WHAT IS A MIDDLE EAR INFECTION?
Middle ear fluid accumulation (Effusion) refers to inflammation that develops in the middle ear cavity located behind the eardrum. It is generally caused by viruses or bacteria. It frequently occurs following impairment of the function of the Eustachian tube, which ventilates the middle ear, due to a recent cold or an allergic problem. One or both ears may be affected at the same time. Since the anatomical development of the middle ear is not fully completed in young children, ear infections are seen more frequently due to differences in the function and anatomy of the Eustachian tube.
Especially;
- In children under five years of age,
- In boys
- In bottle-fed babies,
- In children attending daycare,
- Middle ear infections are more common in children who are in crowded, poorly ventilated environments and are exposed to cigarette smoke.
- Although middle ear infections are less common, they are also seen in adolescents and adults. The most common middle ear inflammations in children are serous / otitis media with effusion and acute otitis media. You can contact us to obtain information about middle ear fluid accumulation (effusion).
Serous Middle Ear Inflammation (Serous Otitis Media, Otitis Media with Effusion)
The most important cause is impairment of the function of the Eustachian tube, which normally opens briefly with each swallowing movement to regulate middle ear pressure, due to causes such as viral infections and allergic reactions. As a result, the middle ear cannot be ventilated and fills with fluid (serous otitis) due to the accumulation of ear secretions and fluid being drawn from the tissues by the negative pressure created as the air is absorbed by the tissues. Secretory otitis media, which is a more chronic condition, occurs as a result of thickening of the mucosal secretion due to prolonged negative pressure. Because of this fluid, the eardrum cannot vibrate as it should and hearing loss occurs in the child. This mild hearing loss causes various changes in the child’s behavior: If this problem becomes chronic, it may cause delays in the child’s mental development and in beginning to speak. The main findings observed in a child with hearing loss are as follows;
The child turns the television volume up very high or sits very close to the television.
The child does not respond immediately to what is said or pays no attention because they cannot hear fully.
At school, the child’s interest in what the teacher says decreases and failure in lessons begins. Middle ear fluid and hearing loss should definitely be investigated in children who are considered lazy at school.
Speech disorders may occur, especially due to the inability to hear consonants such as “s” and “z” properly.
CAUSES OF SEROUS OTITIS
- Enlargement of the adenoids and filling of the nasopharynx (adenoid vegetation)
- Nasal and sinus infections
- Acute middle ear infections
- Allergy, immune system deficiency
- More rarely, tumors affecting the function of the Eustachian tube
DIAGNOSIS OF SEROUS OTITIS
Serous otitis is a silent disease and generally does not occur with obvious complaints such as fever, vomiting, or pain. It is frequently diagnosed during examinations performed due to complaints related to adenoids or as a result of suspicion of hearing loss.
The eardrum has become dull and thickened, and vascularity on it has increased. Depending on the duration of the problem, there may be retractions in the membrane, adhesions toward the middle ear structures, and dark discolorations. The disease frequently affects both ears. In unilateral serous otitis, hearing loss may not be noticed. In these patients, findings such as imbalance, difficulty in sporting activities, and difficulty walking may be observed due to the balance center being affected. As diagnostic tests, middle ear pressure measurement, measurement of hearing reflexes, and hearing tests in children who can cooperate are performed. The hearing loss is conductive. Rarely, sensorineural loss may develop due to substances secreted by microorganisms in the middle ear.
Treatment of Middle Ear Fluid:
Medication treatment:
Antibiotic treatment is initially administered. Medications that reduce mucosal swelling and thin the consistency of mucus may also be used. Anti-allergic treatment should be added in patients diagnosed with allergy. Activities such as chewing gum and inflating balloons may greatly support the function of the Eustachian tube. In this respect, simple systems called Otovent, which are used to inflate a balloon by blowing air through the nose, may be much more beneficial.
It may be appropriate not to send children who attend daycare and have frequently recurring acute otitis attacks together with serous otitis to this environment for approximately 1 month. For bottle-fed children, feeding in a semi-upright position should be recommended.
Changes may be made in treatment planning considering that the disease is frequently seen in parallel with the increase in viral infections during autumn and winter. While the chance of success with medical treatment increases before the summer period, this rate decreases during the winter period.
