Middle Ear Infections

MIDDLE EAR

The middle ear is a space located behind the eardrum (Figure 1). The pressure inside tends to be negative due to the absorption of air by the middle ear mucosa. During swallowing, middle ear pressure is equalized with ambient pressure through the Eustachian canal. When the pressure on both sides of the membrane is equalized, the membrane becomes fully flexible, where sound is best transmitted. However, if the pressure in the middle ear decreases, problems begin to occur in the transmission of sound. This condition usually occurs due to deterioration in the functions of the eustachian tube, which connects the middle ear to the nasal passages. This canal both controls middle ear pressure and provides drainage of middle ear mucosa secretions. In young children, the eustachian tube is both short and straight, but after the age of seven it acquires an anatomy that will provide full functions.

NORMAL HEARING

Normal hearing. In order to do this, the middle ear structures and the eardrum must transmit the sounds coming from the outer ear canal to the eardrum to the inner ear. When the sound wave coming from outside passes through the external ear canal and hits the eardrum, which is an elastic structure, it vibrates the membrane, and the ossicles in the middle ear participate in this vibration. Thus, the vibrations reach the inner ear, are converted into electrical signals in the nerve cells there and are transmitted to the hearing centers in the brain via nerve pathways.

WHAT IS MIDDLE EAR INFECTION?

Middle ear infections are inflammations that occur in the middle ear cavity behind the eardrum. The cause is usually viruses or bacteria. It often occurs following a deterioration in the function of the eustachian tube, which provides ventilation to the middle ear, due to a recent cold or an allergic problem. One or both ears may be affected simultaneously. Since the middle ear has not fully completed its anatomical development in young children, ear infections are more common due to the differences in Eustachian canal functions and anatomy. Especially;

• Children under the age of five,
• Men,
• Bottle-fed babies,
• Children going to kindergarten,
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• Those who are in poorly ventilated crowded environments and exposed to cigarette smoke Middle ear infections are more common in children.


• Although middle ear infections are less frequent, they are also seen in adolescence and adults. The most common middle ear infections in children are serous/effusion otitis media and acute otitis media.


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

The most important reason is the deterioration of the functions of the eustachian tube, which normally opens for a short time with each swallow and adjusts the middle ear pressure, due to reasons such as viral infections and allergic reactions. As a result, the middle ear cannot be ventilated, and as a result of fluid withdrawal from the tissues due to the negative pressure created by the accumulation of ear secretions and the absorption of air by the tissues, the middle ear fills with fluid (serous otitis). As a result of the darkening of the mucosal secretion due to long-lasting negative pressure, secretory otitis media, a more chronic condition, occurs. Because of this fluid, the eardrum cannot vibrate properly and the child develops hearing loss. This mild hearing loss causes various changes in the child's behavior: If this problem becomes chronic, it may lead to a delay in the child's mental development and the start of speaking. The main findings observed in a child with hearing loss are as follows; He doesn't pay any attention

.

At school, his interest in what the teacher says decreases and he begins to fail in his classes. Middle ear fluid and hearing loss should be investigated in lazy children at school

Speech disorders may occur due to the inability to hear consonants especially "s" and "z" well

CAUSES OF SEROUS OTITIS

• Adenoid growth and filling of the nasal cavity (adenoid vegetation)
• Nose and sinus infections
• Acute moderate ear infections
• Allergy, immune system deficiency
• Rarely, they are tumors that affect the eustachian canal function

 

DIAGNOSIS OF SEROUS OTITIS

Serous otitis is a silent disease and does not usually present with obvious complaints such as fever, vomiting, or pain. Diagnosis It is often diagnosed during examinations due to adenoid-related complaints or when hearing loss is suspected.

The eardrum has become dull, thickened and the vascularity on it has increased. Depending on the duration of the problem, there may be shrinkage in the membrane, adhesion to the middle ear structures, and dark color changes. The disease often affects both ears. Hearing loss may not be noticed in unilateral serous otitis. In these patients, symptoms such as imbalance, difficulty in sports activities, and difficulty in walking may be observed due to the impact of the balance center. As diagnostic aids, measurement of middle ear pressure, measurement of hearing reflexes, and hearing tests are performed in children who can adapt. Hearing loss is conductive. Rarely, nerve type loss may occur due to substances secreted by microorganisms in the middle ear.
 

TREATMENT

Initially, antibiotic treatment is applied. Medicines that reduce mucosal swelling and thin the mucus consistency can be used. Anti-allergic treatment should be added to patients diagnosed with allergy. Activities such as chewing gum and blowing up balloons can help the function of the eustachian tube.

