Chronic Ear Pain and Hearing Loss: Seeking Answers for Ongoing Symptoms

Severe pain in the left ear?

Hello Doctor, I would like to inquire about my mother's condition.
Below is a summary of her medical records that I have translated.
My mother is 59 years old and had no significant medical or surgical history prior to her hospitalization.
She has been experiencing purulent discharge from her left ear for over three months.
In 2015, she had serous otitis media in her left ear and underwent tympanostomy tube placement; however, the purulent discharge persisted postoperatively.
The ventilation tube was removed on December 14, 2017, but the discharge continued.
My mother complains of hearing loss on the left side, swelling in the left ear, and accompanying headaches.
Examination revealed a perforation in the left tympanic membrane with yellow mucoid discharge.
Audiometric testing indicated mild to moderate mixed hearing loss of 48 dB with an air-bone gap of 25 dB.
A CT scan of the temporal bone showed some soft tissue density in the left mastoid and middle ear.
Due to chronic otitis media on the left side, she required surgery, which included left mastoidectomy and tympanoplasty.
However, post-surgery, she has continued to experience inflammation.
After about six months of ongoing medical visits, the doctor stated that there was no longer any inflammation and the discharge had improved.
Nevertheless, my mother still experiences pain in her ear and headaches, requiring daily pain medication to manage her symptoms.
Last month, the ENT specialist indicated that he could not provide further assistance and recommended a referral to neurology for evaluation.
Currently, she has undergone an EEG in the neurology department, and we are awaiting the results.
I am very worried and feel lost about the underlying cause.
Do you have any recommendations for us? Thank you very much!

Mr. Lin, 40~49 year old female. Ask Date: 2018/09/02

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the issues you mentioned may have the following two possibilities:
1) Otitis Media:
a) Acute Otitis Media: This often occurs alongside upper respiratory infections (such as colds) and sinusitis.
In severe cases, there may be discharge of fluid or pus from the ear.

b) Chronic Otitis Media with acute exacerbation: This usually occurs when there is a pre-existing perforation in the eardrum, which can be caused by unclean water or improper ear cleaning, leading to inflammation.
Treatment options include using ear drops along with oral medications (such as antibiotics and anti-inflammatory pain relievers) for mild cases, while severe cases may require hospitalization.
If hearing is affected, it is advisable to seek medical attention promptly.
2) Temporomandibular Joint Disorder (TMJ): This condition involves the joint located in front of the ear and often presents with ear pain.
It is commonly caused by poor biting habits.
Management may include medication for pain control and adjustments to biting habits.
Based on the information provided, it is difficult to accurately determine the condition.
It is recommended to consult an Ear, Nose, and Throat (ENT) specialist or a neurologist for a thorough examination.
Wishing you good health,
Dr.
Chi Chao-Yun,
Director of ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2018/09/02

More Info

Chronic ear pain and hearing loss can be distressing symptoms, especially when they persist despite medical intervention. Your mother's case, as you've described, involves a history of chronic otitis media, which has led to complications such as tympanic membrane perforation and mixed hearing loss. The fact that she has undergone multiple surgeries, including tympanostomy tube placement and mastoidectomy, indicates a significant and ongoing issue with her left ear.

Chronic otitis media can lead to various complications, including persistent ear discharge, hearing loss, and even pain. The presence of soft tissue density in the mastoid and middle ear, as noted in the CT scan, suggests that there may still be some residual infection or inflammation, even if the doctors have indicated that there is no active infection at the moment. This can sometimes occur in cases of chronic inflammation where the tissue does not heal properly, leading to ongoing symptoms.

The symptoms of ear pain and headaches that your mother is experiencing could be multifactorial. One possibility is that the chronic inflammation has led to changes in the surrounding structures, including the temporal bone and the surrounding nerves, which could contribute to her pain. Additionally, the presence of fluid in the middle ear can create pressure changes that might lead to discomfort or pain, especially when there are changes in altitude or during activities that affect ear pressure, such as swallowing or yawning.

Given that the ENT specialist has suggested a referral to a neurologist, it is essential to consider that there may be neurological factors contributing to her symptoms. Conditions such as neuralgia, which is pain caused by irritation or damage to a nerve, could be a possibility. Additionally, if there is any involvement of the facial nerve or other cranial nerves due to the chronic infection or inflammation, this could also explain some of the pain she is experiencing.

In terms of next steps, it is crucial to await the results of the neurological evaluations, including the EEG. These results will help determine if there are any underlying neurological issues that need to be addressed. In the meantime, managing her pain with appropriate medications is essential. If over-the-counter pain relievers are insufficient, discussing stronger pain management options with her healthcare provider may be necessary.

Furthermore, if her symptoms persist, it may be worth seeking a second opinion from another ENT specialist or a multidisciplinary team that includes both ENT and neurology. They can provide a comprehensive evaluation and consider other diagnostic imaging, such as MRI, to rule out any structural issues that may not have been previously identified.

Lastly, it is essential to maintain open communication with her healthcare providers about her symptoms and any changes she experiences. Keeping a symptom diary that tracks her pain levels, triggers, and any other associated symptoms can be helpful for her doctors in understanding her condition better.

In summary, your mother's ongoing ear pain and hearing loss are likely due to a combination of chronic otitis media complications and possibly neurological factors. Continued evaluation and a multidisciplinary approach will be crucial in managing her symptoms and improving her quality of life.

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