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Abstract: This patient is a 25-year-old man who reported recurrent running water and pus in both ears for 19 years, hearing loss, persistent tinnitus, and occasional headache and dizziness. 10 years ago, he underwent surgery on his left ear, but his condition did not resolve, so he sought treatment in our department. He was diagnosed with middle ear cholesteatoma (double), acquired external auditory canal stenosis (left), and postoperative cleft lip and palate after completion of otoscopy and CT of temporal bone. He was given medication + surgery. After the surgery, the symptoms of pus flow and headache in the left ear were relieved, and his hearing improved, and he was treated well.
[Basic information] Male, 25 years old
Type of disease】Cholesteatoma of middle ear (double), acquired external auditory canal stenosis (left), postoperative cleft lip and palate
Hospital】Qilu Hospital of Shandong University
Date of Consultation】March 2022
【Treatment plan】Surgical treatment (left ear mastoid modified radical treatment + external otolaryngoplasty) + medication (cefradine capsule, oxyfloxacin ear drops)
Treatment period】6 days of inpatient treatment, regular outpatient review within 6 months
Effectiveness of treatment】The symptoms of pus flow and headache in the left ear were relieved, and the hearing was improved.
I. Initial consultation
Patient’s description: For 19 years, both ears had repeatedly runny pus with thick pus and foul odor, accompanied by hearing loss, tinnitus, a persistent cicada sound, occasional headache and dizziness. 10 years ago, the left ear was treated with surgery, but the condition did not subside, so he was seen in our department. Otoscopic examination showed that the left external auditory canal was narrowed and the tympanic membrane was not accessible. CT of the temporal bone considered bilateral middle ear cholesteatoma formation. The patient had a history of cleft lip and palate surgery, and the initial diagnosis was: middle ear cholesteatoma (bilateral), acquired external auditory canal stenosis (left), and post-operative cleft lip and palate. Hospitalization was required for surgical treatment to clear the cholesteatomas and prevent progression of the disease.
(Otoscopy)
(CT of temporal bone)
II. Treatment history
The patient’s diagnosis of middle ear cholesteatoma was clear. The patient’s preoperative examination showed that the hearing in the left ear was worse than that in the right ear, and there was external auditory canal stenosis, so we decided to treat the left ear first after communicating with the patient. The cholesteatoma was not involved in the tympanic chamber, so the epithelium of the cholesteatoma was completely removed, the surgical cavity was contoured, and the external auditory canal was enlarged and filled with iodoform. Postoperative pressure dressing and cefradin capsules were used for anti-infection treatment, and the patient was discharged after 3 days with medication change and regular outpatient review. The gauze was extracted at 3 weeks and antibiotic ear drops (ofloxacin ear drops) were administered.
III. Treatment effect
The patient was discharged from the hospital after 6 days of hospitalization following a modified radical treatment of the left ear mastoid + external otolaryngoplasty, with regular outpatient medication changes and review. Three weeks after the operation, the intra-ear ooze was gradually reduced after the iodoform gauze was extracted and the oxyfloxacin ear drops were given. Three months after the operation, on review, the operative cavity was spacious, without stenosis, with good epithelialization and no flowing pus in the ear. He requested elective surgery to treat the right middle ear cholesteatoma. In conclusion, the symptoms of pus flowing from the left ear and headache were relieved, the hearing improved, and the treatment effect was good, and the patient expressed satisfaction with the treatment effect.
IV. Notes
We are glad that after the treatment, the patient’s pus flow and headache in the left ear have been relieved and his hearing has improved. After being discharged from the hospital, pay attention to your daily diet, prohibit the consumption of spicy and stimulating foods, do not smoke and drink alcohol, and eat more vegetables and fruits. In life, avoid getting water in the external ear canal. Prevent colds, avoid blowing nose, keep the nasal cavity unobstructed to prevent infection. 3 weeks after surgery, draw iodoform to take gauze, need to use oxyfloxacin ear drops, observe the process of epithelialization of the surgical cavity, review every 2-3 weeks, timely clean up the surgical cavity secretions and scabs to prevent infection and promote epithelialization. After 2-3 months of surgery, the cavity will be completely epithelialized and the ear will be dry.
V. Personal insight
Patients with cleft lip and palate are prone to eustachian tube dysfunction due to anatomical abnormalities of the palatopharyngeal muscles, which can cause middle ear diseases, such as middle ear cholesteatoma or secretory otitis media, as in the patient in this case, because it is difficult to restore the function of the eustachian tube, resulting in negative pressure in the middle ear and inversion of the eardrum, thus affecting hearing reconstruction. Therefore, patients with cleft lip and palate should be examined regularly, and for patients with combined middle ear cholesteatoma, timely intervention and surgery should be performed to avoid progression of the disease, and for those with middle ear effusion, tympanotomy should be performed at the same time or as early as possible.