Draining Ear: A Significant Condition
Guest: Dr. Ted Meyer – Otolaryngology - Head & Neck Surgery
Host: Dr. Linda Austin –
Dr. Linda Austin: I’m Dr.
Linda Austin. I’m interviewing Dr. Ted
Meyer who is Assistant Professor of Otolaryngology here at the Medical
University of South Carolina. Dr. Meyer,
let’s talk about a common ear problem, chronic draining ear. What are some of the ways that patients
experience that problem when they complain of it to you?
Dr. Ted Meyer: Chronic
draining ears occur from patients with eustachian tube problems, with
perforations or holes in the eardrum, with PE tubes or pressure equalization
tubes, which are tubes simply holding a hole open in the eardrum. A chronic draining ear can also occur with a
patient who has recurrent otitis externa or swimmer’s ear, or even a chronic
Dr. Linda Austin: You used
the word eustachian tube and that may be kind of a mysterious anatomic
structure for some people. What is the
Dr. Ted Meyer: Eustachian
tube disease is the bane of the otolaryngologist’s existence, or maybe it’s the
reason for our existence. It’s the
little tube between the middle ear and the back of the nose or the nasopharynx,
and if it works well, patients don’t have ear problems. If it doesn’t work well, patients have
eustachian tube problems or ear problems.
Children have ear infections.
Patients can’t make their ears pop when they’re coming up and down on an
airplane or an elevator.
Dr. Linda Austin: So, when
you’re evaluating chronic draining ear, as an ENT doctor, how do you go about
Dr. Ted Meyer: First, if
there’s a lot of drainage in the ear, we need to, very carefully, clean out the
external ear, and we do this under the microscope with small instruments or a
small suction device. This can be very
difficult to do in a child. Sometimes,
in a child, this even necessitates a trip to the operating room because you
don’t want to cause further problems. If
this looks to be an infectious process, the patient will often benefit from
some eardrops. If this drainage happens
to be quite bloody, it’s still, often, an infectious process. Treating the infection with oral or topical
antibiotic usually helps to get this under control.
Patients can actually have drainage that’s clear and copious. And, if this is the case, we are concerned that
this is a spinal fluid leak. This
doesn’t happen very often, but sometimes patients will have fluid in the middle
ears, and an otolaryngologist will perform a miryngotomy or place a hole in the
eardrum, or put tubes in, and then the ear just drains. And, if that’s the case, we send off some of
this fluid, and if it turns out to be spinal fluid, they often require a
considerable surgery to repair the defect.
Dr. Linda Austin: This
turns out to be spinal fluid? Now, how
does that occur?
Dr. Ted Meyer: Spinal fluid
leaks can occur if there are holes between the brain and the ear. The top part of the temporal bone, which is
the floor of the brain, is called the tegmen, which means roof in Latin. And if there’s a hole in the roof, just like
if there’s a hole in the roof of your house, rain will come in, or in this
case, cerebral spinal fluid, which is surrounding and bathing the brain, can
come down through the roof and get into the middle ear and the mastoid. It can even come dripping out of the nose if
it gets through the eustachian tube and out the nose that direction.
Dr. Linda Austin: I would
think that could be, potentially, very serious if there were infection.
Dr. Ted Meyer: Potentially,
very serious. Meningitis is a major
sequelae of a spinal fluid leak.
Fortunately, it doesn’t happen that often, but it certainly can. And I have several patients who’ve had
meningitis because of this and required significant surgery to repair the
Dr. Linda Austin: So, it
sounds like chronic draining ear is nothing to mess around with. You really need to get it treated.
Dr. Ted Meyer: Absolutely.
Dr. Linda Austin: Dr.
Meyer, thank you so much.
Dr. Ted Meyer: Thank you.
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