Rensink, Michael J.; Martin, Robert L.
Michael J. Rensink, MD, an Otolaryngologist in the San Diego area, has been in practice for more than 30 years. Robert L. Martin, PhD, a Dispensing Audiologist, has been in practice in the San Diego year for 30 years and been writing Nuts & Bolts since 1989. Correspondence to Dr. Martin at 7750 University Avenue, La Mesa, CA 91941.
Some patients have a chronic draining ear on one side and little or no hearing in the other ear. When their functional ear is not draining and their hearing aid works well, these folks can lead normal lives. But when their ear gets plugged up or their hearing aid stops working, their lives are turned upside down.
Treating these patients successfully depends upon the skills of both the medical and the hearing care profession; therefore practitioners of these two disciplines need to work together for the benefit of the patient.
We are not encouraging audiologists or hearing instrument specialists reading this to give your patients medical advice; quite the contrary. But, we do want you to see the bigger picture and understand the options, so that when a patient gets tired of going back to the doctor, you can be supportive and helpful.
Patients with chronically infected or draining ears often become frustrated or even give up all hope. Yet, in truth, there is hope. Huge strides have been made in both medicine and hearing aid technology. These folks should not despair, but they may need you to guide, encourage, support, and help them so they can spend their lives hearing rather than worrying about the possibility of not hearing.
We would like to start with some basic principles to teach these patients.
v Patients must keep water out of a draining ear at all times. In the old days, patients were often told to plug the ear with cotton saturated with Vaseline whenever they took a bath or shower. This works. However, custom-made silicone swim plugs or, in this case, “water plugs,” work much better and are far easier to use. Call on your impression-taking and earmold-ordering skills to make the patient a couple of good “water plugs.” Watch the patient insert and remove the plug. If the person has any difficulty, modify the plug or have the patient apply a bit of baby oil to the ear and the plug before inserting it.
v In such cases, it is critically important to keep the “sick” ear clean because if any moisture and/or debris gets into the ear, it's unlikely to stay healthy. The health and stability of the ear will dictate the cleaning schedule. Some ears need meticulous cleaning every month or two. Naturally, patients would prefer to minimize these cleanings, but they need to understand that all the medication in the world won't take care of the problem if the ear isn't kept clean.
v These patients need more than one good hearing aid. All of us have more than one pair of glasses, several pairs of shoes. People who depend on their hearing aid need a high-quality backup. Those of us in hearing healthcare understand that hearing aids break down, usually at the most inopportune time. So, multiple instruments are a necessity for these patients.
v When the ear is draining, the users must clean the earmold or hearing aid with an alcohol wipe every night. You don't want the patient reintroducing infected material back into the ear. If the patient wears BTE hearing aids, you need to re-tube the earmolds every 3 to 6 months. The patient needs to be able to remove the earmold from the hearing aid easily, which isn't possible if the tubing is hard and brittle. Instruct the patient to remove the earmold and clean it with hot soap and water. Then use a rubber bulb and blow through the tube to remove the moisture. It also helps to make these patients extra earmolds so they have a spare if they encounter difficult removing or replacing the tube on the hearing aid.
MORE ADVANCED IDEAS
Sometimes it helps to obtain a culture from a sick ear to see what organisms are contained in the drainage. Knowing that enables the physician to prescribe the best medication for dealing with those particular organisms.
When the physician (an ear-nose-throat specialist) sees a patient on a regular basis, he or she can usually keep the ear dry and stable. There are now many tools available that can help prevent infections from recurring. For example, Domeboro's solution, a saturated suspension of aluminum acetate, is very helpful in keeping bacteria and other pathogens from growing in the ear. It is inexpensive, not antibiotic, and causes no allergic reactions. Alcohol can be added to the solution to dry the ear if there are no perforations or other contraindications. White vinegar and rubbing alcohol can also be used to keep infections under control.
If a patient is treated with standard eardrops and the problem persists, the physician should consider other medications and treatment modalities. For example, Cortisporin Otic and a category of eardrops known as the aminoglycocides and neomycin-type medications are ototoxic and can also cause allergic reactions. These medications have their place and are valuable when used appropriately. However, they are only part of the spectrum of medications available.
The newer Floroquinalone drops (Ciprofloxin, Floxin, etc.) are not ototoxic and produce better results in most patients. Unfortunately, these medications are very expensive, costing over $100 for a 5-cc bottle. The high cost may preclude some health plans from covering this type of medication, so the MD may be prohibited by his or her HMO from prescribing it. Nevertheless, it may be helpful for patients to realize they have other choices in the marketplace. Remember the old saying, “The least expensive medication is the one that works.”
Sometimes, a chronically draining ear can be treated with powders, rather than drops. For example, such powders as chloromycetin, sulfanilamide, and fungizone, have antibiotic, antifungal, and steroid components.
Patients who have had a mastoidectomy may have chronically wet ears. This may occur because the cavity has an area of mucus membrane that chronically weeps. Such patients may need to be seen frequently, sometimes as often as once a month. The ENT doctor needs to monitor their ears to watch for build-up of cholesteatoma tissue and other squamous debris.
Audiologists and hearing instrument specialists often see patients with chronic ear problems who have gone to a physician and used a recommended treatment, but still have a draining ear. These patients need to be told that there are different levels of expertise and knowledge within every profession, including medicine, and a wide variety of treatment options whose degree of success varies greatly from case to case.
So, before a patient decides that nothing can be done to help a “sick” ear and gives up, he or she needs to try other options. Sometimes a change in medication or a different cleaning method produces a dramatically better result.
People who have no hearing in one ear and a chronically draining ear on the other side present a difficult challenge. They often become frustrated when something happens to their functioning ear and they cannot hear.
Medical and audiological professionals need to work together to help these people. Frequent cleaning of the ears by the physician and support and maintenance of multiple hearing aids by the hearing healthcare provider can often make the lives of these people much better.
© 2005 Lippincott Williams & Wilkins, Inc.