Medical Forum / Diseases and Disorders / Tinnitus / September 2003
Perforated tympanic membrane
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Mike Preece - 12 Sep 2003 05:39 GMT Hi I hope someone can offer some me some advice. I had a prolonged case of otitis externa late last year. This was treated by my GP for several weeks by various drops - none of which proved effective. Eventually a swab was taken and I was referred to the ENT department at my local hospital. The swab showed a fungal infection. After a brief examination microsuction was performed. The doctor performing the microsuction was obviously doing it for the first time - under instruction from a colleague. During the microsuction he exclaimed "Hey! That was a big bit!". Afterwards I was given a prescription for Canesten (Clotrimazole?) drops - which I had used several times previously. On returning to my office I applied the drops. The pain this caused to my right ear was excruciating. I have never experienced pain like it - even though I had, as I said, used the same drops on many previous occasion without any discomfort what so ever. The same drops caused no discomfort to my left ear. I have been searching the net looking for something to back up what I now know - that Canesten drops are definitely innapropriate for perforated eardums - but haven't managed to turn anything up surprisingly?!?! Also, I began to notice that the my hearing had improved in my left ear since the microsuction had removed the debris but that my hearing in my right ear appeared to be no better. When I went back for the follow-up consultation I suggested that I believed my right ear-drum had been perforated during the microsuction. It was obvious to me by this time that this was the case, as when I blew my nose I was also now blowing my ear, and I had experienced for the first time that horrible feeling of water entering my middle ear while washing my hair. More microsuction was performed in order to provide an unobructed view of the ear drum but, as I was obviously not comfortable, this was not persevered with, and a pope wick was inserted instead. I was given an appointment to return to see a senior registrar. When my ear was again examined the rupture of my ear drum was confirmed. No discharge was evident from my middle ear. Being unhappy with the treatment I received I registered a complaint. It has now been almost nine months since my ear drum was perforated and more than seven since I registered the complaint. The person with whom I am corresponding regarding my complaint seems to be unresponsive and unhelpful. Where do I go from here? Mike. PS. I have recently had a middle-ear infection in the damaged ear and was mistakenly prescribed some VoSol drops. These caused exactly the same painful experience as the Canesten drops had - although they are just fine in my undamaged left ear.
terri231@knowspam.mam - 12 Sep 2003 11:50 GMT >Hi > [quoted text clipped - 55 lines] > same painful experience as the Canesten drops had - although they are > just fine in my undamaged left ear. I think anything introduced to the ear with the perforated eardrum is going to hurt.
Are you able to say where this is occurring. That might help with the suggestions about what recourse to try next. We have participants from all over the world and it isn't immediately clear if you are from the States or elsewhere.
Terri
http://pub219.ezboard.com/btinnitusactivismandsupport
Susanne Sourire - 12 Sep 2003 19:53 GMT > >Hi > > [quoted text clipped - 67 lines] > > http://pub219.ezboard.com/btinnitusactivismandsupport Mike
As a person with a long history of outer ear infections and complications I would sure say to NEVER EVER apply drops into the ear if the eardrum is perforated. Many of the eardrops available are ototoxic if they can travel to the middle ear etc. Sadly I'm not able to give you the info I would like to. It is on my own computer (I'm using my sons here) which is stuck in a moving van. I have a whole list of what NOT to use when having a perforated eardrum but can't give it to you now:-((((( Hope someone else here can kick in with info about ototoxity (spelling)
Hope you improve soon, Mike
Susanne
Jim Chinnis - 12 Sep 2003 20:31 GMT sagesseinfinie2002@yahoo.com (Susanne Sourire) wrote in part:
>I have a whole list of what NOT to use when having a perforated >eardrum but can't give it to you now:-((((( Hope someone else here can >kick in with info about ototoxity (spelling) I would really be opposed to anything at all without the careful review of a physician. Even some of the things that are supposedly safe may not be in the presence of a fungal or bacterial infection or other problem.
 Signature Jim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG
ENTconsult - 13 Sep 2003 04:13 GMT re Never put any drops in your ear if thiere is a perforation" There are plenty of non ototoxic drops available and this is an excellent form of treatment of middle ear infections. Sometimes we even deliberately perforate the drum in order to get the theraputic drops into the middle ear. Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
Susanne Sourire - 13 Sep 2003 17:44 GMT > re Never put any drops in your ear if thiere is a perforation" > There are plenty of non ototoxic drops available and this is an excellent form [quoted text clipped - 3 lines] > http://www.ent-consult.com > http://www.hydromedonline.com/presentingthehydropulse/ Sorry Murray Grossan if my post was misleading:-( Just bad personal experience of getting physicians (ENT's AND a surgeons) presciptions for drops etc to use (while my ear drum was perforated) only to later find out that this shouldn't have been done. One of the things prescribed and "performed" at hospital in huge quantities was applying Terracortril to my ear while my ear drum was perforated. I later learned that cortisone is NOT to be put into an ear with a perforated eardrum. It's even listed in the package (which I sadly didn't know back then). So my point is basically to be sure (ie by asking) if a prescribed eardrop really is safe.