It may be appropriate not to send children, especially those who have frequent acute otitis attacks along with serous otitis and those who go to nursery, to this environment for about 1 month. For children who are bottle-fed, it should be recommended that feeding be done in a semi-sitting position.

Changes can be made in the treatment planning, taking into account the frequent occurrence of the disease in parallel with the increasing viral infections in the autumn and winter periods. While the chance of success with medical treatment increases before the summer period, this rate decreases during the winter period.

If the treatments applied in six to eight weeks are not successful and there is hearing loss above 20-25 dB, surgical treatment is preferred. If there is thinning, collapse, pocketing in the eardrum, nerve type loss or imbalance, direct surgical treatment can be chosen.

In surgical treatment, a ventilation tube is inserted into the eardrum, following which the hearing loss heals immediately. Additionally, adenoids and tonsils can be removed if necessary. Ventilation tube for children under general anesthesia It is applied in the eardrum, usually remains in the eardrum for 6-12 months and then falls out on its own or is removed by the doctor. With these treatments, most patients recover fully. Rarely, repeated tube applications or permanent tube application may be required. Allergy and immune system functions should be evaluated, especially in children with recurrent serous otitis complaints.

It is generally okay for children with tubes attached to their eardrums to swim in areas where the water is clean, as long as they do not dive more than one meter, but especially in swimming pools and when showering or bathing with soapy water, they should use Vaseline cotton or a suitable ear plug. Water should be prevented from entering the middle ear through the external ear canal by closing the external ear canal.

• Acute Otitis Media


• Acute middle ear infections are usually caused by bacteria or It is created by a virus. These agents are easily carried from the throat to the middle ear through the eustachian tube, which is shorter in children. Once microbes reach the middle ear, they settle and multiply there, causing swelling of the mucosa that lines the middle ear and lies within the eustachian duct, which is in close relationship with it. Due to the blocked tube, the middle ear cannot be ventilated, the pressure drops as the existing air is absorbed and the eardrum is pulled inward. The sound transmission of the membrane loses its flexibility and decreases. On the other hand, the inflammatory fluid caused by microorganisms inside or withdrawn from the nasal passage with the effect of negative pressure accumulates in the middle ear and pushes the membrane outward.
  
  Early in the examination, the eardrum is red, edematous or swollen like a balloon (Figure:2). The middle ear is full of inflammation. When the membrane becomes thinner and pierced at a point due to inflammation, the fluid in the middle ear flows out and creates ear discharge. During this period, fever and pain complaints decrease relatively. Failure to receive appropriate treatment may result in progression of the disease and complications.

 

• Impairment of Eustachian tube function
• Proliferation of bacteria in the middle ear
• Diseases of the nose and sinuses

CAUSES OF ACUTE MIDDLE EAR INFECTION

• Other upper respiratory tract diseases
• Allergy
• Immune system deficiency
• Blood It may be (rare) that the infection spreads to the ear through the ear.
• DIAGNOSIS OF THE DISEASE
• It is an inflammatory process that starts and progresses rapidly in the middle ear.
• Ear pain, fever, vomiting, loss of appetite, It is recommended that you immediately go to an ear, nose and throat specialist if you experience complaints such as ear blockage, discharge or hearing loss, or babies pulling their ears.
• In such a case, it is important to diagnose infection and start treatment as early as possible.


• If it is thought that there is a problem in your child's ear, both eardrums should be examined and necessary tests should be performed. The approach to treatment is planned according to the results of the examination and tests and the general health condition of your child.
   

  EXAMINATION FINDINGS

  In children with large tonsils, the nasal cavity is usually located just around the mouth of the Eustachian duct opening into the throat. Its flesh is also large and negatively affects the function of the Eustachian duct. In some cases, it is possible for microbes from the air to be retained here and transmitted to the middle ear through the Eustachian tube. Adenoids have a very important place in ear infections. When a middle ear problem is suspected, the eardrums, nose, throat and adenoids need to be examined. Adenoid examination is especially important in children who have frequent infections and complaints of chronic nasal congestion, sleeping with their mouth open or snoring. He has a middle ear infection many times. The frequency of infection and the length of time the infections are active play a role in determining treatment. Antibiotics should be used for at least 10 days in the treatment of acute otitis. In the pre-antibiotic years with today's drugs, very serious consequences such as facial paralysis, hearing loss, intracranial infections, meningitis and brain abscesses, which occurred as a result of the spread of inflammation from the middle ear to neighboring organs, were rarely observed.
  
  In the treatment, antipyretics, painkillers and medications to reduce mucosal swelling are used along with an appropriate antibiotic. The healing process must be monitored. In many children, medication and elimination of risk factors are sufficient for treatment. With antibiotic treatment, complaints decrease significantly in the first 24-48 hours.

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