Question: Dear Doctor,

I am a 39-year-old male. I have had recurring ear problems, in the right ear only, for several years and would be grateful for a second opinion on a course of antibiotic ear drops. I am a type 1 diabetic with excellent control. I take insulin injections 4x daily and Rampril 250mg 1x daily.

I had glue ear in both ears as a child and had grommits and/or t-tube operations on 4-5 occasions. From ages 10-12 I needed a hearing aid in the right ear only, but these problems went away again from ages 12-35.

Around four years ago I had a painful ear infection which was treated with ear drops (I forget which) but after it resolved I began to experience painless, foul-smelling discharges of watery pus, usually once per day when lying down for bed in the evening. It kept flaring up and easing again for a long time, so I often thought it would go away on its own. After a while I noticed some hearing loss and attended a hearing aid consultation with an audiologist. The audiologist told me I had otitis media and they would not be able to fit a hearing aid until this resolved.

The GP prescribed a course of oral antibiotics, and these reduced the discharge to almost nothing but after some time it returned again, milder than before. A prescribing nurse then took a sample to test for candida which came back negative, followed by another sample which showed pseudonomas.

In October 2020 I had a second external ear infection and was prescribed Cilodex ear drops (5 drops twice daily). On the third time I used them I experienced a facial spasm while the drops were inside the ear, I wiped the drops out and discontinued treatment. Since this I have been experiencing resting tremors in the sides of the arms and legs and body, shooting pains in the heels, pain inside the head when I lie on the right side, and slurred speech that starts when I say the letter "L". The ear infection seemed to resolve though and was okay until February 2021.

For the last two weeks I have had another external ear infection, which has been diagnosed as otitis externa by an ENT consultant and drained by microsuction. He said that the infection is impacted and will take a long time to treat. The consultant has referred me to a neurologist, and for the ears recommended Ciprodex ear drops, but I was unwilling to take them again so he has prescribed Clioquinol Flumetasone ear drops.

I am scared in case these drops have any potential for neurological side effects, and have lots of things I want to understand but will just ask the main questions:-

Does the previous bad reaction I experienced with ciprodex mean I am at more risk of side effects from clioquinol, or are the neurotoxic side-effects of different antibiotics irrelevant to each other? How likely is it that I have a perforated ear drum, or cholesteatoma? Are there any milder treatments without neurological side-effects? If there is an eardrum perforation can it be closed before a topical antibiotic is administered?

Thank you for your time in considering my questions