Retracted eardrum

[Jeung]

My son is 10 years old and has always had problems with his ears. He has had multiple PE tube placement, one was did not fall out on its own and along with repeat infections has left a large hole in his left eardrum since age 2. The right ear was just examined by our ENT  who found it to be severely retracted. He seemed very concerned with this and its potential for causing hearing loss and even a cholesteatoma. This is the first time I have heard him mention this eardrum retracting. He is examined about every 6 months. He is asked that I follow up in 5 to 6 months.  I may have encouraged this waiting period by questioning how this ear has been reported to look good certain times of the year and be full of fluid other times of the year.
My questions are, should I wait to place a PE tube in this ear, are there alternative treatments and what time frame would hearing loss or a cholesteatoma develop if they do?
Thank you for your input.
Charla

[Emilio44]

As a nurse audiometrist in a previous life and a parent of a 3 children, one who in particular suffered many perforations, otitis media with effusion and eustachian tube dysfunction.  Can I say that your child will likely grow out of all these problems onces he reaches pubity.  You didn't mention any hearing loss so I am assuming it is fluctuating conductive (middle ear) hearing loss from ranging normal/mild/moderate depending on infection status.  How is he going in school?  If there is no hearing loss associated with the perforated ear, I wouldn't worry about it too much at this stage as it can be fixed via a simple operation called a tympanoplasty (that's what it's called in Australia at least).  Essentially the ENT will graft a new piece onto the eardrum and the remaining eardrum should grow over the grafted piece. The effectiveness of this operation is dependant on how large the perforation (hole) is and how much tympanic membrane (eardrum)  is left.  Anyway for now your son has natures own grommet (PE tube) and probably a little more suseptible to infection but I have managed many children that do okay with a perforation until it grows back or is operated on.   As Eric has mention previously it sounds likely that your son is suffering from Eustachian Tube Dysfunction (ETD).  Once the Eustachian tube (tube from nose to ear) blocks it creates a negative pressure in the middle ear cavity, this is sort of like a vacuum effect in the middle ear, hence the eardrum retracting inward.  Is your son sometimes nasally and a mouth breather? The trick with ETD is Eustachian tube stimulation to unblock the tube, however it is likely to clear on its own.  Ordinarily nose blowing, eating cruchy type foods, even chewing gum can assist in this stimulation.  I would hold off on the nose blowing until you get the okay from your ENT, due to the perforation in the left ear, you don't want to do any futher damage to the eardrum.  Anyway it all sounds messy and worrying for you, but hang in there, it should begin to get better soon.  All the best. Emilio

[Eric P Wilkinson, MD]

It sounds like your son has chronic Eustachian tube dysfunction.  There is no good evidence that PE tubes will prevent cholesteatoma in the long term.  If the eardrum is retracted but "safe" (meaning that there is no buildup of skin or suspicion of cholesteatoma) and the hearing is fairly good, the ear could probably be observed.  If there is significant conductive hearing loss or there is an unsafe condition, then surgery may be necessary.

Hope this helps.  Good luck!

You may want to see an ENT physician and have a full exam and balance testing to determine the cause of your dizziness.  It doesn't necessarily sound like it's from the inner ear, though.  Testing can determine if this is the case.  They can also decide if you need imaging of your brain.

Hope this helps.  Good luck!

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