Treating serious, chronic, ear infections and preventing their return requires a thorough and systematic approach. We need to know what is causing the infection and what medicines will be most effective in treating it. While a “Culture and Sensitivity” test reveals what is causing the problem and what the organism is susceptible to, this requires special interpretation when it comes to ear disease. “Sensitivity” tests tell us at what “blood level” concentration a certain drug will work. Fortunately, we can achieve much higher concentrations of antibiotics than those reached in the bloodstream in topical medications we prepare to use in the ear canal and bulla. Not all antibiotics can be used inside an ear canal. In fact, some antibiotics commonly found in “ready made” ear preparations are “oto-toxic” and can cause deafness if the ear drum is ruptured. With this in mind, successful treatment usually includes the following:
- Complete and thorough physical exam including appropriate lab work.
- Cytology (a slide is made and stained and examined under the microscope to identify yeast, bacteria, or parasites)
- Culture and Sensitivity (for chronic infections it is critical to accurately identify the organisms responsible and to determine the most effective drugs available to treat the infection). Certain bacteria (Gram negative) require an alkaline environment for antibiotics to work while yeast are killed in acidic environments.
- General anesthesia and oto-endoscopic irrigation of the outer and middle ear (if involved). Total removal of all infected material and wax from the canal and bulla is critical. Applying medication on top of thick wax and pus is usually ineffective. Medications need to be in contact with the tissue in order to work.