I remember a few raised eyebrows by different specialists when they saw what I had been given right upon surgery, so in tend to rather ask a few questions too many than not ask at all.
Susanne
ENTconsult - 13 Sep 2003 18:55 GMT Yes, Suzanne. Today, it is very important that persons always use a singe pharmacist who knows you and your allergies. This is the best protection against "mistakes". My patient who is a college professor went to his pharmacist with a new prescription and the pharmacist realized that he was already taking a similar medication from another doctor. The two together would have been toxic. I always urge my patients to use a single pharmacist. They are equipped to pick up drug contraindications. Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
Susan Fein - 14 Sep 2003 18:50 GMT >My patient who is a college professor went to his pharmacist with a new >prescription and the pharmacist realized that he was already taking a similar >medication from another doctor. The two together would have been toxic. >I always urge my patients to use a single pharmacist. They are equipped to >pick >up drug contraindications. I also think no physician should write a prescription without asking the patient what else he/she is taking.
Susan
ENTconsult - 15 Sep 2003 00:24 GMT I also think no physician should write a prescription without asking the patient what else he/she is taking.
that is certainly true but patients forget, misunderstand or worse. My patient bled for 3 days and I kept repeatingly asking what he was taking. Finally his wife said he was taking Gingko. "But that's not a medication " he insisted. . The label says dietary summplement.
If you are takng more than one medication, I recommend having a single pharmacist who knows you. This has saved lives.
Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
terri231@knowspam.mam - 15 Sep 2003 01:10 GMT >I also think no physician should write a prescription without asking the >patient what else he/she is taking. [quoted text clipped - 8 lines] > >Murray Grossan, M.D. I have to agree with Murray on this one, although the Gingko wouldn't have shown up with the pharmacist. Establishing a relationship with a particular pharmacists has other benefits, including them taking the time to answer your questions about supplements and interactions and OC preparations because you are a repeat customer.
Terri
http://pub219.ezboard.com/btinnitusactivismandsupport
conlon doesn't want to work - 15 Sep 2003 00:51 GMT > x-no-archive: yes > [quoted text clipped - 7 lines] > I also think no physician should write a prescription without asking the > patient what else he/she is taking. that's brilliant.
Susan Fein - 15 Sep 2003 14:37 GMT >that's brilliant. Coupled with Murray's good advice to use a single pharmacist, it can save lives.
Susan
Stephen Nagler - 15 Sep 2003 14:56 GMT >x-no-archive: yes > [quoted text clipped - 4 lines] > >Susan Stephen Nagler - 15 Sep 2003 17:44 GMT Apologies.
I was reading the post and hit the wrong key.
But, FWIW, Susan's observations above in this thread are right on the mark, IMO.
smn
ENTconsult - 12 Sep 2003 16:16 GMT I suggest you make sure that the perforation is closed. Ask for an examination and a tympanogram. It is easy to close a TM perforation and dangerous to leave it open. Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
Martin - 13 Sep 2003 03:02 GMT >I suggest you make sure that the perforation is closed. Ask for an examination >and a tympanogram. It is easy to close a TM perforation and dangerous to leave >it open. That's good information, Murray. Thanks for posting it. Hopefully it helps the gentleman
>Murray Grossan, M.D. >http://www.ent-consult.com >http://www.hydromedonline.com/presentingthehydropulse/ Now, could you help me?
I'm interested in investigating any way to lessen my tinnitus levels. I have visited your site linked above and read about the Nasal Irrigator. Should I be purchasing it because it will reduce my tinnitus, or is this just an advertisement of some sort for an unrelated product that you might be profiting from? If the latter, I don't think that you should be advertizing the product on a tinnitus support group.
Thank you, Martin
ENTconsult - 13 Sep 2003 04:08 GMT "'m interested in investigating any way to lessen my tinnitus levels." Martin this is what you say but this is not what you do. Dozens of persons and recommenders have detailed that you amplify tinnitus when you spend 7/24 writing about it, taliking about it and think of nothing else including the world series. If you read the 20 suggestions of Australia group and DID some of their recommendatins you would stop reinforcing your T. If you did something besides insulting anyone who offered advice you would quit reinforcing your T. Until you stop your own reinforcing behaviour you will not lower or cure your T. But in addition to all that you do bodily harm to persons seeking assistance here. Your mind is so warped towards doing harm you come out with statements The AMA is against doctors trying to help patients. How come the major portion of the AMA budget goes to advising people on their health? How come the AMA prints and distributes free information on lip cancer and thyroid and hundreds of other diseases?
