Q: I am 17 years old and have a hole in my ear. I looked up the Internet to find that it could be a sinus defect, and if it is not bothersome then there is no reason to worry. But my ear hurts badly. I have had the hole from my birth, but for the past 2-3 months I have started getting acute pain. There has also been some discharge for a few days accompanied by swelling. What could be the reason behind this? Do I need to consult any doctor? I get worried easily and have been thinking whether or not it is a tumour. Is it serious?

A:Not all the holes in the ears can be ignored. There could be several diseases that lead to a hole in the ear drum. One such diseases is sinusitis. Almost all the types of ear perforations (holes) need closure surgery. The decision to leave it alone is taken when a patient is very old or otherwise not fit for surgery, or when there are other more serious diseases that require immediate attention. Regarding the perforation itself, there are two main types - safe and unsafe. The safe type is caused due to an infection ascending from the nose, sinuses and throat. This type is called safe because it does not lead to any complications, other than a hearing loss. This perforation can be closed by placing a graft, usually the tough membrane covering the temporalis muscle. This operation is called myringo plasty. The second type of perforation is the 'unsafe' type. In this condition, the infection would have spread further into the bone surrounding the ear. Once it shows a tendency to spread, the assumption is that its expansion may erode vital tissues like the facial nerve, the brain, the nearby balancing apparatus, etc. That is why it is called unsafe. Such a process usually takes several months. The two types may be differentiated by a clinical examination. Of course, a high index of suspicion is required, during such examination. Pain is one of the indications of impending complications. So, the policy of leaving it alone is not correct. You certainly need a personal consultation with an experienced ENT specialist. The medical web sites can only serve to spread awareness of medical conditions. Further, may I give you a personal and concerned advice: A lot of care is taken in these web sites to render the medical information understandable and to give a correct insight into the medical conditions. Hence, care should be taken in reading them. Perhaps, a second reading also would help. A casual attitude in reading them may lead to avoidable delays and problems. I may be mistaken; but when I read your letter, I get a creepy feeling that you are a little too casual in your query. Please consult an ENT surgeon. Many times, the pain could be due to an innocuous infection of the external ear canal skin, due to a discharge from a pre-existing ear perforation. An experienced ENT surgeon can certainly differentiate the wolf from the sheep.