{"id":371,"date":"2024-12-30T17:30:06","date_gmt":"2024-12-30T14:30:06","guid":{"rendered":"https:\/\/drsabancelebi.com\/?p=371"},"modified":"2026-02-04T15:45:07","modified_gmt":"2026-02-04T12:45:07","slug":"middle-ear-infections-acute","status":"publish","type":"post","link":"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/","title":{"rendered":"Middle Ear Infections (Acute)"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_73 counter-flat ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#MIDDLE_EAR\" title=\"MIDDLE EAR\">MIDDLE EAR<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#NORMAL_HEARING\" title=\"NORMAL HEARING\">NORMAL HEARING<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#WHAT_IS_MIDDLE_EAR_INFECTION\" title=\"WHAT IS MIDDLE EAR INFECTION?\">WHAT IS MIDDLE EAR INFECTION?<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#Serous_Middle_Ear_Inflammation_Serous_Otitis_Media_Effusion_Otitis_Media\" title=\"Serous Middle Ear Inflammation (Serous Otitis Media, Effusion Otitis Media)\">Serous Middle Ear Inflammation (Serous Otitis Media, Effusion Otitis Media)<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#CAUSES_OF_SEROUS_OTITIS\" title=\"CAUSES OF SEROUS OTITIS\">CAUSES OF SEROUS OTITIS<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#TREATMENT\" title=\"TREATMENT\">TREATMENT<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#SURGICAL_TREATMENT\" title=\"SURGICAL TREATMENT\">SURGICAL TREATMENT<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#ACUTE_MIDDLE_EAR_INFECTION_Acute_Otitis_Media\" title=\"ACUTE MIDDLE EAR INFECTION (Acute Otitis Media)\">ACUTE MIDDLE EAR INFECTION (Acute Otitis Media)<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#CAUSES_OF_ACUTE_MIDDLE_EAR_INFECTION\" title=\"CAUSES OF ACUTE MIDDLE EAR INFECTION\">CAUSES OF ACUTE MIDDLE EAR INFECTION<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#DIAGNOSIS_OF_THE_DISEASE\" title=\"DIAGNOSIS OF THE DISEASE\">DIAGNOSIS OF THE DISEASE<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#EXAMINATION_FINDINGS\" title=\"EXAMINATION FINDINGS\">EXAMINATION FINDINGS<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#TREATMENT-2\" title=\"TREATMENT\">TREATMENT<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"#\" data-href=\"https:\/\/drsabancelebi.com\/en\/middle-ear-infections-acute\/#SURGICAL_TREATMENT-2\" title=\"SURGICAL TREATMENT\">SURGICAL TREATMENT<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"MIDDLE_EAR\"><\/span>MIDDLE EAR<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The middle ear is a cavity located behind the eardrum (Figure 1). The pressure inside it tends to be negative due to the absorption of air by the middle ear mucosa. During swallowing, the Eustachian tube equalizes the middle ear pressure with the ambient pressure. When the pressure on both sides of the eardrum is equalized, the eardrum becomes fully flexible, allowing optimal transmission of sound. However, if the pressure in the middle ear decreases, problems begin to arise in the transmission of sound. This usually occurs due to dysfunctions in the Eustachian tube, which connects the middle ear to the nasopharynx. The Eustachian tube controls the pressure in the middle ear and facilitates the drainage of secretions from the middle ear mucosa. In young children, the Eustachian tube is short and straight, but after seven years of age, it achieves an anatomy that fully supports its function.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"NORMAL_HEARING\"><\/span>NORMAL HEARING<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>For normal hearing, the structures of the middle ear and the eardrum must transmit sounds from the external auditory canal to the inner ear. When sound waves from the outside pass through the external auditory canal and strike the eardrum, it vibrates. The tiny bones in the middle ear\u2014hammer, anvil, and stirrup\u2014participate in these vibrations. These vibrations reach the inner ear, where they are converted into electrical signals by nerve cells and transmitted via the auditory nerve to the hearing centers in the brain.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"WHAT_IS_MIDDLE_EAR_INFECTION\"><\/span>WHAT IS MIDDLE EAR INFECTION?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>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, the anatomical development of the middle ear is not fully complete, so ear infections are more common due to differences in the function and anatomy of the Eustachian tube. Specifically:<\/p>\n<ul>\n<li>Children under five years old,<\/li>\n<li>Males,<\/li>\n<li>Infants fed with a bottle,<\/li>\n<li>Children attending daycare,<\/li>\n<li>Children in crowded environments with poor ventilation and exposed to cigarette smoke, middle ear infections are more frequently observed.<\/li>\n<li>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.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Serous_Middle_Ear_Inflammation_Serous_Otitis_Media_Effusion_Otitis_Media\"><\/span>Serous Middle Ear Inflammation (Serous Otitis Media, Effusion Otitis Media)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The most important cause is the dysfunction of the Eustachian tube, which normally adjusts the middle ear pressure by briefly opening with each swallow, due to viral infections, allergic reactions, etc. 