We see your type in our clinic. They are so wedded to their disease, it is their entire life and when offered a cure they reject it because then they have no life to live for.
I would guess that, if you do have Tinnitus, if you were offered a cure you would reject it, as you have all the suggesstions given here, because there would be this terrible emptyness that only coming here and getting noticed fills. Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
terri231@knowspam.mam - 13 Sep 2003 12:58 GMT >"'m interested in investigating any way to lessen my tinnitus levels." >Martin this is what you say but this is not what you do. Dozens of persons and [quoted text clipped - 26 lines] >http://www.ent-consult.com >http://www.hydromedonline.com/presentingthehydropulse/ But does the hydropulse help tinnitus or are you just listing it here to make a profit?
Terri http://pub219.ezboard.com/btinnitusactivismandsupport
ENTconsult - 13 Sep 2003 18:59 GMT and Teri too proves that any meaningful advice will fall on deaf ears of those who are wedded to their illness and chose to amplify it. Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
terri231@knowspam.mam - 13 Sep 2003 19:49 GMT >and Teri too proves that any meaningful advice will fall on deaf ears of those >who are wedded to their illness and chose to amplify it. >Murray Grossan, M.D. >http://www.ent-consult.com >http://www.hydromedonline.com/presentingthehydropulse/ I see that you remember I am deaf. Good for you.
Terri
http://pub219.ezboard.com/btinnitusactivismandsupport
Mike Russell - 13 Sep 2003 20:31 GMT > and Teri too proves that any meaningful advice will fall on deaf ears > of those who are wedded to their illness and chose to amplify it. > Murray Grossan, M.D. > http://www.ent-consult.com > http://www.hydromedonline.com/presentingthehydropulse/ This strikes me as very jaded advice that belies your other excellent contributions here.
Mike Russell
Martin - 14 Sep 2003 04:44 GMT >This strikes me as very jaded advice that belies your other excellent >contributions here. Mike, I can't get an answer from Murray. Why don't you ask why he advertises a nasal product on a tinnitus support board?
Martin Aquinas
ENTconsult - 14 Sep 2003 04:51 GMT This strikes me as very jaded advice that belies your other excellent contributions here No its not jaded. It is easy to see that certain persons are reinforcing their illness. If you have a crippled foot and speak about feet problems 7/24 your foot pain will seem worse. If you have a crippled foot and worry about the Dodgers your foot won't bother you as much. Tinnitus o the other hand is specifically a problem that lends itself to reinforcement. Why do I keep recommending the 20 steps of the Australian Tinnitus Society? They are all suggestions that lower the reinforcement askpect of Tinnitus. Basically this is part of the therapy I give my own patients - which works. these persons who are here 7/24 are reinforcing their tinnitus and certainly ignoring steps that could help them. Their insistance in proventing others from benefiting is part of their pathology. Murray Grossan, M.D. http://www.ent-consult.com http://www.hydromedonline.com/presentingthehydropulse/
Mike Russell - 14 Sep 2003 07:08 GMT >> This strikes me as very jaded advice that belies your other excellent >> contributions here
> No its not jaded. It is easy to see that certain persons are > reinforcing their illness. [quoted text clipped - 10 lines] > help them. Their insistance in proventing others from benefiting is > part of their pathology. Point taken.
> Murray Grossan, M.D. > http://www.ent-consult.com > http://www.hydromedonline.com/presentingthehydropulse/ Martin - 14 Sep 2003 19:47 GMT >these persons who are here 7/24 are >> reinforcing their tinnitus and certainly ignoring steps that could >> help them. Their insistance in proventing others from benefiting is >> part of their pathology. > >Point taken. I see no basis for his comments at ll nd I think he is hiding behind his "credentials" to level baseless insults.
Part of the pathology of any individual who is trying to get something out of other people could also be to assume a sanctimonious and condescending stance against those who try to show others what they are really doing.
Magicians use it too. It is called deflection. "Look somewhere else and you won't see what I am really doing."
Martin Aquinas
terri231@knowspam.mam - 14 Sep 2003 12:16 GMT >This strikes me as very jaded advice that belies your other excellent >contributions here >No its not jaded. It is easy to see that certain persons are reinforcing their >illness. What illness is that, Murray?
