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Abstract: The majority of hearing impairments are associated with broken auditory chains, damage to the auditory nerve, secretory otitis media, and perforation of the eardrum. The patient in this case complained of intermittent running water and hearing loss in both ears for 5 years, and was diagnosed with bilateral eardrum perforation, bilateral conductive deafness, and bilateral chronic otitis media. Due to the more severe condition in the left ear, the left eardrum repair surgery under general anesthesia otoscopy was required, and the patient felt a significant improvement in hearing after the surgery, and it was recommended that the right eardrum repair surgery be performed six months later.
Basic information
Basic information】Female, 36 years old
Disease Type】Double eardrum perforation, bilateral chronic otitis media, hearing impairment
Hospital】Henan Provincial People’s Hospital
Date of Consultation】April 2022
Treatment plan】Surgical treatment (left eardrum repair surgery) + medication (intravenous cefuroxime, oral cefixime)
Treatment period】7 days of inpatient treatment, 2 weeks of outpatient follow-up
Results】No perforation of the eardrum and improved hearing
I. Initial consultation
Five years ago, the patient had water flowing in both ears due to cold, and was examined for eardrum perforation and hearing loss. However, in the future, water flowed in both ears and hearing loss would occur after the resistance to water in the ears, cold and flu, and so on, and the symptoms were relieved after medication. In the past six months, there was no water flowing in both ears, so she came to the clinic today and asked for treatment. An otoscopic examination and pure tone hearing examination were done in the clinic, suggesting bilateral eardrum perforation and bilateral conductive deafness, and a CT of the temporal bone suggested bilateral chronic otitis media, and the patient was told that surgery was needed.
II. Treatment history
However, since both eardrums were perforated and the left side was more serious, it was decided to do the heavier left eardrum first and then perform the right eardrum repair after the left side had returned to normal, i.e. six months later. Under general anesthesia, the temporalis fascia was taken as the graft membrane and operated under otoscopy to clean the granulation tissue in the middle ear cavity, and after laying the membrane the eardrum was intact and fixed with a filling. After surgery, anti-inflammatory drugs (cefuroxime) were given intravenously to combat the infection.
III. Treatment effect
Through the endoscopic repair of the left eardrum under general anesthesia and postoperative cefuroxime anti-infection treatment, the patient felt that his hearing improved after 3 days, and there were no postoperative complications or comorbidities. The patient was discharged from the hospital after 7 days of hospitalization. The patient was advised to take oral cefixime to prevent infection and consolidate the therapeutic effect after discharge, and was followed up in the outpatient clinic for 2 weeks.
At the follow-up, the patient’s graft membrane was dry and intact, the eardrum was not perforated, and he felt that his hearing had improved compared with the preoperative period, so he could consider the right eardrum repair surgery after six months.
IV. Notes
We are glad that the patient has no perforation of the eardrum and improved hearing after treatment, but the following points should be noted.
1. After discharge, the patient should continue to take oral cefixime for 1 week to consolidate the efficacy, and also ensure regular work and rest, avoid emotional excitement, water and noise to prevent disease recurrence, and do regular review.
2, because the patient is a long-term chronic inflammation caused by the perforation of the eardrum, and the hearing loss caused by the hearing chain is not damaged, so after the eardrum repair will improve the airway, improve hearing.
3.It is recommended that the patient wait for six months for dry ear after the inflammation is controlled, and then perform endoscopic eardrum repair, which will improve hearing after the eardrum repair.
4. Patients are advised to avoid spicy and irritating food in their daily life and maintain a light diet to help the inflammation eliminate and the condition recover.
V. Personal insight
In daily life, we should pay attention to good ear protection, avoid long time in the noise environment, and pay attention to early treatment of diseases that may cause hearing impairment, such as hypertension, diabetes, etc. In addition, we should avoid the application of ototoxic drugs to achieve early prevention of hearing impairment.
For hearing impairment caused by any reason, early diagnosis is the direct cause of the treatment effect. In this case, the patient had mild hearing loss caused by long-term chronic inflammation and perforation of the eardrum in both ears. Because of timely consultation, timely improvement of various examinations after admission, and standardized medication treatment, postoperative consolidation treatment in accordance with medical advice, regular review, regular and quantitative medication, so the treatment effect is ideal.