I have had a tube in my ear for about 12 years. The doctor who put the tube in said it is a permanent tube. Is there any harm in this type of tube? This ear drains dark fluid out every day. I recently went to a doctor, who prescribed Amoxil. She said if the fluid does not stop, there could be something else wrong. Do you have any suggestions as to what is causing the problem?

J.D.

The tube may be causing the drainage, but it is more likely that the tube is only providing a conduit for the drainage. The fact that you have drainage indicates that the tissue lining your middle ear is at the very least inflamed and may in fact be infected. The appropriate management of chronic ear drainage is for your doctor to take a sterile sample of the fluid and send it to a microbiology lab in order to identify the bacterium that is causing the infection. The microbiology will also give your doctor "sensitivities." In other words, the lab will tell the doctor which antibiotics will kill the bacterium, and which will not. Your doctor can then put you on appropriate eardrops and/or oral antibiotics to eradicate the infection.

"Permanent" tubes last for several years (they are usually not truly permanent), and when they fall out, they tend to leave behind a non-healing eardrum perforation. This is often not a bad thing. Permanent tubes are usually placed because the doctor thinks you need long-lasting ventilation of the middle-ear space. A non-healing eardrum perforation accomplishes the same thing as a tube: it allows for ventilation of the middle-ear space. Nevertheless, if you have outgrown the ear problems that led to tube placement in the first place, then the tube (or a perforation) is unnecessary and inconvenient.

The fact that you have chronic ear drainage suggests, however, that you have NOT outgrown the problems. Indeed, you may have a condition known as "chronic mastoiditis." The mastoid is the bone immediately behind your ear lobe. The mastoid is not a solid bone. It contains a honeycomb of interconnected "air cells." The mastoid air cells are also connected to the middle-ear space. Chronic infections can fester in the mastoid for years and can be a source of pain and ear drainage. Unfortunately, eradication of chronic mastoiditis usually involves an operation (mastoidectomy) in which an ear surgeon drills out the mastoid bone, physically eliminating the air cells. No mastoid, no mastoiditis.

Your history is suggestive of chronic mastoiditis, but it is also possible that the inflammation or infection is limited to the middle-ear space. The only way to tell the difference is to obtain a CT scan of the bone that houses the middle ear, inner ear and mastoid. This bone is called the temporal bone, so the test is a "temporal-bone CT scan."

In my opinion, you need to see an ear, nose and throat specialist (ENT). Appropriate action at this point would include the following, in roughly this order:

1. A complete medical history and head-and-neck examination (assuming that this ENT is not already very familiar with you).
   
2. Examination of your ear with a binocular microscope.
   
3. An audiogram (hearing test), assuming that your ENT has not already obtained one in the last year or so.
   
4. Sterile culture of the fluid draining from your ear, as described above, with subsequent antibiotic treatment determined by the results of the culture and the sensitivity of the organism to various drugs.
   
5. If the above tests suggest the possibility of chronic mastoiditis, a temporal bone CT scan.
   

Good luck!