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&#8217;s mental development and the initiation of speech. The main findings observed in a child with hearing loss are:<\/p>\n<ul>\n<li>Turns up the TV volume very high or sits very close to the TV;<\/li>\n<li>Does not respond immediately or at all to what is being said because they cannot hear it fully;<\/li>\n<li>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;<\/li>\n<li>Especially, speech disorders may occur due to the inability to hear silent letters such as \u201cs\u201d and \u201cz\u201d properly.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"CAUSES_OF_SEROUS_OTITIS\"><\/span>CAUSES OF SEROUS OTITIS<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>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 during an examination.<br \/>\nThe 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.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"TREATMENT\"><\/span>TREATMENT<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Initial 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 assist in the function of the Eustachian tube.<\/p>\n<p>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.<\/p>\n<p>Considering that the disease is frequently seen in autumn and winter months due to increasing viral infections, changes may be made in treatment planning. The chance of success with medical treatment increases before the summer period, while in the winter period, this rate decreases.<\/p>\n<p>Surgical treatment is preferred in cases where treatments applied for six to eight weeks are unsuccessful and there is a hearing loss of 20-25 dB or higher. If there is thinning, retraction, or adhesion of the eardrum, sensorineural hearing loss has developed, or balance disorders have begun, direct surgical treatment can be selected.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"SURGICAL_TREATMENT\"><\/span>SURGICAL TREATMENT<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>In surgical treatment, a ventilation tube is inserted into the eardrum, after which hearing loss immediately improves. Additionally, if there are adenoids and palatine tonsils, the tonsils can be removed. The ventilation tube is applied under general anesthesia in children, typically remains in the eardrum for 6-12 months, and then falls out on its own or is removed by a doctor. 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.<\/p>\n<p>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.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"ACUTE_MIDDLE_EAR_INFECTION_Acute_Otitis_Media\"><\/span>ACUTE MIDDLE EAR INFECTION (Acute Otitis Media)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Acute middle ear infections are usually caused by a bacterium or a virus. In children, these agents are easily transmitted from the throat to the middle ear via the short Eustachian tube. Once the pathogens reach the middle ear, they establish themselves and reproduce there, causing the mucosa of the middle ear and the Eustachian tube, which is closely related, to swell. Thus, due to the blocked tube, the middle ear cannot ventilate, the existing air is absorbed by the tissues, and negative pressure is created, pulling the eardrum inward and reducing its flexibility, which decreases sound transmission. Meanwhile, the inflammatory fluid that accumulates in the middle ear due to pathogens from the nasopharynx through the Eustachian tube pushes the eardrum outward.<\/p>\n<p>&nbsp;<\/p>\n<p>During the early stages of examination, the eardrum appears red, swollen, or balloon-like (Figure 2). The middle ear is filled with inflammation. When the eardrum is perforated at a point due to inflammation, fluid from the middle ear flows out, causing ear discharge. During this period, fever and pain complaints relatively decrease. Prompt treatment is crucial to prevent the disease from progressing and leading to complications.<\/p>\n<p>Figure 2. The left side shows the normal eardrum appearance, and the right side shows the eardrum appearance in acute middle ear inflammation.<\/p>\n<ul>\n<li>Dysfunction of the Eustachian tube,<\/li>\n<li>Proliferation of bacteria in the middle ear,<\/li>\n<li>Diseases of the nose and sinuses.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"CAUSES_OF_ACUTE_MIDDLE_EAR_INFECTION\"><\/span>CAUSES OF ACUTE MIDDLE EAR INFECTION<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>Other upper respiratory tract diseases,<\/li>\n<li>Allergy,<\/li>\n<li>Immune system deficiency,<\/li>\n<li>Infection reaching the ear via the bloodstream (rare).<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"DIAGNOSIS_OF_THE_DISEASE\"><\/span>DIAGNOSIS OF THE DISEASE<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Acute otitis is a rapidly progressing inflammatory event. When complaints such as ear pain, fever, vomiting, loss of appetite, ear blockage, discharge, or hearing loss are observed, or when infants tug at their ears, it is recommended to immediately visit an ear, nose, and throat specialist. In such cases, it is important to diagnose the infection and start treatment as early as possible. If a problem in the child&#8217;s ear is suspected, both eardrums should be examined, and necessary tests should be performed. The treatment approach is planned based on the examination and test results and the overall health condition of the child.