Ear drainage and blocked ears can occur due to several causes. Commonly it can occur with impacted ear wax or ear infections. These include external ear infections (otitis externa) or middle ear infections (otitis media and Chronic suppurative otitis media).
Otitis Externa (External Ear Canal Infections) usually present with pain and discharge from the ear canal. The ear may feel blocked constantly and hearing is often decreased as well. There may be an associated fever in young children but oftentimes adults do not have a fever. The external ear may also appear red and scaly at the opening of the ear canal. These infections are mostly caused by bacteria. However, in quite a few individuals, the infection is caused by special fungi. The treatment of Otitis Externa involves primarily the use of topical antibiotic and antifungal ear drops. This helps to coat the entire ear canal with the medicines to kill the bacteria and fungi. A family general practicioner may also sometimes prescribe a course of oral antibiotics. A visit to the ENT surgeon allows the debris and infected material in the ear canal to be thoroughly cleaned. This aids the delivery of the topical ear drops and speeds up the treatment of the infection. This toilet or cleaning of the ear canal may have to be performed regularly in the first few weeks. The ear should be kept dry during this time, with attention paid to preventing water from entering the ear during showers and avoiding swimming.
These infections if treated early, are often self limiting over a few weeks. In selected individuals, particularly those who have poorly controlled Diabetes Mellitus or who have impaired immunity, these infections may be very hard to treat and may involve the bones of the ear canal and skull base, in a condition called Malignant Otitis Externa. This is a potentially life threatening condition and requires aggressive treatment with intravenous antibiotics. If your external ear canal infection does not resolve within a few weeks, seek an early consultation with an ENT specialist who will be able to diagnose and treat you.
Otitis Media is an infection of the middle ear space. This is often the result of an ascending infection from the upper respiratory tract, where bacteria travels up the Eustachian tube opening, located at the back of the nose, up the tube into the middle ear space. This often leads to a sensation of a blocked ear, pain in the ears and occasionally discharge from the ears. It often happens after an upper respiratory tract infection (“cold” or “flu”).
Otitis media is usually painless. It often presents with blocked sensation and may affect hearing.
Treatment of Otitis Media involves a course of oral antibiotics. Nasal decongestants may also be used to relieve nasal obstruction. These infections usually resolve within a few weeks.
However, the fluid behind the ear drum may remain. If it is persistent the fluid is often drained by means of a simple procedure called a myringotomy and grommet tube insertion, where a small cut is made on the ear drum under an operating microscope and a small tube inserted to allow the fluid to drain out through the ear canal.
In another group of patients, there may be a hole in the ear drum caused by previous Otitis Media infections. If this hole does not heal spontaneously, then there will also be a route of entry of bacteria into the middle ear space through the external ear canal. This is particularly common during a swim or when water enters the ear canal after a shower. This predisposes to an infection of the middle ear space and these patients will have discharge of infected fluid from the ear canal. Treatment involves the use of topical antibiotic ear drops and oral antibiotics. This infection situation is called Chronic Suppurative Otitis Media. If repeated many times, it may further damage the small bones of hearing. A surgical procedure called myringoplasty or tympanoplasty can be performed to repair the hole in the ear drum.
The human ear is designed to be self-cleaning, where ear wax (also called cerumen) migrates out of the external ear canal and onto the skin of the external ear (pinna). However, in certain circumstances, ear wax does not clear and instead accumulates in the ear canal. This occurs more frequently when the external ear canal is crooked, or where it is narrow, in which case the wax does not migrate out of the ear canal easily. This also occurs when the ear wax is particularly hard and dry and builds up rapidly. When ear wax is unable to migrate out, it tends to become impacted in the external ear canal.
Impacted Ear wax is one of the most common causes of decreased hearing. This can develop suddenly in the case of sudden expansion of the ear wax after a swim for instance. The hearing loss can also develop slowly over several months where the ear wax slowly builds up in the external ear canal and completely occludes it.
There are several ways to remove ear wax. Some commercial preparations of wax softeners can be used. However this should be used with caution among children with known allergies.
If wax softening agents fail, you should seek professional help. An Ear, Nose and Throat (ENT) Surgeon will directly visualize the external ear canal with a microscope in the clinic while removing the ear wax with suction apparatus or various microscopic instruments. As the surgeon is able to see the ear canal during the procedure, accidental damage to the ear drum and external ear canal can be avoided. At the same time, the ear canal and ear drum can be carefully inspected under a microscope.