If treatments applied for six to eight weeks are unsuccessful and there is also hearing loss above 20-25 dB, surgical treatment is preferred. If there is thinning, collapse, or pocket formation in the eardrum, if sensorineural loss has developed, or if a balance disorder has begun, direct surgical treatment may be selected.
Surgical treatment:
In surgical treatment, a ventilation tube is inserted into the eardrum, after which the hearing loss improves immediately. In addition, the adenoids and, if necessary, the tonsils may be removed. The ventilation tube is inserted in children under general anesthesia, usually remains in the eardrum for 8-12 months, and then falls out on its own or is removed by the doctor (grommet tubes that do not fall out after 15 months). In general, removal of the tube is performed under office conditions without the need for an additional surgical intervention. With these treatments, the majority of patients recover completely. Repeated tube applications or placement of a permanent tube may rarely be required (T tube). Especially in children with recurrent complaints of serous otitis, allergy and immune system functions should be evaluated.
Children with tubes inserted into the eardrum generally have no restriction on swimming in the sea in areas where the water is clean, provided that they do not dive deeper than one meter. However, especially in swimming pools and while showering or bathing with soapy water, the external ear canal should be closed with petroleum jelly-coated cotton or an appropriate earplug to prevent water from entering the middle ear through the tube.
Since 2005, I have applied grommet tubes to approximately 120 patients and T tubes to 7 patients in Çorlu. Permanent eardrum perforation occurred in only 1 patient who had a grommet tube inserted, and this patient was later diagnosed with immotile cilia syndrome (Cystic fibrosis). In addition, after the tubes of 7 patients were expelled, I had to insert ventilation tubes for a second time because their middle ear effusions and hearing loss continued. I did not encounter any serious problems or complications.
I advise my patients who have had tubes inserted to attend follow-up examinations on the 3rd and 10th days after the procedure and monthly throughout the period the tubes remain in place, and to protect their ears from water. As can also be seen below, ventilation tubes equalize the pressure difference between the middle ear cavity and the external ear canal through their small openings. In this respect, a small plug of cerumen (earwax) blocking the opening may render the tube nonfunctional. Therefore, throughout the period the tubes remain in place, they must be evaluated once a month by ENT Specialists and hearing must be assessed with audiometry examinations.
Frequently Asked Questions
What Is Middle Ear Fluid Accumulation (Effusion)?
Middle ear fluid accumulation (effusion) is the accumulation of fluid in the middle ear behind the eardrum without infection. This condition may cause hearing loss and a sensation of fullness in the ear.
What Are the Causes of Middle Ear Fluid Accumulation?
Effusion may develop due to causes such as upper respiratory tract infections, allergies, enlarged adenoids, Eustachian tube dysfunction, and previous middle ear infections.
What Are the Symptoms of Middle Ear Fluid Accumulation?
The most common symptoms are reduced hearing, a sensation of fullness in the ear, mild balance problems, a sensation of pressure in the ear, and delayed speech development in children.
How Is Middle Ear Fluid Accumulation Diagnosed?
The diagnosis is made by an Ear, Nose, and Throat specialist through ear examination, tympanometry, hearing tests, and additional evaluations when necessary.
Does Middle Ear Fluid Accumulation Go Away on Its Own?
Yes, in many cases the fluid may disappear on its own within a few weeks or months. However, treatment may be required in conditions that continue for a long time.
How Is Middle Ear Fluid Accumulation Treated?
Treatment is planned according to the underlying cause. Follow-up, medication treatment, or surgical methods such as insertion of an ear tube may be applied when necessary.
Is Middle Ear Fluid Accumulation Common in Children?
Yes, due to the structural characteristics of the Eustachian tube, middle ear fluid accumulation is seen more frequently in children than in adults.
Does Middle Ear Fluid Accumulation Affect Hearing?
Yes, fluid accumulated in the middle ear may block sound transmission and cause temporary hearing loss. Hearing usually returns to normal after treatment.
What Happens If Middle Ear Fluid Accumulation Is Not Treated?
Long-term fluid accumulation may lead to permanent hearing problems, delayed speech and language development in children, and reduced quality of life.
When Should a Doctor Be Consulted for Middle Ear Fluid Accumulation?
If hearing loss, a sensation of fullness in the ear, or symptoms continue for longer than a few weeks, an Ear, Nose, and Throat specialist should be consulted for evaluation and appropriate treatment.
