Based on a true story.
Allysa is otherwise a healthy 5 year old girl. Poor girl, she had an episode of upper respiratory tract infection (URTI) 2 weeks ago: runny nose, fever then cough. She was recovering rather well, but later noted having left ear pain 4 days ago.
The pain got increasingly worse and 2 days ago became unbearable. She had spiking fever as well. She was screaming in pain late last night in bed. Poor girl.
Just when she was about to go to hospital, the mother noted the left ear had yellowish discharge flowing out, mixed with blood. Surprisingly, the pain and fever is gone. The doctor noted that the ear drum has a hole in it.
What happened?
Allysa had an episode of acute otitis media. It usually starts with a URTI (upper respiratory tract infection). The infection spread from the nose into the ear. This is possible because the nose and ear is connected via Eustachian tube.
Image 1: appearence of normal ear drum on endoscopic view
The infection builds up in the middle ear (the space behind the ear drum) This gives rise to ear pain, reduced hearing and fever. The fluid behind the ear drum may turn to pus. This will cause severe ear pain and spiking fever as in Allysa’s case.
Why did the pain and fever disappear after there was discharge and blood noted in the ear?
The pus behind the ear drum causes pressure on the ear drum. If the immune system fail to control the infection or antibiotic treatment is delayed, the ear drum ruptures. Once there is a hole, the pus and blood will flow out from behind the ear drum and into the ear canal.
Since there is no more pus build up, the fever and pain will relief by itself.
Image 2: the eardrum is ruptured with mucus in the ear canal
What do I do about the hole in the ear drum?
If it is a small hole, dry, no infection there after- there is a chance that the hole will close. Children tend to have the perforation close early due to their rapid rate of healing.
Most important is to keep the ear dry. When taking shower, please cover the ear canal with a small piece of cotton ball dipped in oil which is non irritant to the skin (baby oil is one of the recommendation) Some of the patients claim this method is much better than using the swimming ear plugs.
Image 3
step 1 take a cotton ball
step 2 tear it into a small size ball to fit just outside the ear canal
Step 3 soak it with a bit of oil
Image 4 place the oil soaked cotton ball just outside the ear canal when taking a shower
Remember not to use cotton buds. This was already explained in length previously in this article (https://www.mmgazette.com/to-
When having future upper respiratory tract infection or other conditions leading to runny nose, please take antihistamine early. This will reduce nasal mucous and reduce ear discharge subsequently.
It has been almost a year, there is still a hole in the ear drum. Can anything be done?
You need to consult an ENT doctor. If the ear is persistently dry after certain period, the doctor will recommend you for surgery. Myringoplasty is a surgery to patch a graft on the ear drum. The surgery is mainly to prevent further ear infection rather than for improvement in hearing, but usually done for adults.
(Acknowledgement: I would like to thank the patients and parents again for allowing the use of their pictures for the benefit of public health education)
Dr Ahmad Nordin is an ENT surgeon currently working in Sabah. Find out more about him on The Team page.
The Malay version of this article can be found at https://www.mmgazette.com/otitis-media-apa-yang-perlu-dibuat-untuk-gegendang-telinga-berlubang-dr-ahmad-nordin/
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
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