My mother, who is 61, has been troubled by eczema in her ears for the last few years. The fungus currently in her ears is known as Pseudomonas. The problem: her ear canals are too small, so they always stay moist. The doctor says the only solution is to remove the cartilage in the ear, so that air can flow through the canal, clearing up the moisture that causes the eczema or fungus. Will this procedure help, and is there not another way?

N.F.

Pseudomonas is not a fungus. It is the name for a group of water-loving bacteria that thrive in moist places, such as the human ear canal. However, many fungi (such as Aspergillus, better known as bread mold) also love damp, warm environments, so your mother may well have had fungal infections in the past.

My approach to such patients is, first, to clean their ear canals as thoroughly as possible and to get them on an appropriate antibiotic or antifungal eardrop. Just as quickly, I try to get them OFF THE DROPS, since (being wet, of course) the drops contribute to the problem to some degree. It is vital that the patient avoids getting any other water in the ear canal. An inexpensive and very effective ear plug can be made by rubbing petroleum jelly (Vaseline) into a hunk of cotton.

Once the immediate infection resolves (usually after one or two weeks), I stop the drops and tell the patient to continue to keep her ears DRY. This may be all that your mother needs to do. On the other hand, if she continues to have infections despite following this advice, she may indeed need an operation.

I doubt that her canals are narrow. If so, she would have had these problems for most of her life, not just for the last few years. It is much more probable that the opening to the ear canal, also known as the meatus, is "collapsing." Ear cartilage continues to grow throughout our lives. If the cartilage immediately in front of the meatus (the conchal cartilage, which means "shell cartilage") gets too large, it can partially block the meatus. This leads to the problems you have described, as well as wax buildup and hearing loss.

The operation to correct this condition is called a meatoplasty. Your mother should ask her doctor if this is what he is planning to do. Meatoplasty can be performed with conscious sedation. (That means she will be awake during the operation, but the anesthesiologist will give her drugs so that she will not feel pain and cannot recall the operation later.) It can also be performed in the office under local anesthesia. I prefer the former method for my patients. In a meatoplasty, an incision is made immediately in front of the meatus, and a portion of the conchal cartilage is excised. This is an oversimplification, of course, but the net result is a meatus that remains open and does not "collapse." There is better air circulation through the canal, so the canal is less humid and thus less prone to bacterial and fungal infection. This is an excellent procedure for patients with collapsing meatuses who do not respond to the simple measures outlined above.