Terri http://pub219.ezboard.com/btinnitusactivismandsupport
Ian Cessant - 14 Sep 2003 18:32 GMT > >This strikes me as very jaded advice that belies your other excellent > >contributions here [quoted text clipped - 5 lines] > Terri > http://pub219.ezboard.com/btinnitusactivismandsupport hmmmm..... what could it be? Is it time to change the subject to ....NAGLER?
terri231@knowspam.mam - 14 Sep 2003 19:00 GMT >> >This strikes me as very jaded advice that belies your other excellent >> >contributions here [quoted text clipped - 8 lines] >hmmmm..... what could it be? >Is it time to change the subject to ....NAGLER? You only said that once. Have you had a breakthrough, Bruce, or are you developing carpal tunnel syndrome?
Terri http://pub219.ezboard.com/btinnitusactivismandsupport
Martin - 14 Sep 2003 19:47 GMT >What illness is that, Murray? I believe that Muzzy would call that the "I have no tolerance for shameless advertizer's disease." It is where people continue to try and talk someone out of advertizing on a support group. As the advertizer, he sees their acts as a disease, IMO.
He must think people are stupid.
Martin Einstein
conlon doesn't want to work - 15 Sep 2003 00:52 GMT > I believe that Muzzy would call that the "I have no tolerance for > shameless advertizer's disease." It is where people continue to try [quoted text clipped - 4 lines] > > Martin ICollectSSI Martin - 14 Sep 2003 19:47 GMT >Murray Grossan, M.D. >http://www.ent-consult.com >http://www.hydromedonline.com/presentingthehydropulse/ Muzzy, I'm begging for an answer. PLEASE!
I'm interested in investigating any way to lessen my tinnitus levels. I have visited your site linked above and read about the Nasal Irrigator. Should I be purchasing it because it will reduce my tinnitus, or is this just an advertisement of some sort for an unrelated product that you might be profiting from? If the latter, I don't think that you should be advertizing the product on a tinnitus support group.
Thank you, Martin
Martin - 14 Sep 2003 04:44 GMT >Murray Grossan, M.D. >http://www.ent-consult.com >http://www.hydromedonline.com/presentingthehydropulse/ Dear Dr. Grossan,
I'm interested in investigating any way to lessen my tinnitus levels. I have visited your site linked above and read about the Nasal Irrigator. Should I be purchasing it because it will reduce my tinnitus, or is this just an advertisement of some sort for an unrelated product that you might be profiting from? If the latter, I don't think that you should be advertizing the product on a tinnitus support group.
Thank you, Martin
Martin - 13 Sep 2003 19:28 GMT >Murray Grossan, M.D. >http://www.ent-consult.com >http://www.hydromedonline.com/presentingthehydropulse/ Murray, please address my question before I spend my money.
I'm interested in investigating any way to lessen my tinnitus levels. I have visited your site linked above and read about the Nasal Irrigator. Should I be purchasing it because it will reduce my tinnitus, or is this just an advertisement of some sort for an unrelated product that you might be profiting from? If the latter, I don't think that you should be advertizing the product on a tinnitus support group.
Thank you, Martin
Jim Chinnis - 12 Sep 2003 20:29 GMT michael@preece.net (Mike Preece) wrote in part:
> PS. I have recently had a middle-ear infection in the damaged ear and > was mistakenly prescribed some VoSol drops. These caused exactly the > same painful experience as the Canesten drops had - although they are > just fine in my undamaged left ear. This is probably evidence that your eardrum has not healed and is still open. This is dangerous and can lead to a whole range of serious problems. It needs to be closed by a surgeon.
It's also possible that you have developed some hypersensitivity to components of all the drops that were tried. But, in any case, nothing at all should be used as an ear drop without the authorization of a (competent) physician who is fully informed of your situation.
 Signature Jim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG
Oregon7 - 16 Sep 2003 22:07 GMT I believe quite a few of those 'drops' do produce permanent hearing loss, if they can enter the middle ear space and soak into the inner ear through the two small openings in the skull there: the oval and the round windows.
When given orally, the amount of medication that is delivered to the inner ear is quite small as the fluid there is like cerebrospinal fluid, clear, and not blood filled. This means that the amount of medication that can enter this fluid, which doesn't replace itself very rapidly, is quite small, and therefore the harm to the delicate hair cells is minimalized.
However, when you allow the full med to soak in through the thin membranes of the round window, and soak around the base of the stapes bone, which sits in the oval window, then you can actually achieve a much much higher level into this fluid.
You should really have an audiology exam including tympanometry to rule out any perforations BEFORE prescribing or using antibiotic eardrops.
MJ
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