Acute Ear Infections

Middle Ear

The space behind the eardrum, which is filled with air under normal conditions, is called the "middle ear". The pressure in the middle ear tends to be negative due to the absorption of air by the ear mucosa. The middle ear pressure is equalized with the ambient pressure by taking air from the nasal passage through the Eustachian tube, which opens during swallowing. When the pressure on both sides of the membrane is equalized, the membrane becomes fully flexible, where sound is best transmitted. When the pressure in the middle ear decreases, problems begin to occur in the transmission of sound.

This situation usually occurs due to deterioration in the functions of the Eustachian canal, which connects the middle ear to the nasal passages. The basic functions of the eustachian canal are to control middle ear pressure and to ensure the discharge of middle ear mucosa secretions. Functional problems of the Eustachian tube, which is both short and straight, are observed more frequently in young children. After the age of seven, the canal acquires an anatomy that will enable its normal functions. Surgical Treatment

Normal Hearing

For normal hearing, 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, sound waves 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 nerves.

What is Middle Ear Infection?

Middle ear infections occur in the middle ear space located behind the eardrum. are inflammations. The causative agent of middle ear infections is usually viruses or bacteria. Middle ear infections often occur following a deterioration in the function of the eustachian canal, 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 in young children has not fully completed its anatomical development, the ear canal is affected by the differences in eustachian canal functions and anatomy. bsp; infection is more common.

Characteristics;

• In children under the age of five,

• In men

• In bottle-fed babies,

• In children going to kindergarten,

• Good Middle ear infections are more common in children who live in unventilated crowded environments and are exposed to cigarette smoke.

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

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

Normally, the middle ear is opened for a short time with each swallow. The most important reason is the disruption of the Eustachian tube functions, which regulate ear pressure, due to reasons such as viral, bacterial infections or allergic reactions. As a result, the middle ear cannot be ventilated and the middle ear fills with fluid (serous otitis) as a result of fluid withdrawal from the tissues due to the accumulation of ear secretions and the negative pressure created by the absorption of air from the mucosa. As a result of the darkening of the mucosal secretion due to long-term negative pressure, secretory otitis media occurs, which is a more chronic condition.

Because of this fluid, the eardrum cannot vibrate properly and transmit sound waves, and hearing loss occurs in the child. This mild hearing loss leads to 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 turns up the volume of the television too much or sits too close to it.
• He does not immediately respond to what is said or does not pay any attention to what is said because he cannot hear it properly.
• At school, the teacher's interest in what he says decreases, and he begins to fail in his classes.
• Middle ear fluid and hearing loss should be investigated in lazy children at school.
• Especially like "s" and "z". Speech disorders may occur due to consonants not being heard well.

Causes of Serous Otitis

• Enlargement of the adenoid. Targeted nasal filling (adenoid hypertrophy)
• Nose and sinus infections
• Acute middle ear infections
• Allergy, immune system deficiency
• More rare These are tumors that primarily affect the function of the eustachian duct.

Diagnosis of Serous Otitis

Serous otitis is a silent disease and does not usually present with obvious complaints such as fever, vomiting and pain. The diagnosis is often made during examinations due to adenoid-related complaints or as a result of suspicion of hearing loss.

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 middle ear structures, and dark color changes. The disease often affects both ears. Hearing loss may not be noticed in unilateral serous otitis, but symptoms such as imbalance, difficulty in sports activities, and difficulty in walking may be observed in these patients due to the impact of the balance center. As diagnostic aids, middle ear pressure measurement, hearing reflexes measurement, 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 of Serous Otitis

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 canal.

It may be appropriate not to send children who go to nursery to this environment for about 1 month, especially those who have frequent acute otitis attacks along with serous otitis. It should be recommended that bottle-fed children be fed 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.

The failure of the treatments applied in six to eight weeks also results in hearing loss over 20-25 dB. In this case, surgical treatment is preferred. If there is thinning, collapse or pocketing in the eardrum, if nerve type loss has occurred or if balance disorder has begun, direct surgical treatment can be chosen.

In surgical treatment, a ventilation tube is inserted into the eardrum, following which the hearing loss recovers immediately. Additionally, adenoids and tonsils can be removed if necessary. The ventilation tube is applied to children under general anesthesia, 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. Allergies and immune system functions should be evaluated, especially in children with recurrent serous otitis complaints.

There is generally no harm in children with eardrum tubes inserted into the sea, as long as they do not dive more than one meter in areas where the water is clean, but especially in swimming pools and with soapy water. While taking a shower or bath, the outer ear canal should be closed with Vaseline cotton or a suitable ear plug to prevent water from entering the middle ear from the tube.

Acute Middle Ear Inflammation

Acute middle ear infections are usually caused by bacteria. or 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 ventilate, 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 cavity with the effect of negative pressure accumulates in the middle ear and pushes the membrane outwards.

In the early period of the examination, the eardrum is red, edematous or swollen like a balloon. The middle ear is full of inflammation. When the membrane thins and pierces at a point due to inflammation, the fluid in the middle ear flows out and creates ear discharge. During this period, complaints of fever and pain are relatively common. decreases. Failure to receive appropriate treatment may result in progression of the disease and complications.

Causes of Acute Otitis Media

• Impairment of Eustachian tube function

• Multiplication of bacteria in the middle ear
• Diseases of the nose and sinuses
• Other upper respiratory tract diseases
• Allergy
• Immune system deficiency
• Blood-borne infection to the ear may occur (rare)

Diagnosis of the Disease

It is an inflammatory process that begins and progresses rapidly in the middle ear. It is recommended that you immediately go to an ear, nose, and throat specialist when you experience complaints such as ear pain, fever, vomiting, loss of appetite, ear blockage, discharge or hearing loss, and babies pulling their ears.

In such a case, diagnosis of infection is made and treatment begins as early as possible. It is important.

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 treatment approach 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 adenoid, which is usually located right around the opening of the Eustachian duct opening into the throat, is also large and It negatively affects the function of the eustachian duct. In some cases, it is possible for airborne microbes to be retained here and transmitted to the middle ear through the Eustachian canal. 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 complain of chronic nasal congestion, sleeping with their mouth open or snoring.

Treatment

Most children have at least one middle ear infection in their first two years of life. passes. 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. The middle age of inflammation in the pre-antibiotic years with today's drugs

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