Expert: Harriet B Jacobster, Au.D. - 2/27/2009

Question
Hello and thank you so much for volunteering your time.

My son is 39 years old and has a history of allergies (animal dander and peanuts). He is currently fighting an ear infection and is on his third course of antibiotics. The pain has gone but his ear is ringing. My question is how concerned should we be that this will develop into something that will migrate to another area and what signs would we see if it were to do so.

Thank you again.

Kari

Answer
Hi Karin,
May I ask...is your son being treated by an ear specialist?  Many times a general physician will see fluid and mistake this for an "infection."  In such cases, the use of antibiotics will not help. So, if you have not yet consulted an ENT, you must do so. The main cause of build-up of fluid is a dysfunction in the Eustachian Tube (ET) - a tube that passes from the middle ear to the nose and is responsible for maintaining normal pressure in the middle ear.  It is not unusual for this tube to dysfunction in people with history of allergies. This tube opens and closes regularly - it is the pop that you feel when you yawn. If this tube remains closed, that's when fluid starts to build up in the middle ear.  If this fluid remains too long, bacteria start to grow.  So, to get back to my point, antibiotics will clear up the infection, but not the fluid. If there is fluid in the middle ear and it does not resolve within a reasonable time (and three courses of antibiotics seems more than reasonable), an ENT will try several options to get rid of the fluid.  First he may try steroid nasal sprays that will shrink the membranes and hopefully open the Eustachian tube.  If this does not work, then he will place a small tube into the ear drum that will replace the dysfunctional ET. The ENT will also drain the fluid at this time. If the ET problem is not corrected and the fluid is allowed to remain, it can erode the little bones of the middle ear as well as burst the eardrum.  If this happens, surgery may be needed to repair the damage. In severe cases, the fluid can invade the mastoid bone, which is the bony bump right below the ear, and can spread to other parts of the head and neck. If this happens, the area behind his ear may become red, swollen and painful.

Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology