WHAT IS MIDDLE EAR INFECTION?

Middle ear infections are inflammations that occur in the middle ear cavity located behind the eardrum. They are usually caused by viruses or bacteria. They often occur following a recently contracted cold or an allergic problem, which disrupts the function of the Eustachian tube that ensures ventilation of the middle ear. One or both ears can be affected simultaneously. In young children, since the anatomical development of the middle ear is not fully complete, differences in the function and anatomy of the Eustachian tube make ear infections more common. Specifically;

  • Children under five years old,
  • Males,
  • Infants fed with a bottle,
  • Children attending daycare,
  • Children in crowded environments with poor ventilation and exposed to cigarette smoke, middle ear infections are more frequently observed.
  • Although less common, middle ear infections also occur in adolescents and adults. The most frequently seen middle ear inflammations in children are serous/effusion otitis media and acute otitis media.

Serous Middle Ear Inflammation (Serous Otitis Media, Effusion Otitis Media)

Normally, the function of the Eustachian tube, which adjusts middle ear pressure by briefly opening with each swallow, is disrupted due to causes such as viral infections and allergic reactions. As a result, the middle ear cannot ventilate, leading to the accumulation of ear secretions and absorption of air by tissues, which creates negative pressure that draws fluid from the tissues into the middle ear cavity (serous otitis). Prolonged negative pressure causes the mucosal secretions to thicken, resulting in a more chronic condition known as secretory otitis media. The eardrum cannot vibrate properly due to this fluid, leading to hearing loss in the child. This mild hearing loss can lead to various behavioral changes in the child: If this problem becomes chronic, it can delay the child’s mental development and the initiation of speech. The main findings observed in a child with hearing loss are;

  • Turns up the TV volume very high or sits very close to the TV.
  • Does not respond immediately or at all to what is being said because they cannot hear it fully.
  • Shows decreased interest in what the teacher says at school, starts failing in classes. In lazy children at school, middle ear fluid and hearing loss should definitely be investigated.
  • Especially, speech disorders may occur due to the inability to hear silent letters such as “s” and “z” properly.

CAUSES OF SEROUS OTITIS

Serous otitis is a silent disease and usually does not present with obvious complaints such as fever, vomiting, or pain. It is often diagnosed during examinations conducted for complaints related to the adenoids or as a result of suspicion of hearing loss.

The eardrum is dull, thickened, and has increased vascularization. Depending on the duration of the problem, there may be retractions of the eardrum, adhesions towards the middle ear structures, or color changes to a darker shade. Fluid accumulation frequently affects both ears. In unilateral serous otitis, hearing loss may not be noticeable. In these patients, symptoms such as imbalance, difficulty in sporting activities, and difficulty in walking may occur due to the involvement of the balance center. Diagnostic tests that assist in diagnosis include middle ear pressure measurement, measurement of hearing reflexes, and hearing tests in children who can cooperate. The hearing loss is of the conductive type. Rarely, a sensorineural type loss may develop due to substances secreted by microorganisms in the middle ear.

TREATMENT

Medication Treatment:

Initially, antibiotic therapy is administered. In addition, medications that reduce mucosal swelling and thin the mucus can be used. In patients diagnosed with allergies, anti-allergic treatment should be added. Activities such as chewing gum and blowing balloons can greatly assist in the function of the Eustachian tube. In this regard, simple systems called Otovent, which help in balloon blowing by supplying air through the nose, can be much more beneficial.

Especially, it may be appropriate to keep children who have frequent recurrent acute otitis attacks along with serous otitis and are attending daycare away from this environment for about a month. In children fed with a bottle, feeding should be done in a semi-upright position.

Surgical Treatment:

In surgical treatment, a ventilation tube is inserted into the eardrum, after which hearing loss immediately improves. Additionally, if there are adenoids and tonsils, they can be removed. The ventilation tube is applied under general anesthesia in children, typically remains in the eardrum for 8-12 months, and then falls out on its own or is removed by a doctor (grommet tubes that do not fall out after 15 months). Usually, removing the tube does not require any additional surgical intervention and can be done in an office setting. With these treatments, the majority of patients fully recover. Rarely, recurrent tube applications or permanent tube installations (T-tubes) may be necessary. In children with recurring serous otitis complaints, allergies and immune system functions should be evaluated.

Children with ventilation tubes in their eardrums generally have no problem entering the sea as long as they do not dive more than one meter in areas with clean water. However, especially when swimming pools or taking showers or baths with soapy water, the external ear canal should be sealed with Vaseline-soaked cotton or an appropriate earplug to prevent water from entering the middle ear through the tube.

Since 2005, I have applied grommet tubes to around 120 patients and T-tubes to 7 patients in Çorlu. Permanent eardrum perforation occurred in only 1 patient who had a grommet tube inserted; this patient was later diagnosed with immotile cilia syndrome (Cystic Fibrosis). Additionally, in 7 patients, I had to insert ventilation tubes a second time due to persistent middle ear effusions and hearing loss after the tubes fell out. I did not encounter any serious issues or complications.

I advise my patients with tubes to come for follow-up examinations 3 and 10 days after the procedure and during the period the tube remains, and to protect their ears from water. Ventilation tubes equalize the pressure difference between the middle ear cavity and the external ear canal through small perforations, as shown below. In this regard, a small cavity (earwax) can block the hole and render the tube non-functional. Therefore, it is essential that the tubes be evaluated by ENT specialists at least once a month during their placement and that hearing is assessed through audiometry tests.