Chronic Draining Ear: A Significant Condition

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Chronic Draining Ear:  A Significant Condition




Guest:  Dr. Ted Meyer – Otolaryngology - Head & Neck Surgery

Host:  Dr. Linda Austin – Psychiatry


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 external otitis.


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 eustachian tube?


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 evaluating that?


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 problem. 


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.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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