After a difficult day at work due to on-and-off headaches due to the ear pain, I put hydrogen peroxide - urea drops in my ears and irrigated with a bulb. This had been the prescription 5ish years ago when I had some persistent ringing in my ears and an overabundance of earwax flushed out by a PA at my doctor's office. It had also worked wonders on my trip to California in February when my ears felt clogged, the pressure changes on the plane were intense, and I had trouble focusing in an all-day meeting because of headaches coming and going and noticeable tightness in my neck muscles.
The drops and irrigation seemed to help for a couple days, then two weeks ago Friday the dull headache quickly shifted into a "You will devote almost all of your attention to the sharp pain in the left side of your head." My task on Friday is reading interview packets and then participating in hiring committee. After struggling through the first packet I realized that there was no way I would be able to make it through another four hours of reading and talking with this level of pain, so I called my doctor's office and asked the meeting coordinator to hand off my other packets.
At the doctor's office, I rated my pain an 8 out of 10. An NP inspected my ears and irrigated with a fancy bottle and warm water, which was more effective than the bulb dropper. A rather large chunk of goo came out of my left ear, and after sitting still for a moment to readjust my balance I felt major relief, right back down to a 2 or so on the pain scale. She recommended using the hydrogen peroxide drops for 3–5 days to get residual wax out and I biked home. I felt so good when I got home that I messaged the coordinator and said "Hey, I can read again, can you give me a packet back?" In my history of injury and illness It's very rare that a treatment takes effect that immediately; even the morphine I got when I broke my arm took longer to kick in, and didn't dial things down that far.
The next day I had another intense ear headache after several hours playing Magic and sadly opted not to go out to see Godspeed You Black Emperor!, since the artful amplified distortion of post-rock didn't seem like a great idea when your ears already hurt. Back home to lie in bed with peroxide making popping sounds as it combats wax.
I didn't have any more sharp pain, but over the next several days my ears felt pretty clogged. At first I figured this was residual ear wax, but fingers and Q-tips weren't pulling much wax out. I have the perk of being married to an NP; Kelly looked in my ears with her otoscope and noted that she couldn't see my ear drums, but everything looked pretty inflamed. I called the doctor's office and got in to see another NP who confirmed that it didn't look like wax, but wasn't sure just what to do. Hypothesizing that it was bacterial, she prescribed ciprofloxacin drops in each ear twice a day (possibly to be combined with Flonaze to combat inflammation), then come back for another irrigation.
Cipro ear drops are apparently an infrequently used medicine. My usual King Soopers pharmacy didn't have any, and sent me to the Louisville location. After a day of taking the drops I realized there were only 14 dropperettes in the package, which only covers half a week for two ears twice a day. I called the pharmacy to get a refill, which led to a multi-hour adventure wherein I learned (a) the insurance company didn't want to authorize it, because the refill date was for after a week and (b) I'd apparently gotten the only box of this medicine at any King Soopers in the Denver area. Oh, and hey, it's Memorial Day weekend, so good luck ordering anything. Fortunately, these are solvable problems. I think the pharmacist was able to convince the insurance company that I'd only received a half-week dose (since apparently people usually only get an infection in one ear). The on-call doctor called in a "Yeah, totally get more of that" prescription, too. (And apparently King Soopers had a coupon that would've made the drug cheaper than going through insurance, if they'd had any in stock.) After a couple calls I found a Wallgreens that had a box in stock and they were able to transfer the prescription from King Soopers.
Ordinarily I would take the position "I'll just skip this drug on Memorial Day and get it sorted out on Tuesday and it doesn't seem to be making that big of a difference anyway." But stopping an antibiotic half-way through isn't usually a good idea, and "a colony of drug-resistant bacteria in your ears" is not an attractive idea when you've just spent two weeks having aural discomfort.
Through Memorial Day, I'd generally had one ear or the other clear enough to hear conversations accurately, though I didn't have great spatial localization and I could tell I wasn't getting the full spectrum from music. Starting Tuesday, both ears felt very clogged almost all of the time; I could have a conversation, but only if I positioned myself strategically and the other person spoke up. Assuming that this was just buildup of ear drops and inflammation residue, I eagerly awaited my followup appointment for irrigation.
On Thursday, the NP looked in my ears again and pulled out a black chunk and inspected it. She concluded that it wasn't ear wax and that the antibiotic treatment hadn't solved the problem, so I should go see an ENT. I called around and found that there was an appointment early (for me) on Friday morning, as luck would have it.
I set my alarm the night before, but it didn't go off because I'd set up my clock off by 12 hours when I moved in. Oops. Fortunately, Kelly gets up early for work anyway, so she asked me "When's your appointment again?" early enough that I could do the morning gig and get to the appointment.
I really should've headed to the ENT rather than my primary care office after the first round of treatment didn't solve the whole problem. They've got a whole bunch of fancy ear tools, including long tweezers that go through the otoscope and a device that amounts to an ear vacuum. She quickly concluded that the big black hunks of goo in my ears were fungal, which clearly explains the ineffectiveness of my week of antibiotics. After removing large chunks she sprayed white antifungal powder in my ears and told me to keep them dry. Now that's something I've never had before :-)
I asked if my psoriatic arthritis might have played a role in this ear inflammation and debris buildup. The PA said that psoriasis can lead to ear issues, but that my case didn't look related. That's definitely a relief, because I was really not looking forward to my ears pulling my neck and screaming at my brain as a chronic condition.
So for the last day and a half, my left ear has been refreshingly clear and able to hear while my right ear has been ringing (though not as loudly as it was) and has reduced hearing capacity but gracefully no pain. My neck, shoulders, and jaw have also been refreshingly loose today. I've got a followup on Wednesday before I head to Apogaea where the PA will clean up the antifungal powder and take another look. Hopefully this ringing is just a little more debris stuck to the drum.