardrum is a paper-thin membrane, shaped like a miniature satellite dish, 8-10 mm diameter. The vibrations are transmitted to the inner ear via three small bones (ossicles) suspended in the middle ear.
The inner ear acts like a microphone, turning sound vibrations into electrical signals which are sent to the brain in the nerve of hearing. For this to occur, the middle ear must contain air at the same atmospheric pressure as the outer ear. If you paint a dot of ink in the middle of someone’s eardrum, then go back a week later and look at it, it will have moved toward the edge.
Ear canal skin grows in such a way that the outer layers are slowly moved outwards, like a conveyor belt. In otitis externa, the conveyor belt either stops, or doesn’t go fast enough to cope with the increased rate of turnover of skin cells. Sometimes, otitis externa is due to more deep seated disease affecting the middle ear or inner ear.
Occasionally, otitis externa will first come to medical attention as a result of complications from the more serious disease.
The reaction of the skin to the infection may result in a vicious circle of inflammation, swelling, shedding of dead skin which provides food for the germs.
This unusual condition, thought to be caused by swimming in cold water in childhood, predisposes to otitis externa.
Sometimes, otitis externa is the presenting sign of a more severe disease affecting the middle ear or inner ear.
Sudden onset of severe vertigo may be due to the disease eroding into the lateral semicircular canal of the inner ear. The mycelium (my-seal-ee-um) is the mat of fine white wispy fibres, rather like cotton wool.
Until otitis externa has been treated, it is impossible to know if we are dealing with an underlying middle ear condition such as cholesteatoma, because the eardrum is not visible. Taking a swab, and sending it to the microbiology lab for conventional microscopy, culture and sensitivity is of very limited value in otitis externa.
Swab-taking and antibiotic prescription does not help much in a biofilm disease like otitis externa. When several different germs grow from one swab, deciding between culprits and innocent bystanders is a matter of judgement. The reason antibiotics don’t always help much is because otitis externa is much more than a simple infection.
If you are prescribed ear drops, make sure you use them properly, otherwise they probably won’t work.
You then massage the tragus (the piece of skin that sticks out just in front of the ear canal like an open trapdoor) to force the drops right down to the eardrum. Microsuction is an examination and treatment of the ear using a high powered binocular operating microscope.
It usually causes some short lived vertigo (dizzines), lasting no more than a minute or so.
An alternative to microsuction often used in children with runny, discharging ears is to gently mop out the ear with a cotton wool applicator. If we can’t carry out an adequate examination with the child (or adult) awake, a General Anaesthetic may be recommended. Pope wick held in crocodile forceps ready to be placed in a swollen narrow ear canal to treat otitis externa. Sometimes, and especially in fungal cases, an ointment based dressing is the most useful method of treatment. The worst kind of water is bath water – it contains germs from the rest of the body and irritant soap. Plug your ears with cotton wool balls rolled in Vaseline® to provide a waterproof seal when showering or hair washing.
A neoprene headband such as the Ear Band-it® will help stop the ear plugs from falling out. If you have a long term problem with otitis externa, and want to swim, you may prefer to buy a custom made ear mold from an audiologist.
Never poke anything down your ear canal – the skin is very delicate and easily damaged. Many otitis externa patients find that they can’t wear hearing aids because they cause infection, with painful, discharging ears.
Some audiologists try to get around the problem of blockage by using loose fitting or vented moulds. A bone conductor hearing aid uses bone conduction to put sound directly into the inner ear, bypassing the middle ear problem.
This medical information is provided to enhance and support, not replace, individual advice from a qualified medical practitioner. Eczema with secondary infection, painful fissuring of the skin at the opening of the ear canal.

In otitis media, discharge from the middle ear, coming through a perforated eardrum, causes inflammation of the ear canal skin.
This is one of the reasons why it is important to clean the ear canal thoroughly, usually by microsuction. Gradually, over a few weeks, it will work its way further out, until it passes the edge of the eardrum and passes into the ear canal skin. Humid air and lack of ventilation encouraged this mixed fungal growth on the damp surface of the fabric.
Painful skin blisters in the left ear due to herpes zoster virus associated with facial paralysis. Ear infections following swimming, dunking the head in the bath, or ear syringing, are common in otitis externa.
It is a vicious circle of infection, inflammation, swelling, shedding of dead skin, more infection, and so on. Illumination is from light shone over the child’s shoulder and focussed onto the ear by a head mirror worn by the surgeon.
This is normally applied under high powered microscopic control, following the removal of as much debris as possible. Bone conduction of sound is often better than air conduction if the ear canal is blocked in otitis externa. Old fashioned bone conductor hearing aids are placed on metal springs like an Alice band, or sometimes built into a pair of spectacles. This speeds up skin metabolism and produces more layers of dead skin, which is food for the germs.
In this case, small round beige drumsticks are typical of the aspergillus (asp-er-Jill-us) flavus fungus. There are also partially digested skin and inflammatory cells from the body, and toxic chemical waste released from both the bacteria and the body’s own defences.
So, the microbiology lab report, which invariably takes time, needs to be taken with a very large pinch of salt. Antibiotics taken by mouth don’t penetrate at all well into the layers of dead skin debris and pus that block the ear canal in otitis externa. The view is nothing like as good, and we can’t normally reach right down to the eardrum, but it is less scary for the child. Tri-Adcortyl ® ointment contains antifungal, antibacterial and a steroid in order to reduce the inflammatory response of the skin. The test doesn’t diagnose the condition, but does tell us how much hearing has been lost. Once the infection clears up, they go back to wearing the hearing aid, then the whole miserable cycle repeats itself. Modern digital hearing aids can be programmed to stop feedback, allowing a more open fitting. They are cumbersome, and very uncomfortable to wear for any length of time, because they have to press very hard. This slow outward movement prevents a build-up of dead layers of skin from blocking the ear canal. Most of the dust in your home is made up of those flakes of dead skin that have dropped off. The swelling of the bone is permanent, and makes it difficult to carry out microsuction treatment. The result can easily mislead doctors without specialist experience into thinking that the prescription of an antibiotic, to which the germ that happened to grow is sensitive in the lab, will cure the problem. Sometimes, and especially in younger children, it is done as a day case surgery under general anaesthetic. It also tells us whether it is a conductive hearing loss (usually due to blockage of the ear canal in otitis externa) or a sensorineural hearing loss due to damage to the inner ear. However, even partial blockage of the ear canal reduces ventilation and encourages infection.
On the hand, as with most of the body, skin squames get rubbed off during normal everyday activities.
We need to measure and know how much hearing has been lost, and how much remains, to help advise on the likely outcome of treatment. Like dead dried leaves on a tree in autumn, the tiny flakes of dead skin are now ready to fall off. Although you can catch germs from dirty water, often it is your own resident germs who cause the trouble.
Until the eardrum has been fully examined, it is impossible to know whether or not there is an underlying middle ear disease such as cholesteatoma. The most effective way of getting around this problem is to put sound directly into the bone of the skull, by the titanium screw of a BAHA osseointegrated auditory implant. Hearing tests before and after treatment are important in assessing the results of what we do. Sometimes the wick will fall out by itself, but usually it is removed by the specialist under the microscope. It can be quite painful to put in a wick when the ear canal is very tender and swollen, but the pain lasts only a few seconds and the relief is worth it.

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