Question: I probably need an ENT to answer this. I started treating an ear infection and swelling of the Eustachian tubes with stopped up ears and redness in the left ear, on 8-21, with my primary care physician. He treated me with antibiotics and a 5mg per day dose of prednisone. On 8-31, he recommend that I see an ENT, as my left ear was still stopped up, although the redness in the ear canal had gotten a lot better. I saw the ENT on 9-3. He put a tube in my right ear to relieve pressure and sent me for CT scan. He said they saw a lot of swelling and started me on another antibiotic and a regimen of 60 mg prednisone and allergy meds and steroid nasal spray. I took another CT scan on 9-17 and was evaluated today 9-21. He told me the CT scan showed my fluid in my eustachian tubes had cleared, but there was still something showing in the honeycomb bone called the mastoid bone and he wasn't sure if it was swelling or infection and all we could do was give it a month and retake the CT scan and see if it clears up. He wasn't very encouraging as he said there was a 30 % chance it would clear up without further treatment and he said he didn't want to give me more steroids or antibiotics as I had already taken a lot. He said that if it didn't clear up, he would need to do surgery. I am very confused and frightened right now, first because I find it hard to believe that I can't do anything to help it with more medicines and also the surgery comes with a risk of hearing loss, and I don't know the risks of hoping it will clear up, or how long can I wait before it becomes a risk to my health, or how long should I expect to wait to see if it clears, & how will I know if it's improving. I feel no pain in that ear and with the tube in it I have been hearing pretty well. Please give me some good advice or information as I have been as detailed as I can. I have a lot of anxiety over this issue as I don't want to make a bad decision when it involves any surgery that could cause me permanent damage, or might be unnecessary. I am 63 years old and have not had any serious issues with my ears besides the occasional stuffy ear or sinus congestion.

Also, I have tinnitus that hardly bothers me anymore. Would this surgery make the tinnitus come back worse. How would I approach my ENT with your evaluations and ask for the necessary test results, without making feel like I'm insulting his intelligence and taking a chance on having to start over with another.

I'm getting a second opinion after I confronted my ENT with the information you gave me about the IV antibiotics. Originally the ENT told me that he saw a cloudy spot that he could not be sure was infection or inflammation. Now he is sending me to an infectious disease doctor that could treat me for that, but also told me now, that he believed that it was inflammation not infection as he originally told me. Anyway, I just wanted to be sure I had all my bases covered with you, since this is my last follow up question without starting over. My ENT is sending over all my test information to the new doctor. Now let me ask you that if they both agree that it is not an infection and just inflammation, is there a way to treat the inflammation without surgery. Surely the inflammation could not have caused permanent damage, as I've only had this condition for around 4 weeks. Also, let me tell you I am having a occasional small pain in that ear, but it only comes and goes briefly and not very bad. How long do you believe I have to figure this out before it could do serious damage to my hearing? The ENT wasn't planning on doing surgery until Nov 5th, if it was determined I needed it, Also, if you don't mind I have one more thing I want to address with you. As I told you, I had a CT scan of the temporal bones and inner ear. My other ear also has a little pressure still in it, but the CT scan looks ok. The ENT did a ECOG test on my ears and says I may have a little hydrops in that ear that should clear up. He said If there was a tumor anywhere there, that would have shown up on the CT scan and the ECOG test. Is that correct? Also, I've been going to a chiropractor for TMJ adjustment and the chiropractor informed me that my chiropractic health could have something to do with my ear problems. Please give as much detail as you can from the information I have given you, or feel free to make any other observations that you think might help me. I just don't want to guess or speculate on something that is probably not going to help me make a decision and maybe confuse me more. In the process of waiting, what signs should I look for, that the problem is resolving itself. Thanks so much for your help. If I want to ever request more consultation with you, how do I request you?

You did not tell me how to treat it, if it was swelling. The ENT told me he didn't want me to have any more steroids, because I had already taken a course. Is this true or is there another method to treat the swelling? That was part of my last question as to what treatment is there for the swelling.

