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Medical Forum / Diseases and Disorders / Tinnitus / September 2003

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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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