The most common expression of this most common disease of childhood is "water accumulation in the middle ear". The condition of fluid accumulation in the middle ear in childhood is most commonly referred to as SOM (serous otitis media) in the ENT literature, but most accurately it is called EOM (otitis with effusion). It is called media). EOM is a disease that can be treated definitively. In a significant portion of children, the disease may even resolve spontaneously. If there is no improvement within a month, drug treatments may be tried. In stubborn cases, definitive treatment can be performed by surgical.
STRUCTURE OF THE MIDDLE EAR
The outer eardrum It is located at the end of the ear canal. The front surface of the membrane is adjacent to the external ear canal, and the back part is adjacent to the middle ear cavity. Sound waves hitting the membrane reach the inner ear by vibrating the hammer bone, which is connected to the membrane, and then the anvil and stirrup bone, respectively. These hammer, anvil and stirrup bones, located in the middle ear and connected to each other, are known as the ossicular chain. In order for sound energy to reach the inner ear in the most ideal way, a solid and freely vibrating eardrum and ossicular chain are needed. In order for the eardrum and bone chain system to vibrate comfortably, both sides of the eardrum must be filled with air at equal pressure. The outer side of the eardrum is directly open to the atmosphere through the outer ear and is under the influence of 1 atmosphere of air pressure. The air of the middle ear cavity at the back of the membrane comes from the nasal passage through the Eustachian tube. >The nasal area is located at the back of the nasal cavity, in the upper area of the soft palate and uvula. During breathing, air passing through the nose passes through the nasal passages and reaches the larynx. During the development of a healthy child, adenoid tissue (adenoid) begins to grow in the nasal area from an early age. If a mass is found occupying space in the nasal area, nasal congestion occurs and the mouth is used to breathe. Eustachian tube due to adenoids If there is a dysfunction in the ear, air delivery to the middle ear is disrupted.
FLUID COLLECTION IN THE MIDDLE EAR
If the Eustachian tube does not work, the air pressure in the middle ear decreases. and a vacuum effect occurs. In other words, the air pressure in the outer ear remains relatively high, and the eardrum begins to collapse towards the middle ear under the influence of positive pressure. If this situation lasts for a long time, secretion is produced by the middle ear covering. As a result, the middle ear cavity is filled with fluid and inner support is formed for the eardrum.
If the Eustachian tube dysfunction is corrected within a few weeks, the secretions will be discharged into the nasal passages and everything will return to normal. However, if the obstruction lasts longer, the secretions gradually thicken and reach the consistency of glue, preventing the membrane and ossicles from vibrating and causing moderate hearing loss. If the problem persists for months, it may cause adhesions in the middle ear and permanent problems that extend into adulthood.
MEDICAL TREATMENT OF THE DISEASE
Sometimes improvement can be achieved even without medication during the follow-up of EOM. It may happen. If the complaints do not improve within a few weeks in a newly detected case, middle ear pressure should be measured and treatment with various medications should be tried. If both the patient's history and examination and test results suggest that there is a long-term problem, the treatment option should be surgery before it is too late.
SURGICAL TREATMENT OF THE DISEASE
Ear surgery The membrane is pierced and the fluid is drained, and a tube must be placed to help carry air to the middle ear so that the hole does not close immediately. If the adenoid is thought to be the cause of the pathology, the adenoid also needs to be removed surgically.
FOLLOW-UP AFTER SURGERY
By inserting a tube into the eardrum, the integrity of the membrane is disrupted. In this case, if water gets into the outer ear canal, it is possible for the water to pass into the middle ear and cause inflammation in the middle ear. Ear plugs should be used to prevent water leakage, and the head should not be submerged when entering the pool or the sea. Tubes should be checked and monitored every 2-3 months. Just as our body disposes of all foreign substances in its body, it will also generally dispose of the tubes. If the tubes are removed before the problem that prevents the Eustachian tube from ventilating in the nasal cavity is corrected, they may be removed again. may need to be placed. In patients whose nasal obstruction persists for a long time, special tubes that can remain in place for a long time can be inserted. In general, tubes are not allowed to remain for more than 2 years. Tubes that remain in place for a long time or tubes that cause inflammation in the middle ear can be removed during an ENT examination.
MUST NOT BE FORGOTTEN
– EOM is the most common disease of childhood.
– Usually the reason is the enlargement of the adenoid.
– Treatment of this disease is possible.
– Even if the adenoid is removed, it may grow back depending on the child's age and physiology, and if it causes dysfunction, it may need to be removed again.
– Water should not be allowed into the ears where tubes are inserted.
strong>– Monitoring of ear tubes is important.
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