By Tedler D. Depaynos, MD
The patient felt that a slight “fluid” appears to be draining from time to time from his right ear. He claims to have no loss of hearing however and he never felt any pain. Because of this, he never sought any consultation. Recently, he experienced pain at his left ear and even with palpation below his left ear lobe. He attributed this to his constant use of his ear apparatus in hearing his favorite cowboy music even while working. Again he claims to have no hearing loss.
Because of the discharge, an infection of the inner ear or “otitis media” was entertained by his private MD. Physiologically, when sounds enter the ear canal, the ear drum vibrates and stimulates three little bones beyond it which in turn stimulates the nerves responsible for hearing. A defect in the ear drum and /or the little bones like infection results obviously to a loss of hearing. The location of the little bones is called the inner ear and it has a canal called “eustachean tube” connected to the para nasal cavity. Infection then in the nasal area may infect the inner ear thru the canal resulting in the so called “otitis media”. With accumulation of pus, pain may be experienced and relieved when the ear drum finally ruptures. This may then result in foul smelling ear discharges. Actually this is the most common cause of “otitis media” especially in children.
Chronic “otitis media” may be due to incomplete treatment resulting in the bacteria becoming resistant to the usual antibiotics. This may be manifested by recurrent aural foul smelling discharges resulting in permanent defect in hearing. Complications may arise when the infection extends into the adjacent mastoid bone resulting in “mastoiditis” and even inside the skull resulting in “meningitis” or “brain abscess”.
In this patient the non-loss of hearing was a puzzle to his MD who had no otoscope to view the aural canal. He referred then his patient to an ear specialist.
Ear Nose Throat or ENT specialists are now with modern instruments. They could visualize the ear canal thru a camera inserted into the ear canal and attached to a computer which the patient could likewise see.
The patient was excited in relating to his MD that he saw his ear drums intact. There were however “whitish materials” in both his ear canals but the left one has an area which was “reddish”. Just by the looks of it, the specialist gave a diagnosis of Fungal Infection as he cleaned both ears by flushing and suctioning. It was probably introduced when the patient was cleaning his ears from time to time. The “reddish” area was obviously traumatized since the aural skin in the canal may be sensitive. Since the infection was limited to the aural canal, the specialist called it “otitis externa” and prescribed some ear drop medications.
The patient cannot imagine somebody who is even a doctor cleaning his ears, so that in his appreciation he kept on mentioning the name of the specialist, Dr. Anthony M. Vanadero.
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