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"EXAMINATION_FINDINGS\"><\/span>EXAMINATION FINDINGS<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>In children with large tonsils, the adenoids located around the opening of the Eustachian tube into the nasopharynx are also enlarged, negatively affecting the function of the Eustachian tube. In some cases, it is possible for microbes arriving from the air to be trapped here and transmitted to the middle ear via the Eustachian tube. The adenoids have a very important role in ear infections. When suspecting a middle ear problem, the eardrums, nose, throat, and adenoids should be examined. Examination of the adenoids is especially important in children who frequently experience infections and have chronic nasal congestion, sleep with their mouth open, or have snoring complaints.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"TREATMENT-2\"><\/span>TREATMENT<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>Most children experience at least one middle ear infection by the age of two. The frequency of infections and the duration of active infections play a role in determining the treatment. In acute otitis treatment, antibiotics should be used for at least 10 days. Nowadays, serious complications such as facial paralysis, hearing loss, intracranial infections, meningitis, and brain abscesses resulting from the spread of inflammation from the middle ear to adjacent organs, which were common before the advent of antibiotics, are rarely observed.<\/p>\n<p>Treatment includes appropriate antibiotics along with antipyretic, analgesic, and mucosal swelling-reducing medications. The healing process should be monitored. In many children, medication and elimination of risk factors are sufficient for treatment. In antibiotic therapy, complaints should significantly decrease within the first 24-48 hours. Although the eardrum fluid typically clears up within 8-12 days, it may sometimes take up to six weeks. If fluid accumulation becomes chronic, long-term follow-up and possibly surgical intervention may be necessary. The main factors increasing the risk of chronic middle ear fluid (serous otitis, secretory otitis media) in children are:<\/p>\n<ul>\n<li>Daycare or crowded, poorly ventilated environments,<\/li>\n<li>Allergic constitution,<\/li>\n<li>Exposure to cigarette smoke,<\/li>\n<li>Enlarged adenoids,<\/li>\n<li>Frequent upper respiratory tract infections.<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"SURGICAL_TREATMENT-2\"><\/span>SURGICAL TREATMENT<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>In some cases, medication alone may not be sufficient to control middle ear problems. If the fluid in the middle ear does not disappear despite consecutive treatments and causes hearing loss and\/or eardrum retraction, surgical methods should be pursued. In frequently recurring acute middle ear inflammations and persistent middle ear fluid, the most commonly applied surgical method is the insertion of a ventilation tube into the eardrum. The tube remains in the child&#8217;s ear for 6-12 months. The duration the tube remains is related to the child&#8217;s growth period. After a growth spurt, the tubes may fall out on their own. Otherwise, they should remain for at least 6 months and preferably be removed before the summer period if they do not fall out. A small hole in the eardrum created by the tube usually closes on its own within 2-3 weeks. If ear problems persist after the tubes fall out, re-inserting the tube may be necessary.<\/p>\n<p>During tube insertion, if the adenoids are present and the child frequently experiences recurring acute otitis or has excessively large tonsils, the tonsils may also need to be removed.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>MIDDLE EAR The middle ear is a cavity located behind the eardrum (Figure 1). The pressure inside it tends to be negative due to the absorption of air by the middle ear mucosa. During swallowing, the Eustachian tube equalizes the middle ear pressure with the ambient pressure. When the pressure on both sides of the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":539,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-371","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/posts\/371","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/comments?post=371"}],"version-history":[{"count":4,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/posts\/371\/revisions"}],"predecessor-version":[{"id":570,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/posts\/371\/revisions\/570"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/media\/539"}],"wp:attachment":[{"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/media?parent=371"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/categories?post=371"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsabancelebi.com\/en\/wp-json\/wp\/v2\/tags?post=371"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}