The Medical Consumer's Advocate

Chronic otitis externa and "small ear canals";meatoplasty

Q: My mother has been troubled by eczema in her ears for the last few years. The fungus currently in her ears is known as Pseudomonas. The problem: her ear canals are too small, so they never get dry, always staying moist. She has been treated with antibiotics and cortisone and is currently being treated with selicae, which is a homeopathic medication. The doctor says the only solution is to operate and to remove the cartilage in the ear, making the ear canal bigger so that air can flow through the canal, making it dry, and clearing up the moistness, causing the eczema or fungus. Will this procedure help clear up the eczema, and is there not another way?

A: Pseudomonas is not a fungus; it is a water-loving bacteria that thrives in moist places, like the human ear canal. However, many fungi love damp, warm environments (such as Aspergillus, better known as bread mold), so she may well have had fungal infections in the past.

My approach to such patients is, first, to clean their ear canals as thoroughly as possible and to get them on an appropriate antibiotic or antifungal ear drop. Just as quickly, I try to get them OFF THE DROPS, since (being wet, of course) they contribute to the problem to some degree. It is critical that the patient avoids getting any other water in the ear canal. An inexpensive and very effective ear plug can be made by rubbing petroleum jelly (Vaseline) into a hunk of cotton.

Once the immediate infection resolves (usually after one or two weeks), I stop the drops and tell the patient to continue to keep her ears DRY. This may be all that your mother needs to do. On the other hand, if she continues to have infections despite following this advice, she may indeed need an operation.

I doubt that her canals are narrow; if so, she would have had these problems for most of her life, not just for the last few years. It is much more probable that the opening to the ear canal, also known as the meatus, is "collapsing." Ear cartilage continues to grow throughout our lives. If the cartilage immediately in front of the meatus (the conchal cartilage, which means "shell cartilage") gets too large, it can partially occlude the meatus. This leads to the problems you have described, as well as wax impaction and hearing loss.

The operation to correct this condition is called a meatoplasty. Your mother should ask her doctor if this is what he is planning to do. Meatoplasty can be performed with conscious sedation (she will be awake during the operation, but the anesthesiologist will give her drugs so that she will not feel pain and not recall the operation later.) It can also be performed in the office under local anesthesia. I prefer the former method for my patients. In a meatoplasty, an incision is made immediately behind the meatus, and a portion of the conchal cartilage is excised. This is an oversimplification, of course, but the net result is a meatus that remains open and does not "collapse." There is better air circulation through the canal, so the canal is less humid, and thus less prone to bacterial and fungal infection. This is an excellent procedure for patients with collapsing meatuses who do not respond to the simple measures outlined in the preceding paragraphs.

 

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