Ignore, self-treat middle ear problems at your peril

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Nguyen Thi Phuong was rushed to a hospital in Ho Chi Minh City in January unconscious, having suffered a brain hemorrhage, and one side of her body was paralyzed.

It was a week before the reason for such a serious problem became clear. She had suffered from inflammation to her middle ear.

She was discharged from the hospital after more than three weeks, during which two operations were conducted one to release bleeding in her skull caused by blocked veins in the brain, and another to treat the ear condition. Her life was saved but she is still paralyzed.

Doctors say that what seems like a mild condition, known technically as otitis media, has caused many people to go deaf and even suffer fatal brain inflammation because the need for urgent treatment is not realized.

Phuong's family said she had suffered fever and headache for three days before she went to a small hospital which diagnosed her with vestibular disorder. But despite the medication, half of her body grew weaker and then she went into a coma. 

Pham Anh Tuan, a neurologist from the Nguyen Tri Phuong Hospital where she was treated, said Phuong's was a rare severe case that they had managed to save.

"Normally, the pus from the infected ear will flow outward. But with Phuong, the swelling blocked the middle ear and the pus was not released and caused complications inside the skull," Tuan said.

He said the complications can include encephalitis and brain abscess. Hearing impairment is a more common problem.

Doctors say middle ear inflammation is the second most common infection that children suffer in Vietnam, after respiratory inflammation; and that this also afflicts many adults. 

It can be caused by direct exposure of the ears to infected environment, or the infection of the nasal and throat areas due to polluted air like tobacco smoke, or cold weather.

People need to get themselves examined if their hearing weakens and there is pain and fluid discharge from the ears. Some patients develop fever, dizziness, loss of appetite and have difficulty sleeping.

Tuan said people with symptoms of middle ear inflammation tend to prescribe and consume some medicine on their own, but warned this could end up having serious consequences.

Some people also make it worse for themselves by using Q-tips to cure the itches, which will only tear the ear more and possibly push any earwax as well as bacterial organisms further inward, he said.

Tuan said his colleagues from the city ENT (Ear, Nose and Throat) Hospital have had to treat many people who started with having slight middle ear inflammation but made it worse with excessive use of Q-tips or hook-shaped ear picks.

Ngoc Lan of the city's Binh Thanh District only went to the hospital when she could not hear anymore, after going through various ear problems.

Lan first felt regular pains in her right ear and buzzing sounds. She thought that was earwax and used an iron hook-shaped pick every day to clean her ear.

The ear released fluid after sometime, and Lan gave herself some antibiotics and eardrops, which gave her no comfort. Instead, her face started to get swollen and she began having a temperature of over 39 degrees Celsius.

Doctors at the city ENT Hospital said Lan's condition was not discovered and treated early, so the hearing loss was permanent.

Tuan said people can protect themselves by treating early risky conditions such as nasal and throat inflammation including tonsillitis, which is inflammation of the tonsils of the mouth, or sinusitis which is the inflammation of the cavity filled with air in the bones of the face and skull.

He said people can manually check for ear blockage using the Valsava maneuver, a moderately forceful exhalation used to clear the ears and sinuses or also as a test of cardiac function.

The maneuver is practiced by closing the mouth, pinching the nose shut and pressing out as if blowing up a balloon.

No air being heard hitting the eardrum means there is blockage in the ear tube, which is inserted into the eardrum to keep the middle ear exposed to air, Tuan said.

He said people can also get themselves vaccinated against Pneumococcus, a significant human pathogenic bacterium that causes many types of infections including otitis media, acute sinusitis, meningitis, septic arthritis, endocarditis (inflammation of membrane of heart), peritonitis (inflammation of abdomen lining), cellulitis (inflammation of tissues beneath skin), and brain abscess.

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