Serous Otitis

What is the importance of being informed about otitis media with effusion and otitis media with effusion?

Otitis media with effusion is a disease that is mostly seen in childhood (infancy and play childhood). Otitis media with effusion is the most common ear disease after acute otitis media in childhood. The greatest importance is that it is the first cause of hearing loss in childhood. Since children need hearing to learn to speak, this hearing loss, which occurs in the early stages of life, also causes delay or deterioration in speech. Secondly, otitis media with effusion is a silent disease. Especially in children whose routine control examinations are not performed, the symptoms that will warn the family are faint until hearing loss occurs. Even when hearing loss occurs, it is quite common to interpret it as “attention deficit”. The family’s knowledge of otitis media with effusion facilitates the recognition of the disease. Third, there are currently many dilemmas in the treatment of otitis media with effusion that are open to interpretation. For this reason, the physician needs the cooperation of the family – and the patient, if he is old enough to understand – more than any disease in determining the ideal treatment plan. In addition, follow-up has an important place in the treatment of otitis media with effusion, in this case, the anxiety about the feeling of “standing without doing anything” that may occur in the parents will decrease as they are informed about the disease.

What are the symptoms of otitis media with effusion?

Otitis media with effusion in childhood is a silent disease. The most common symptoms are restlessness, behavioral changes, hearing loss in the later stages, delay in speech and impaired speech. Some of the children with otitis with effusion may have ear pain during the periods when they have a cold. Deafness manifests itself in the form of insensitivity to sounds, not responding when called from behind, and for older children turning up the volume or watching the television closely.

How is otitis media with effusion diagnosed?

Diagnosis is made during routine examination. Otoscopy or otoendoscopy (examination of the eardrum by reducing the light with an otoscope or endoscope) is the first step in diagnosis. The system called pneumatic otoscope, which allows to apply positive or negative pressure to the eardrum during the examination, makes it easier to reach the diagnosis. Otomicroscopy, that is, examination of the eardrum with a microscope, also increases the diagnostic value. The test, which is frequently used in diagnosis and follow-up, is the recording of the vibration created in the eardrum by a sound wave given from the ear canal. This test is called impedancemetry or tympanometry. However, it should be kept in mind that although the tympanometry is normal, it almost always shows that the middle ear aeration is normal, the oblique (type B) curve, which shows the limitation of the movements of the eardrum, does not always prove the presence of fluid in the middle ear cavity.

What is an ear (ventilation) tube? What is the purpose of tube insertion? How does it function?

Ventilation tubes are small (1-2 mm in diameter) cylinders made of inert materials such as Teflon, silastic, and gold, with a hole in the middle to allow air to enter the ear, and arranged wider at the front and back. The reason for tube insertion is that the eardrum self-repairs 48-72 hours after the fluid in the middle ear is removed by scratching the eardrum, and the effusion reoccurs in a short time. CO2 and O2 levels return to normal, the changes in the middle ear mucosa in the following periods are completely reversed and the secretion is normalized. The main purposes of tube insertion are to restore normal hearing, to protect the child from permanent hearing loss and to prevent speech problems. Tube insertion should be considered as a preventive intervention rather than a therapeutic one. Because when we extend the follow-up for more than 3 months, some of the effusions will heal on their own. However, tube insertion both prevents the prolongation of hearing loss and the development of possible speech problems related to it, as well as the emergence of permanent inner ear type hearing loss that can rarely occur during the course of otitis media with effusion, and structural disorders such as atrophy (thinning), collapse pocket, and complete collapse of the eardrum. aimed at preventing its development. A significant decrease in the frequency of ear diseases has been observed in adults who spent their childhood after the widespread use of ventilation tubes in all countries, compared to adults who spent their childhood in the period before ventilation tube insertion became widespread.

How are ventilation tubes attached?

Although it is an easily performed procedure with local anesthesia in the examination room in adults, it is performed under general anesthesia in children. In this case, tube insertion is done in the operating room while an anesthesiologist is putting the child to sleep and monitoring. The duration of anesthesia is about 5 to 10 minutes. Without any external incision, the eardrum is reached through the ear canal opening and a hole is made with a small incision, usually the existing fluid is drawn with an aspirator and the ventilation tube is placed in this hole. You can leave the hospital after two hours. Children under three months of age and children with chronic conditions such as heart and lung diseases or cerebral palsy may stay in the hospital overnight.

What should a child with a tube in his ear do?

Children do not feel the tube and do not feel any pain. However, children with ventilation tubes should protect their ears from water while swimming and bathing. Vaseline cotton or earplugs can be used for this. In regions such as Perth/Australia or the Atlantic Coast/USA where swimming is a part of the public’s life, options such as using antibiotic drops after swimming instead of protecting the ear during swimming are also on the agenda.

When and how does the tube come out?

After an average of 6-8 months, ventilation tubes are thrown from the eardrum and fall into the ear canal. During follow-ups at monthly or bimonthly intervals after tube insertion, it is seen that the tube is discarded and is usually taken from the ear canal by the physician. Sometimes it falls out of the ear canal spontaneously. Two years after the tube is inserted, the tubes still remaining in the eardrum are removed by the physician. This procedure is performed with anesthesia in the operating room if the child is younger, and in the examination room if the child is older.

Does the disease recur after the tube is removed?

It can. One time ventilation tube insertion is curative for 90% of children, and even if fluid is seen in the middle ear later on, it will improve with medication. However, in 10% of children, it is necessary to apply the tube again. This rate rises to 25% for children under the age of two when the first tube is inserted. Children who require a second tube insertion often require repeated tube insertion attempts up to the age of eight. For this reason, a “T-tube” with a longer residence time in the eardrum can be inserted for the second time in these children.

otitis media with ulcer is a serous or mucoid fluid in the middle ear for more than 3 months. It is the most important cause of hearing loss in children in developed countries and peaks between the ages of 2-5. In normal ears, the middle ear mucosa secretes fluid continuously and this fluid is extruded through the Eustachian tube. . Any problem in excess secretion or excretion of this fluid causes this fluid to accumulate in the middle ear, resulting in otitis media with effusion.

Acute otitis media causes effusion by both increasing the secretion of fluid and decreasing its discharge. Any dysfunction in the eustachian tube (nasopharynx) can also lead to effusion. Middle ear inflammation with effusion does not cause any complaints and can be seen incidentally during examination. The most important complaint is hearing loss. Although older children complain of hearing loss, parents, teachers and caregivers usually notice it first. In young children, the only symptom may be delayed speech or a behavioral disorder. Another finding is the feeling of stuffiness in the ear, in this case, a sign of playing with the ears in young children. On examination, a dull gray and yellow colored eardrum with reduced movement is observed. Sometimes air-liquid level or small air bubbles can be seen.

The first step in treatment is drug therapy. For this purpose antibiotics, cortisone. decongestants, antihistamines are used. After the drug treatment, the patient’s examination and tympanometry are performed and the response to the treatment is observed. In addition, other problems such as nasopharynx causing it are investigated. If there is no response to the treatment, surgical treatment should be considered. As a surgical treatment, if there is a nasopharynx that causes it, it is removed and the tubes that will provide ventilation of the ear are inserted into the eardrum. These tubes, short-term tubes (Grommet) stay in the membrane for up to 12 months, long-term tubes (T-tube) stay for several years.

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