Should I go for the op?

Ears, nose and throat
1

So I won't describe my story in length (unless anyone wants me to) but basically I have a perforated eardrum from a grommet that I had 6 years before it arose.

I've had another grommet since, only for it to do basically next to nothing. This was almost 4 years ago. There was a scare two appointments ago (eardrum collapsing or something?) which I had to have a CT scan for (which came back fine).

After the scare they suggested me having another operation but when the CT scan came back fine they said it was up to me.

I'm struggling to make a decision. The original reason why I got referred to ENT was because the perforated eardrum was causing constant ear infections which nothing seemed to stop (various medications were tried).

I haven't had any ear infections since but I have on and off ear pain every week, and this Autumn/winter was particularly worse as I went half deaf in the bad ear several times and had the blocked up changing pressure water feeling in my ear for a few days once or twice.

I don't see it making much difference now (I can put up with the pain) but my worry is that if I don't have the operation then the problem will come back because I didn't do anything to stop it (which is what is happening to my grandmother now, 20-30 years later)

2

There are several gaps and puzzlements in your history.  

Gaps:  What is your age?  If you are adult, did you have many middle ear infections as a child?  What was the reason for inserting the first tube, and how long did it stay in?  Did it come out by itself, or was it removed?  How many total tubes have ever been inserted in the involved ear?  What is the name of the operation that has been suggested?  (Probably tympanoplasty or myringoplasty)  Has anyone advised you to keep water out of your ear, and are you doing that?  If so, by what technique?  ​How is your hearing in the ear with the perforated eardrum?  Seemingly normal, or significantly impaired?

Puzzles:  Since  a hole in the eardrum serves the same purpose as a tube, it usually doesn't make any sense to insert a second tube in the presence of a perforation, unless the perf was extremely small, which is usually not the case when perfs are caused by tubes.  

Eardrum perforations are not painful.  Your ear pains may be coming from another cause, such as spasm of the chewing muscles.  In any case, surgery on your eardrum does not relieve ear pain, so you would not want to have the surgery for pain relief.

When you say "the problem will come back," what problem exactly?

 

3

I'm not entirely sure of the history myself. What I do know is that I had a grommet at age 6 for glue ear. Then in November 2011 I started having constant ear infections till about March 2012 (age 11). Some point after I turned 13 (in the summer somewhen) I had another grommet (which was 4 years ago now so I don't remember much). Both grommets I think came out on their own (I know the second one did and 99.9% sure the first one did too).

I lost my hearing a couple of times in the bad ear (the left one) in the winter, no colds just randomly went. Sometimes I'll get this ringing noise which used to cause other symptoms but now I'm used to it so just try to block it out when it happens. I have a hearing test everytime I have an appointment and it always comes back fine. However I struggle to hear some sounds even if I am concentrating. I end up just nodding along because I can't recognise what people are saying (doubt it's related to my hearing; my mum has always said it's because I don't pay attention but even when I do it still happens).

Not sure of the specific name of the operation as they never told me! They said it was like what my brother had, which doesn't help as he's had grommets, ear reconstruction and he just had another op that sorted the hole he had in his ear.

I've always been advised to keep my ear out of the water. For the first few years I did this, and for the entire 2 years after my 2nd op I did. However, I've given up with it since. I would always wear an earplug with a swimming hat over, but the last swimming hat we bought did more harm than good (it was painful). I don't go swimming much anyway. When I'm showering, I don't make much of an effort to keep the water out (mostly cause I get wax all around my ear and the water is the only thing that gets it away and stops it bugging me when I close my ears).

By the "problem will come back" I mean the ear infections. I ended up going to school with them after a few days and I was avoided like the plague (seemed stupid and made me isolated) and I wouldn't prefer anything like that to happen again.

It's random stabbing pain that has no rhythm. I have yet to identify what causes it. Sometimes it'll be painful for 5 minutes other times it'll be just random pain for a few seconds and then doesn't come back.

4

The critical questions are:

1.  Is your ear infected?  A reliable sign of very active middle ear infection is leakage of pus from the ear on a regular basis.  Smoldering infection can be present without having drainage to the outside, if the drainage is sparse enough that it evaporates as it goes into the ear canal from the middle ear.

2.  Do you have a perforation in your eardrum?  If you do, your cavalier attitude about letting water go in your ear may be the cause of continuing infection, even if you are using the right antibiotic drops.  You MUST religiously avoid water entering your ear if you want it to have any chance of healing! 

If you have a perforated eardrum, with middle ear infection, the treatment is to use antibiotic drops for 4-7 days AND keep water out of your ear. Many middle ear infections will clear with this treatment, especially if the infection is not longstanding.  The objective then is to continue keeping water out to give the eardrum a chance to heal, but it will NOT heal in the presence of infection.  Allowing water into your ear can put you back at square one, using the antibiotic drops again.  If the infection clears, AND you keep water out, but the eardrum does not heal after 6-8 weeks, you may be a candidate for repairing the eardrum using a tissue graft.  But these grafts do not adhere to an infected eardrum remnant.  The perforation must be completely dry, and the mucosal lining of the middle ear (visible through the perforation using a binocular microscope) must be normal or near normal.

Success in medicine requires motivation on the part of the patient, as well as cooperation in doing your part (no water in ear!).  Getting chronic ear infection to clear up involves attention to detail.  Otherwise it's not going to happen.

The long term success of reconstructive middle ear surgery, including eardrum repair, depends heavily on your eustachian tube (or ET)  function.  It is the anatomical tube that goes from the middle ear to the back of your nose.  You can hear it open and close momentarily every time you swallow, equalizing the pressure between the middle ear and the outside world.  If you have poor ET function, even a successful repair can break down when you get a cold, or you can again get fluid in your middle ear that requires another tube insertion.  

Keep water out of your ear, and find confirm whether or not you have a hole in your eardrum, and whether your ear is chonically infected.

5

Yes I definitely do have a perforated eardrum and a hole in that ear (both were confirmed by my doctor).

I haven't had any ear infections since the ones 5 years ago. I've had the occasional times where my ear kept changing pressure (super super super irritating) but not recently (thank goodness). I'll get wax around my ears but I just clear these with tissue (only the edges) and it's fine.

The reason why I haven't been keeping water out of my ear is what I've explained before (the ill-fitting swimming hat meant that I had to give up because the ear plugs didn't stay in without a swimming hat) and they hadn't been advising it most recently.

6

If you have a perforated eardrum, the perforation is the "hole."  So it's one problem, not two.

If you have a simple, dry perforation with no associated infection, the treatment options depend on the percentage of the eardrum involved by the perforation.   Smaller perforations can be treated in the office with what is called Jouers therapy.  This is removal of the edges of the perforation followed by covering it with a paper patch soaked with glycerin.  More than one such treatment can be necessary to close a perforation completely. For larger perforations, or for patients who don't tolerate Jouers therapy, the eardrum can be repaired in the OR under either local anesthesia with sedation, or general anesthesia, using fascia from the temporalis muslce or perichondrium from the tragus.  I prefer the latter as the graft, as it is much easier to work with.  The OR procedure is called a myringoplasty.

For an uninfected perforation in a young person like yourself, the success rate for myringoplasty should exceed 90%.

Getting water in your ear can start an infection at any time, either before surgery or in the post-op period.  I don't mean to be too obvious, but if the swim cap you have doesn't fit, find one that does.  Keeping water out of your ear is a simple matter that greatly increases your chance of resolving the problem.

Good luck with whatever treatment you choose.