instruction: hi doctor I have a history of ear problems seven surgeries as of right now I had tubes placed in both ears when I was younger and more recent before few years after the tubes were removed both ear drums were left with holes in them which have been closed with surgery in the left ear there was only one tympanoplasty done as for the right ear there was a fat plug done and failed next there was a tympanoplasty which also failed finally a neurotologist preformed another tympanoplasty with cartilage back up and it has taken within the last three months I have had fluid in the left ear twice and prednisone has been used once I was flying and caused barotrauma from being sick and flying the other was just fluid sitting there which is still there after 12 days of prednisone also I have been told to take amoxicillin three times the last three months only I did it with the barotrauma as there was blood sitting behind the ear now I have got three different opinions from ent doctors and still I am confused as to what to try the normal ent that has done all but the last surgery where he made me go elsewhere because he was not comfortable trying again and said the hearing in my right ear has gotten worse from the last hearing test I do not have a copy of the most recent hearing test he wants to put a hole in the right ear the neurotologist was for putting a tube in the right after surgery as there was fluid behind the ear drum but he has left the country so my choices are limited to go back to him I have been traveling back and forth 12 hours each way for the last few months and driving after the barotrauma is getting pain in the left ear now the second doctor opinion he said that he would not recommend tubes as both ear drums are intact he recommended for an allergy test if it helps at all I have been using flonase as well continuously all three doctors said to do it the third doctor told me he would leave the right ear alone and recommended a tube in my left ear with my travel schedule he basically said I need to determine if I want to live with holes or leave them intact and have pain when it comes on also I have been diagnosed with taj after the first tube surgery which I think that lead to the pain that made me go through with the tubes in the first place I have had treatment for that I hit all the limits I could with my dentist and am now having a day time splint made all the problems in the left ear have started since three months back I was placed on prozac by a doctor which is known for making clenching worse I have done the botox in the masseter for taj which has helped in the past and we did 25 units this time last time was 15 units overall I am wondering if it is in my best interest to try and pull off the prozac with the doctor permission or just getting tubes in both ears and not doing any more reconstructive surgery
output: hello thanks for the detailed history I can understand that you have gone through a lot because of your repeated ear issues very clearly none of the conditions you have either fluid in middle ear or hole in the eardrum are painful conditions surgery for these conditions is done mainly to improve hearing repeated collection of fluid in the middle ear can occur due to various reasons such as eustachian tube dysfunction adenoids allergy etc the most common being eustachian tube dysfunction now coming to the treatment of your condition you can continue flonase nasal spray for a few months and see if there is any improvement in fluid in the middle ear if that is not working then the next option would be to undergo balloon dilatation of eustachian tubes which may work sometimes last option would be the insertion of grommet again but an operated ear grommet can cause permanent perforation and you have to live with it all your life as far as pain is concerned it is probably due to taj dysfunction as you said prozac worsens bruxism and you may need to stop it with your symptoms or doctor consent these chronic conditions such as eustachian tube dysfunction are difficult to treat and eustachian tube balloon dilatation may be a good choice for you as you are a frequent flyer