It is a clinical condition characterized by fluid accumulation in the middle ear cavity behind the intact eardrum without signs of acute infection. Symptoms such as fever, rash and severe ear pain are not observed in these patients. Fluid in the ear usually occurs following an acute otitis media. Due to the effect of inflammation, a blockage in the Eustachian tube usually occurs. Over time, a negative pressure occurs in the middle ear. After a while, the middle ear mucosa undergoes a secretory change, causing the fluid in the ear to become permanent. Apart from middle ear infections, barotrauma, nasopharynx cancers, radiotherapy and allergies can also cause fluid accumulation in the ear. Especially in adults, when there is fluid accumulation in the ear on one side, the presence of a nasal tumor must be excluded.
Fluid accumulation in the middle ear is one of the most common diseases of childhood. The reason for this is that the eustachian tube is more parallel to the ground plane in young children. Children in kindergarten and nursery environments are at greater risk. Fluid accumulation in the ear is more common in children from smoking families. The presence of adenoids in children is a risk factor for fluid accumulation in the ear because the adenoids act as a reservoir for microorganisms. When the fluid in the middle ear is examined, the microorganisms frequently produced are S. Pneumonia, H. Influenza and M. Catarrhalis, just like in acute middle ear infections.
HOW TO DIAGNOSE FLUID COLLECTION IN THE MIDDLE EAR
Fever and severe earache are usually not observed in sick children. There is often a state of restlessness in children. These children constantly put their hands to their ears. Patients have a mild degree of hearing loss. On examination, the eardrum is seen to be opaque and bulged outwards. Over time, the eardrum begins to collapse. In the tympanometry test, negative pressure is observed in the middle ear and acoustic reflexes cannot be obtained. Conductive hearing loss is observed in the hearing test.
WHAT IS THE NATURAL COURSE OF FLUID COLLECTION IN THE EAR
The fluid in the ear usually disappears spontaneously within 3 months. However, the fluid may persist in 10-20% of patients. This is In this case, over time, the eardrum begins to collapse due to the effect of negative pressure. Over the years, the eardrum becomes attached to the middle ear wall. Melting occurs in the ear ossicles. Some patients may develop a disease called cholesteatoma.
HOW IS FLUID COLLECTION IN THE EAR TREATED
Medication
Drug therapy is the first choice treatment method. Drugs frequently used for this purpose are antibiotics, decongestants, antihistamines, steroids and vaccines.
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Antibiotics: The most commonly used drugs in the drug treatment of fluid collection in the middle ear are antibiotics. There is no consensus on how long antibiotics should be used. Many physicians prefer to use antibiotics for at least two ten-day applications for a period of 1 month. The most commonly used antibiotics for this purpose are; amoxicillin-clavulanic acid, cephalosporins, co-trimaxazole and macrolides.
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Decongestants: their effectiveness has not been scientifically proven. However, many physicians prefer to use topical decongestants together with antibiotics for a short time (4-5 days). Some physicians may use systemic decongestants taken orally for a longer period of time.
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Steroids: Although steroids used systemically help lose fluid in the short term, fluid re-forms in the long term. Considering its side effects, steroid use is undesirable. However, topical steroids can be used nasally. However, their effectiveness has not been proven.
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Antihistamines: Unless there is an underlying allergy, the use of antihistamines is not the right option.
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Vaccines. : studies conducted in recent years show that pneumococcal and H. Influenza vaccines have positive contributions to the formation and treatment of recurrent middle ear infections and otitis media with effusion.
Surgical Treatment (ear Inserting a tube into the membrane )
Surgical treatment is considered in cases of fluid collections that do not improve with medication for more than three months. The method used in surgical treatment is to insert a ventilation tube into the eardrum. The aim here is to reach the middle ear It is to break the vicious circle by allowing the air to ventilate. Fluid collections in the ear usually respond well to tube insertion. However, in some cases, the ventilation tube may have to be inserted several times. In some cases, the course of the disease may continue despite the ventilation tube. In this case, larger surgeries such as tympanomastoidectomy may be required.
In some cases, ventilation tube application may be considered at an earlier stage. These situations;
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presence of recurrent middle ear infection
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collapse of the eardrum
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Hearing loss greater than 35 dB
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development of inner ear type hearing loss
Inserted ventilation tubes, They stay around 6-12 months depending on the type. During this period, patients should protect their ears from water. Once the ear heals, the tube is usually removed on its own and no further action is required. The hole in the eardrum closes spontaneously in a short time. Very rarely, the hole in the eardrum may not heal after the tube is removed. In this case, it may be necessary to close the hole surgically.
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