When the patient has large hole in the ear drum, this is unlikely to close by medicines and injections.
It will require an operation to close it. If The hole in the drum is not closed by operation, even though medicines and injections may temporarily stop the discharge, the hole will remain open, so that every time you get dirty water into the ear or develop a cold, the discharge is likely to recur.
Recurrent infections cause progressive deafness due to fixation (tympanosclerosis or destruction of the ossicular chain).
It is necessary to clear the underlying infection in the mastoid, correct ossicular defects and close the hole in the drum in order to restore hearing and prevent recurrent ear discharge, by a special operation known as Tympanoplasty. The operation is performed under local anaesthesia (except in children), so the hearing can be checked on the operation table. You will be required to stay 12 hours in hospital, A small 0.5 cm. endaural incision is used with no external stitches so the patient may leave Mumbai the next day by train. No air travel for 6 weeks; no bus travel for 4 days.
Do not use drops if there is no discharge as severe deafness due to inner ear damage can occur.
Keep the ear constantly plugged by a large clean cotton wool ball (a small plug should not be used as it likely to fall inside) which should be changed 3 times daily. This is to prevent dirt, soap water etc. from entering.
Do not blow the nose during a cold prevent infection from nose being forced up into the ear.
Cotton Ball Day & Night.
Every time dirty water goes into an ear with a hole in the drum, it will go straight through the hole in the drum into the middle ear and set up infection. (Note is this connection that though syringing a dry uninfected ear with a dry perforation is contra-indicated syringing an infected discharging ear with a wet perforation is not contraindicated and is one of the most efficient ways of removing the pus.) Operative closure of the perforation prevents recurrence of discharge from this cause. Every time a patient with a perforated drum develops a cold and blows his nose, there is through and through passage of a stream of air with pus from the nose up the Eustachean Tube into the ear with recurrence of ear discharged. After operative closure of the perforation, this through and through passage of a stream of air is stopped. When the patient blows his nose , a little air may go up Eustachean Tube , but this cannot pass out through a hole in the drum, as there is a build-up of air pressure in the middle ear which prevents more air from passing into the ear, so there is no stream of air to carry pus from the nose into ear.
Consulting Otorhinolaryngologist (E.N.T). Dr. Harish Nanda graduated in 1998 from Dayanand Medical College, Ludhiana. Since then he has worked under some of the top specialists in his field, which include fellowships under Dr. Heine Stamburger from Austria and senior residencies at Batra Cancer Research Institute Delhi and Oswal Hospital Ludhiana. He worked in Guru Nanak Mission Charitable Hospital Jalandhar, garnering a reputation for being one of the best head and neck surgeons in northern India. The hospital has had the pleasure of having him for more than a decade.