Middle Ear Inflammation in Children:
Middle ear inflammation is the inflammation of the eardrum and the air chamber behind it. It usually occurs in two ways in children:
1. Acute (painful)otitis media
2. Serous (painless) middle ear inflammation (collection of water in the ear)
Middle ear inflammation can be seen at any age, but it is more common in childhood.
ACUTE OTITIS MEDIA:
CAUSES:
Viral upper respiratory tract infections (cold), allergic rhinitis, adenoid enlargement, congenital malfunction of the eustachian tube, cleft palate anomaly, bottle feeding while lying down, etc. It occurs when bacteria in the nasal passages reach the middle ear and cause inflammation.
SYMPTOMS AND SYMPTOMS:
An upper respiratory tract disorder occurs in a completely healthy child who has never had any ear disease before. Following tract infection, painful (acute) middle ear inflammation may begin. (It should be noted here that leaking water in the bath or pool does not cause middle ear inflammation.) It manifests itself with pain that begins in one or both ears during or after the course of the cold. While there may be only mild pain, fever, restlessness and nausea and vomiting may also occur. Rarely, bloody discharge may occur when the inflamed bubble on the membrane bursts or the membrane is completely pierced. The pain is severe in the first hours and usually does not exceed 12-24 hours. After the painful period, until it heals, there may be complaints such as buzzing in the ear, feeling of congestion, a slight hearing loss (temporary) and echoing in sounds.
Diagnosis is made by viewing the eardrum with an otoscope or microscope. The eardrum is distinctly red and convex in appearance. (It should not be forgotten here that crying during the examination in babies may also redden the eardrum and this may be confused with middle ear inflammation.)
TREATMENT:
It can be followed without giving any medication, a� Antibiotics can be used orally or by injection, as well as anti-edema medications, nasal spray, anti-allergic and painkillers. Ear drops are not required except in cases of discharge. It usually heals completely within 1-2 weeks. In some cases, the painful condition disappears, but fluid and pus accumulation in the middle ear may continue.
In children with frequently recurring middle ear inflammation (5-6 times a year or more frequently), after each attack Even if the ear returns to normal, it is recommended to insert an ear tube.
SEROUS (SECRETARY) OTITIS MEDIA (Collection of water / fluid in the ear):
This condition affects the middle ear. It refers to the accumulation of inflammation in the cavity without pain. It may occur following a painful middle ear infection, or it may occur without any pain following long-standing eustachian obstruction. It depends on factors such as inpatient feeding, smoking at home, going to nursery, allergic rhinitis and adenoids. The most important symptom is hearing loss. Although there are symptoms such as congestion and feeling of pressure, children do not express these. It is either detected incidentally during an examination, or when hearing loss is noticed at home or at school. Restlessness and ear playing behavior in children and babies under 2 years of age (here, ear playing behavior should not be forgotten in babies around 1 year old as they get bored before sleep) -uh, what did you say…), watching television loudly and closely, may cause distraction at school and decrease in academic success in older children. Hearing loss is "temporary" and is around 25-35 Db.
This can be confirmed by measuring ear pressure (Tympanogram) after the examination. However, a decision cannot be made just by looking at the pressure test.
PRECAUTIONS AND TREATMENT:
Giving breast milk for at least 12 months is very important in preventing middle ear inflammation. Avoiding lying down feeding when switching to a bottle, preventing passive smoking, taking a break from the nursery or not sending it to the nursery are preventive methods.
In the treatment, only follow-up, follow-up with intermittent medication, insertion of an ear tube (usually through the adenoid) (e.g.), rarely, extensive ear surgeries may be performed.
In drug treatment, appropriate antibiotics, anti-edema agents, anti-allergic drugs and nasal sprays if there is allergic rhinitis, and short-term oral cortisone drugs may be recommended depending on the child's age and weight. (It is important here that antiallergic drugs are not always given. It may cause darkening of the fluid in the ear)
In cases that do not improve, ear tube insertion is recommended. It is not right to make a decision immediately with a single drug treatment. (Except for special cases such as cleft palate and advanced collapse of the membrane) The same doctor should monitor the patient for 2-3 months and even extend the follow-up period if necessary. It would not be right to make a decision right away for children who have just started kindergarten, in winter and spring months, and in children who do not have large adenoids or severe allergic rhinitis/do not have frequent colds. Although ear tube insertion is a procedure that must be performed at the point when drug therapy is exhausted (not a last resort!!!)and has no known significant side effects, it is still a surgical procedure.
The reason for fluid collection in the ear is that not enough air enters the middle ear from the Eustachian tube. As the air in the ear decreases, negative pressure develops and the eardrum begins to collapse towards the middle ear. A liquid pus accumulates in the narrowed middle ear space. If this condition is neglected for a long time, the structure of the membrane may deteriorate and adhere completely to the middle ear (adhesive otitis), which can then turn into a type of inflammation that can cause osteoporosis, meningitis and facial paralysis (cholesteatoma). The membrane may remain perforated, more severe and permanent hearing loss may develop, and more extensive surgeries may be required. On the other hand, hearing loss of approximately 30 Dbat an age when hearing is very important for speech, mental and social development and academic success may lead to stagnation and regression in these areas.
EAR TUBE:
The basic logic of wearing an ear tube is to ensure that the air that cannot enter the ear through the Eustachian tube directly enters the ear from outside. For this, a small hole is made in the eardrum, the fluid in the middle ear is cleared as much as possible, and then a TUBE is placed to prevent the hole from closing immediately and remaining open for a long time. ear tube These are small tubes that can have different shapes and sizes. Standard tubes resemble a spool of thread 2-3 mm long. It is notched at both ends and has a hole in the middle.
Adenoids are often removed from children who have tubes inserted.
Tube insertion is a simple and generally risk-free procedure. Hearing returns to normal from the moment it is inserted. (like suddenly opening a clogged ear with Valsalva after a plane flight) The tube is not visible from the outside, and its existence is not noticed by the child. It does not restrict the child's daily life. Ears need to be protected from water only in situations such as bathing and swimming pools.
Except for special cases, standard tubes are inserted for a short time in the first stage. It usually remains in the ear for 5-6 months to 1 year and is removed spontaneously. (It does not need to be removed with a new surgery.) The tube, which is actually a foreign object for the body, is tried to be removed from the moment it is inserted, and within 6-12 months, it falls into the ear canal as the eardrum repairs itself. In rare cases, there may be a hole left. In this case, it is monitored for up to 6 months, and if it does not close, it is repaired with a new procedure.
In some children, fluid collection recurs after the tubes are removed and a new tube may be required. There may even be cases where tubes are inserted 3-4 times. In these cases, long-lasting tubes that can last for 2-3 years are generally installed. These tubes are sometimes thrown away on their own, and sometimes they are removed from the ear when it is decided that they have expired. Meanwhile, the hole is repaired with a small patch.
In cases of middle ear infections that have been neglected for a long time, in cases where the membrane continues to collapse despite the tube, and in cases of inflammation in the bone behind the ear, more extensive surgery may sometimes be required.
NOTE ON GOING HOME:
Fluid accumulation in the ear is a very important situation in terms of hearing loss and its negative consequences and the future health of the ear. It is important that these children be followed by the same doctor if possible and for at least 2-3 months, longer if necessary. If it does not improve, ear tube insertion should not be avoided. Adenoids are often removed during ear tube insertion.
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