The road to tympanoplasty
It all started last summer but I didn’t really pay much attention at first. My hearing on my right side seemed just that little bit “off”. I assumed after a couple of chest infections and colds it was just some kind of germy nonsense working its way out of my system and things would soon get back to normal.
Bar the ‘glue ear’ I’d had as a child — solved by the insertion of a grommet and the removal of my tonsils and adenoids — my ears had never really given me cause for concern so I played the waiting game. It was around this time I also had a few spells of nausea and dizziness but again I didn’t really think that much about it.
A couple of weeks passed and with things not getting much better I stopped by my local NHS walk-in centre who confirmed the presence of wax and advised making an appointment for syringing with my GP. In hindsight this should have started alarm bells ringing (albeit ones I couldn’t properly hear) as I’d never had a problem with wax before. Nevertheless, I assumed it was a transient problem and one that would be easily sorted.
In preparation for syringing, I started to use over the counter ear drops to soften things up but they didn’t really seem to do all that much. Again, in hindsight, the occasional bad acidic taste when using the drops should have been a clue that things were not quite right (perhaps hinting at a perforation) but I persevered.
By this time my ear was frustratingly clogged and trying to yawn and pop it resulted in a series of bizarre squelching noises with varying amounts of relief. Social and professional engagements began to get tricky as my hearing remained impaired.
Arriving for syringing I was warned of the potential dangers of a burst eardrum and asked whether I wished to wait three weeks for safer microsuction instead. I decided to press on. It’s here my memory gets a bit hazy as I cannot remember if my ear was examined before starting the treatment or not and therefore whether a perforation should or could have been spotted at this time. Regardless, the syringing was unsuccessful, so I was left waiting for microsuction at a neighbouring GP practice.
Weeks passed and finally, on Halloween, I presented for microsuction to be told that it looked like half my eardrum had disappeared. A marginal perforation (originating from the outermost edge inwards) was confirmed with the edge of the remaining eardrum folded over meaning self-healing was unlikely and the first of many five day courses of antibiotics was prescribed as I was passed back to my GP.
In December my GP referred me to a consultant and while I waited I regularly rocked up at either my practice or the walk-in centre for antibiotics to try and dry out my ear cavity with nobody seemingly willing to prescribe more than five days’ tablets at a time. Obviously it’s difficult to see exactly what’s going on inside your ear so ‘gut feeling’ and potentially unconnected symptoms were often my only guide in turning back up and asking for yet more antibiotics. Finally, at the turn of the year, two lots of five day courses of stronger stuff seemed to do the job (making a staggering six courses in total).
It was around this time that symptoms shifted to sinus pain and excess mucous as my system struggled to drain and vent the inner ear. This meant I often felt like I was “drowning” in my own head which, when coupled with impaired hearing (adding to that wonderful underwater feeling) and the thrill of dizziness, amounts to a pretty miserable existence that I hope others never have to experience.
It was mid-February when I finally got a consultant appointment at the local community hospital. Here I was finally offered a hearing test (though nobody’s yet told me the results) and a perforation was again confirmed. I was then referred on to another consultant who specialises in “this kind of thing” rather than the general ENT kind of thing. An appointment arrived to see the new consultant in May, far exceeding the 18 week target for treatment from GP referral. Becoming increasingly frustrated, I decide to see the specialist in “this kind of thing” privately to speed things along and get put onto the ops list quicker.
In mid-March the second consultant confirmed what everyone else had already confirmed though seems surprised at the sinus and mucus problems I’ve been experiencing. He agrees to pass me back to the NHS for treatment — I soon receive an appointment for tympanoplasty at the end of April with pre-admission checks the week before.
The procedure and recovery
It’s now almost two weeks on from my operation and it took (as best I can tell) around an hour and a half from being put under to being back on the ward. The fact that it took until 10pm to be discharged (and then initially discharged as the wrong patient) is a story for another day.
The surgeon was able to gain access through the front of the ear (most online accounts seem to focus on coming in from behind).
Post-op the surgeon told me that he cleared out a lot of skin from the behind the eardrum suggesting the eardrum had been trying to regrow but with the edge folded back over in the wrong direction my body’s efforts were in vain — something I’m sure wasn’t helping my symptoms.
Pain has generally been a lot less severe than I had imagined and was generally managed reasonably well with occasional paracetamol and ibuprofen and I had no need to touch the prescribed codeine.
I may have returned to my usual diet a bit too soon (mince and dumplings at midday on the day of the op followed by some kind of BBQ chicken at teatime kicking things off while on the ward) as it took a few days for the effects of the anaesthetic to wear off enough to permit bowel movement and I spent much of Bank Holiday Monday being physically sick.
A week after the op I made an appointment to get three tiny stitches taken out of my middle ear. The nurse at my surgery told me I was the second patient she had seen in the last week with the same thing and I was significantly braver (in the sense I actually let her take the things out without screaming the place down).
The inner-ear ‘packing’ was removed 13 days after the op. Seepage into the cotton wool plug was fairly minimal and while at times it felt uncomfortable (like it was scratching up against and even burrowing into the inner ear) it was generally tolerable. The occasional waft of antiseptic smell from the dressing was pretty annoying though!
Today, the day after the packing was removed, hearing seems somewhat strange — it feels like some quiet sounds have been turned up and louder ones turned down. Of course, I need to appreciate that my body is now using a different instrument (the grafted eardrum) to hear and it will take time to learn to make sense of the sounds — sounds that haven’t been heard fully since last Summer. Early days then but things are certainly no worse — just different — and something that will (hopefully) improve with time.
For others about to undergo the procedure I’d advise not underestimating the tiredness — I spent much of the first week bed-bound (bar occasional trips for a few hours into the outside world) feeling a little nauseous and dizzy and (unusually) not in the mood to be distracted by TV or computers. The salty taste (either from packing or sense disturbance) comes and goes but didn’t seem too severe and I’m told this should settle down.
On reflection…
Not quite at the end of the road to recovery, 10 months after this all began, I can at last begin to contemplate some kind of more normal existence and put the last few months into some kind of reasonable perspective.
Ultimately, I still cannot believe the effect that something as seemingly trivial as a hole in a piece of skin can have on your quality of life. As much as I’m hoping for some level of hearing restoration, what I’m actually hoping for most of all is the feeling of being comfortable in your own head that people just take for granted.
The NHS has always been and remains an amazing institution but it astounds me just how many people I’ve had to see in the last ten months and just how insistent and persistent I’ve had to be to get the things that need to happen to actually happen. It doesn’t feel like any particular individual has had overall ownership of my problem from treatment to resolution. It does feel that own determination has been a significant driver in getting things done (waiting to be referred to a second consultant when the first agrees that an op is needed still seems particularly bizarre).
The whole incident has really served as another reminder that I know my own “normal” better than the medical professionals and at the first sign of problems I need to be the one battling with the system to get the treatment I feel that I need. It’s also shown me just how little information from a patient perspective on this surgery actually exists online and I hope sharing my story provides others with some form of solidarity and comfort and I’ll update when I can.
