Earache, Impaired Hearing and Antibiotic Misuse

A 47 year old lady came in last week complaining of her  left ear's worsening hearing problem. She said it started about five weeks before she came to see me and four weeks before that a doctor had prescribed some medications for her left earache.

Her problem has not settled instead it is getting worse. After asking some questions as per history, I proceeded to examine both her ears starting from the right which is supposed to be problem-free. I noticed that ear was very clean and the ear drum visibly normal.

On examination of the left ear I noted yellowish white fluid filling up the ear canal. At first I thought it was pus but the smell was not odorous. The ear drum was not visible of course. I made a comment about this to the patient and then she admitted that she had been using the antibiotic chloramphenicol ear drops prescribed a month ago on and off whenever she felt there was a watery discharge in the ear. No wonder she has problem with her hearing!

I was taken aback by her admission. Obviously this patient is ignorant on the use of antibiotic of this nature.And being English-illiterate she is not able to read the label which says "discard the bottle one week after opening".

One of the possible complications  is overgrowth of bacteria and maybe even fungus due to the prolonged use of the antibiotic in such a closed space.

I also note that people who have ear problem like pain and discharge tend to over clean their ears using cotton buds and when they feel itchy most likely due to dryness of the ear canal, they would poke the ear with all sorts of items. One man admitted he used his car key to scratch his itchy ear and of course ended up with ear pain  due to infection of the ear canal!

The need to educate patients on medication use cannot be overemphasised.