Ok. I'm trying to narrow down exactly why my ENT thinks surgery is an option. I am using the information you provide me to understand this condition. I understand everything we have discussed and still haven't been able to figure out why I would need surgery, at any point, as this all seems to be treatable. Now let me ask you a question that I would like you to be precise and in very much detail about and where I can find more information on this subject. The reason we even discussed surgery, was due to everything I have discussed with you about my condition. Like I told you, I only had the ear stopped up stage for around 10 days before I had the tube put in and pressure relieved. There was never any outward signs of anything going on, such as ear swelling or serious pain, although there was also some redness in my eardrum which my original doctor diagnosed as an outside infection. As as the tube was put in my hearing in that ear got better. I find it hard to believe that the cloudiness is damage to the bone in that short of time, with no outward signs, of a bad infection, such as I have researched on google, with people having the back of the ear swollen and eardrums ruptured. What the ENT is telling me is that the mastoid bone looked cloudy on the CT scan and that's when he started suggesting surgery to clean it up. Like I previously told you, that's when he started telling me that it could possibly be infection or inflammation. He never talked about it being damage, if it wasn't infection or swelling. When he says clean up the cloudiness, he says it like it just a simple,common surgery. Could there be any other reason that he would think surgery was the answer at this stage, without knowing if it is residual swelling or infection, such as damage done to the bone that he would have to be repaired just because the CT scan looks cloudy in that area. I find it hard to believe that it could have had time to damage the bone in 10 days, until the pressure was relieved. I hear ok out of that ear, although it does feel like there is a little pressure there. Please try to give me a answer according to the symptoms of slight pain and a very small loss of hearing in that ear, and all the past history I have given you. I attribute the hearing difference to be because of the tube in that ear. When I swallow, I hear my eustachian tube popping and the tube popping. Is this normal. If am to look for improvement, what would I look for and how long is it going to take. My other ear has a little pressure in it, such as when I close my car door or the door to my house. The ENT says there is possible slight Hydrops there. What can I do to help this and how long should the Hydrops take to resolve, if that is what it is? I looking to you to give me answers, so I can decide how aggressively and soon I need to treat this and if I am endangering my hearing by postponing surgery, if you feel that is even a possibility.

I tried to upload my CT scans, but the site tells me Upload has some errors. Please Check
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It comes directly off the CD provided my my imagining provider. Anyway the first on 9-3-15 report says:
REASON FOR EXAM: Hearing loss, otitis media
TECHNIQUE: Axial and coronal high-resolution images were obtained through the temporal bones without contrast.
COMPARISON: None
FINDINGS
Images of temporal bones demonstrate a normal appearance of the internal auditory canals bilaterally. Facial nerve canals are also within normal limits. The cochlea is unremarkable bilaterally. Vestibule is within normal limits. Semicircular canals show no abnormality.

The right middle ear cavity demonstrates a normal appearance of the ossicular chain. The malleus, incus, and stapes are within normal limits. No mass or fluid in middle ear cavity is identified. The round and oval windows appear normal bilaterally also. Typmpanic membranes show no abnormality. Mastoid air cells demonstrate normal aeration. There is no evidence of a destructive process.

In the left middle ear cavity, there is an abnormal soft tissue density is noted in the hypotympanum, medially and posteriorly. The soft tissue density extends superiorly to involve the stapes and oval window, as well as the incus. It also extends along the umbo of the malleus, and there is slight irregularity of the umbo suggesting the possibility of erosion. The soft tissue density extends along the manubrium of the malleus superiorly, and there is minimal soft tissue density in Prussak's space. There is no erosion of the scutum. The epitympanum and tegmen tympani demonstrate no definite abnormalities.

There is some retraction of the tympanic membrane, but no significant displacement of the ossicular chain is demonstrated/ This would suggest the possibility of granulation tissue. However, the irregularity of the malleus suggests the possibility or erosion, and a cholesteatoma could not be definitely excluded.

Some fluid is seen in the mastoid air cells. No bony erosion or destruction is seen in the left mastoid air cells.

