What is the importance of otitis media with effusion and being informed about otitis media with effusion?
Otitis media with effusion is a disease that is mostly seen in childhood (infancy and childhood). The most common ear disease in childhood after acute otitis media is otitis media with effusion. Its greatest importance is that it is the first cause of hearing loss seen in childhood. Since children need hearing to learn to speak, this hearing loss that occurs in the early stages of life also causes speech delay or impairment. Secondly, otitis media with effusion is a silent disease. Especially in children who do not undergo routine check-ups, the symptoms that would warn the family are faint until hearing loss occurs. In fact, when hearing loss occurs, it is quite often interpreted as "attention deficit". Having family knowledge about otitis media with effusion makes it easier to recognize the disease. Thirdly, there are currently many dilemmas open to interpretation in the treatment of otitis media with effusion. For this reason, more than any disease, the physician needs the cooperation of the family - and the patient, if old enough to understand - in determining the ideal treatment plan. In addition, follow-up has an important place in the treatment of otitis media with effusion; in this case, concerns about the feeling of "sitting around without doing anything" that may occur in parents will decrease as they become informed about the disease.
What are the symptoms of otitis media with effusion?
Otitis media with effusion in childhood is a silent disease. Common symptoms are restlessness, behavioral changes, hearing loss in later periods, speech delay and speech impairment. Some children with otitis with effusion may experience earache when they have a cold. It manifests itself as hearing loss, insensitivity to sounds, not responding when called from behind, and for older children, turning up the volume on the television or watching the television closely.
How is otitis media with effusion diagnosed?
The diagnosis is made mostly during routine examination. In diagnosis, otoscopy or autoendoscopy (the eardrum is examined by lowering the light with the otoscope or endoscope) n examination) is the first stage. The system called pneumatic otoscope, which allows applying positive or negative pressure to the eardrum during examination, makes it easier to reach the diagnosis. Otomicroscopy, that is, examining the eardrum with a microscope, also increases the diagnostic value. The test frequently used in diagnosis and follow-up is to record on paper the vibration caused by a sound wave given through the ear canal on the eardrum. This test is called Impedancemetry or Tympanometry. However, although tympanometry almost always shows that middle ear ventilation is normal, it should be kept in mind that the slanting (type B) curve, which shows the limitation of eardrum movements, does not always prove the presence of fluid in the middle ear cavity.
Ear (ventilation) What is ) tube? What is the purpose of tube insertion? How does it function?
Ventilation tubes are made of inert materials such as teflon, silastic and gold, have a hole in the middle where air can enter the ear, and are small (1) tubes that are wider at the front and back. -2 mm diameter) cylinders. The reason for tube insertion is that the eardrum repairs itself 48-72 hours after the liquid in the middle ear is drawn by scratching the eardrum and the effusion occurs again in a short time. Following tube insertion, hearing immediately returns to the pre-disease period, the amount of CO2 in the middle ear decreases, the amount of O2 increases and CO2 and O2 levels return to normal, changes in the middle ear mucosa in the following periods completely revert and secretion normalizes. The main purposes of tube insertion are to ensure that hearing returns to normal, to protect the child from permanent hearing loss, and to prevent the emergence of speech problems. Tube insertion should be considered a preventive intervention rather than a curative one. Because when we extend the follow-up for more than 3 months, some of the effusions will heal on their own. However, tube insertion prevents the prolongation of hearing loss and the development of possible speech problems related to it, as well as the emergence of permanent inner ear type hearing loss, which may rarely occur during the course of otitis media with effusion, and structural problems such as atrophy (thinning) of the eardrum, collapse pocket, and complete collapse of the eardrum. It aims to prevent the development of disabilities. A significant decrease in the frequency of ear diseases has been observed in adults who spent their childhood after ventilation tubes became widely used in all countries, compared to adults who spent their childhoods before the installation of ventilation tubes became widespread.
How are ventilation tubes inserted?
Although it is a procedure easily performed under local anesthesia in the examination room in adults, it is performed under general anesthesia in children. In this case, tube insertion is done in the operating room while an anesthesiologist has anesthetized and monitored the child. Anesthesia duration is approximately 5 to 10 minutes. Without any external incision, the eardrum is reached through the ear canal opening and a hole is made with a small incision. The existing fluid is usually withdrawn with an aspirator and the ventilation tube is placed in this hole. You can leave the hospital after two hours. Children under three months of age and children with chronic conditions such as heart and lung diseases or cerebral palsy may stay in the hospital overnight.
What should a child with a tube in his ear do?
Children do not feel the tube and do not feel any pain. However, children with ventilation tubes should protect their ears from water while swimming and bathing. Vaseline cotton or ear plugs can be used for this. Perth/Australia or Atlantic Coast/U.S.A. In regions where swimming is a part of people's lives, such as using antibiotic drops after swimming instead of protecting the ear while swimming, options such as using antibiotic drops after swimming are also on the agenda.
When and how is the tube removed?
Ventilation tubes are expelled from the eardrum and fall into the ear canal after an average of 6-8 months. During follow-ups at monthly or bi-monthly intervals after tube insertion, the tube is seen to be expelled and is usually removed from the ear canal by the physician. Sometimes it falls out of the ear canal on its own. Two years after tube insertion, any remaining tubes in the eardrum are removed by the physician. This procedure is performed under anesthesia in the operating room if the child is young, or in the examination room if the child is older.
Does the disease recur after the tube is removed?
It may. One ventilation tube insertion is curative for 90% of children, and even if fluid is detected in the middle ear later, it will be cured with medication. However, in 10% of children it is necessary to re-intubate. This rate increases to 25% for children under the age of two when the first tube is inserted. Children who require a second intubation often require repeated intubation attempts until the age of eight. For this reason, these children can be fitted with a "T tube" for the second time, which has a longer stay in the eardrum.
Aotitis media is the retention of serous or mucoid fluid in the middle ear for more than 3 months. In developed countries, the most important hearing loss in children is hearing loss. It is the cause of ear loss and peaks between the ages of 2-5. In the normal ear, the middle ear mucosa constantly secretes fluid and this fluid is discharged into the nasal passages through the eustachian tube. Any problem in the excessive secretion or excretion of this fluid causes this fluid to accumulate in the middle ear, leading to otitis media with effusion.
Acute otitis media causes effusion by both increasing fluid secretion and decreasing its discharge. Dysfunction (nasal passage) in the Eustachian tube due to any reason can also lead to effusion. Middle ear infection with effusion does not cause any complaints and may be seen incidentally during examination. The most important complaint is hearing loss. Although older children complain about hearing loss, parents, teachers and caregivers are usually the first to notice it. In young children, the only symptom may be delayed speech or behavioral problems. Another symptom is a feeling of blockage in the ear, which is a sign of playing with the ears in young children. During the examination, a dull gray and yellow eardrum with reduced movement is observed. Sometimes an air-fluid level or small air bubbles may be observed.
The first step in treatment is medication. For this purpose antibiotics, cortisone. decongestants and antihistamnics are used. After drug treatment, the patient's response to treatment is observed by examination and tympanometry. In addition, other problems such as adenoids that cause this are investigated. If there is no response to treatment, surgical treatment should be considered. Surgical treatment involves removing the adenoid, if any, and allowing the ear to ventilate. tubes are attached to the eardrum. These tubes are short-term tubes (Grommet) they remain in the membrane for up to 12 months, long-term tubes (T-tube) remain in the membrane for several years.
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