Middle ear infections or “Serous Otitis Media”, is actually a very common ear condition, especially in children. Behind the eardrum is the small bones that are used for hearing and the space is usually filled with air, which allows for the normal sound transmission. However in some cases this space can fill with fluid, which is normally the result of an upper respiratory infection or URI. Ear fluid can also build up behind the eardrum because of a common cold. However after the cold subsides the fluid normally drains from the ears by way of eustachian tubes which are small tubes that connect nose to the middle ear. Many times however there can be a eustachian tube dysfunction that can keep the ear from draining off the fluid, this happens more often in children and the space behind the eardrums remain blocked.
Because of the fluid behind the eardrum sound transmission is delayed and the person or child experiences hearing loss. The child or adult may complain of their ears being plugged up or they may need to turn the television up in order to hear sound. Sometimes however there are little to no symptoms, or symptoms of hearing loss such as being unresponsive to parents or teachers may be mistaken for bad behavior. In some instances fluid can be present for months before someone notices there is a problem such as a pediatrician during a well check.
In adults fluid behind the ears is often found because the patient will notice the muffled or distortion of sounds. In children however the fluid buildup can cause severe speech delay problems, this is because small children must hear in order to develop their vocabulary properly. By the time a child is almost two years of age they should be able to speak a fair amount of words, however if fluid builds up in the middle ear the child may have a noticeable speech delay and speech may be distorted to the child resulting in them having severe pronunciation problems. Speech development problems can be a very devastating problem especially to a young child’s school work such as with reading.
Proper diagnosis of middle ear problems such as fluid is vital in anyone, especially children. Diagnosis and early treatment is also important because if left untreated there can be severe damage to the eardrum and the middle ear causing irreversible hearing loss.
Children will usually have at least one or two ear infections by the age of five years and with proper treatment such as taking medication is taken as directed, most ear infections clear up on their own. Parents can also decrease the risk of ear infections such as otitis media in young children by refraining from propping bottles up when the child is laying down.
The normal treatment for middle ear infections is an antibiotic, if the fluid doesn’t completely go away additional medications may be prescribed. For chronic recurrent ear infections the child maybe referred to an ear, nose and throat doctor for possible pressure equalizing tube insertion.
Audiologic tests can be performed to check the level of hearing loss, in young children a test known as a distortion product otoacoustic emissions test or DPOAE can be performed to measure the amount of hearing loss. Another test known as a tympanogram can also be performed, a tympanogram is used to measure movement of the eardrum when pressure is applied, if fluid is present behind the eardrum the movement will be severely decreased.
Pressure equalizing tube insertion is done to drain the fluid and is performed by making a small incision in the eardrum so that aspiration of fluid can be done and a PE tube is inserted. The surgery is usually conducted in an office setting with a local for adults, however children usually have the surgery performed under general anesthesia on an outpatient basis.
The PE tube is inserted because the incision into the eardrum will generally heal rapidly, and this really is not long enough for the swollen membranes of the ear to return to normal. Thereby causing fluid to rebuild behind the eardrum, the tubes therefore are inserted to keep the ear open long enough for the healing process of membranes to finish.
Tubes also keep the eardrum open allowing air to enter the middle ear space and continue to allow for any residual fluid to drain. Tubes usually will fall out in less than six months to a year time. After the tube is extruded the eardrum usually seals quickly. Special precautions while the ear has a PE tube inserted must be taken such as refraining from getting any water in the ear.
It is also important that once recurrent ear infections are diagnosed and treated that the child regularly has ear checkups in order to identify any recurrent ear infections as quickly as possible. In some cases of severe recurrent infections there may be a need for continual PE tube insertions.
PE tube insertion and early treatment of ear fluid can significantly improve speech development.
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