IMPRESSION:
1. ABNORMAL SOFT TISSUE DENSITY IN THE HYPOTYMPANUM OF THE LEFT MIDDLE EAR EXTENDING TO AND SURROUNDING THE STAPES, INCOSTAPEDIAL JUNCTION AS WELL AS THE UMBO OF THE MALLEUS.
2. THESE FINDINGS ARE CONSISTENT WITH GRANULATION TISSUE AND/OR A CHOLESTEATOMA OF THE LEFT MIDDLE EAR.
3. NO ABNORMALITIES OF THE RIGHT MIDDLE EAR ARE DEMONSTRATED.
4. MINIMAL FLUID IN LEFT MASTOID AIR CELLS.
END OF REPORT FOR 9-3-15

NEW REPORT FOR FOLLOW UP SCAN ON 9-17-15

REASON FOR REPORT AND TECHNIQUE, SAME AS FIRST SCAN.

COMPARISON: SCAN ON 9-3-15

FINDINGS:
Images of left temporal bone demonstrate a normal appearance of the ossicular chain. Since the previous study, the patient shows less prominent opacity in the middle ear cavity. Previously there was a band of opacity in the hypotympanum extending into the mesotympanum and into the Prussak's space but most of this has resolved. Opacity in the oval window shown previously has also improved markedly. There is a very small amount of strandy material in Prussak's space remaining, probably representing post inflammatory debris. No erosive changes are seen.

The patient shows persistent moderate opacification of the left mastoid air cells. The cochlea and vestibule appear normal. IAC is normal. Semicircular canals are within normal limits on the left.

Images of the right temporal bone show a normal appearance of the middle ear
cavity. The ossicular chain on the right is normal. Cochlea and vestibule are normal. Semicircular canals appear normal. Right mastoid air cells appear normal and unchanged.

IMPRESSION:

1.PROMINENT IMPROVEMENT IN INFLAMMATORY CHANGES IN THE LEFT MIDDLE EAR CAVITY SINCE 9/3/15. ONLY MINIMAL STRANDY CHANGE IS SEEN REMAINING IN PRUSSAK'S SPACE WITHOUT EROSION. FINDINGS MOST CONSISTENT WITH IMPROVING OTITIS MEDIA.
2.PERSISTENT LEFT MASTOID OPACIFICATION UNCHANGED.
3.NORMAL CT OF RIGHT TEMPORAL BONE.

These are a complete transciption of my two recent scans. There obviously some terms in here that a layman like me doesn't understand. Could please explain them to me in laymans terms and translate them to me so that I will understand them. If you need to refer back to some of my previous questions to provide me with the answers I was looking for. Like I told you before, my ENT thinks I might need mastoid surgery. I'm trying to avoid that. I'm seeing an infectious disease doctor on Tuesday, so that he can evaluate me and decide if he can treat me with IV antibiotics or also for swelling.
I know you are only giving me your best opinion when advising me, by what you can see, but I have provide you now with much more information. If its infection or inflammation, the infectious disease doctor can treat it. Could there be a possibility that the opacification could be fluid and if so, will that also clear on it's own? Or what else could it be? What are the chances that I can avoid the surgery?

On the previous question, I assumed you would realize this, but the first scan result report for 9-3-15, was before I was treated with 10 days of oral antibiotics and oral steroids and the second scan result report on 9-17-15, was after 10 days of treatment. I'm just telling you this so that you can use it in your reply to my last question.

If I'm feeling like something is going down from the top to the bottom of my inner eardrum & is itching down the inside of my eardrum and I hear crackling, does that mean it's healing?

I'm sorry, but you have not answered my question. The surgery was suggested as an option, after the second scan, to clean up the opacity in the left mastoid, and this is what I have been asking you all along. All my questions relate back to this as I could not understand why I would need surgery to clean up moderate opacification of the left mastoid cells. As you told me, this could be treated with IV antibiotics and inflammation could also be treated. This is why I sent you the body of the reports from the CT scans, in hopes that you could confirm that your first diagnosis was correct and that there was still no need for surgery to clean up the mastoid opacity, unless the cholesteatoma you refer to, could be the cause of the mastoid clouding. I know nothing about this and the doctor has only mentioned cleaning the opacity in the mastoid.