It is one of the most common diseases of childhood and is also called “water collection in the middle ear” among the people. It is called “Serous otitis media (SOM)” or “otitis media with effusion (EOM)” by Ear Nose Throat physicians. Children in the 3-6 age group are most frequently affected.
How and for what reasons does fluid accumulation occur in the ear?
The structure we call the eustachian tube, which opens behind the nasal cavities and to both sides of the nasopharynx, ensures that the middle ear pressure is equalized with the outer air pressure (atmospheric pressure), thereby ventilating the middle ear. Functional disorders in the eustachian tube, which can develop for many reasons, disrupt the ventilation of the middle ear and create negative pressure (vacuum effect). As a result, fluid accumulation occurs in the middle ear. In time, thickening of the fluid in the middle ear is observed and this fluid becomes sticky (like a glue). Moreover, it may result in the eardrum retracting towards the middle ear and in the long term, the adhesion of the membrane to the middle ear base.
Causes such as the presence of adenoid (adenoid hypertrophy), allergies, upper respiratory tract infections, and insufficient treatment of middle ear infections cause fluid accumulation in the middle ear in childhood.
How is fluid accumulation suspected in the ear?
In the presence of fluid accumulation in the ear, the most common problem recognized by the family is hearing loss. If the problem continues for a long time, negative effects on speech and mental development may occur in children, as well as school failure, especially in school-age children. Another common problem with hearing loss is nasal congestion. The presence of an adenoid as a cause of nasal obstruction is frequently seen as the reason for fluid accumulation in the ear in these children.
How should the treatment approach become for fluid accumulation in the middle ear?
If there is no improvement in the fluid accumulation in the middle ear despite the medical treatments given in the appropriate content and time, a tube (ventilation tube) is inserted into the eardrum. Before deciding to insert a tube for fluid accumulation in the ear, the patient should be followed up for 2-3 months and if the patient does not recover during this period, then it should be decided to insert a tube. Because in most patients, fluid accumulation in the ear can spontaneously heal during this period. The purpose of inserting a tube into the eardrum is to drain the fluid accumulated in the middle ear and to provide the ventilation function which cannot be provided by the eustachian tube, by the external auditory canal through the ventilation tube. In this process, it also contributes to the healing of the disease in the middle ear.
In some exceptional cases, it is beneficial not to wait for the 2-3 month follow-up period and to insert the ventilation tube in a short time. These situations;
- Severe retraction in the eardrum,
- 35-40 dB or more hearing loss levels
During the ventilation tube insertion procedure, removal of the adenoid (adenoidectomy) and tonsils (tonsillectomy) can also be performed in the same session, if it is necessary.
How is the ventilation tube placed and how long is the duration of stay in the eardrum?
After this procedure, which is performed under general anesthesia and lasts as short as 10-15 minutes, the tubes placed in the eardrum remain for about 6 months on average. Tubes can sometimes be expelled in less than 6 months, or they may remain in the eardrum for up to 2 years. In case of a long stay, it is removed by the physician if deemed necessary.
The perforations in the tympanic membranes close in a short time after the tubes dropped. Although most of the patients recover completely with this treatment, repeated tube applications are rarely required. If repetitive applications are required (especially more than 2), permanent tube is applied and tubes of different structure called T-tube are used for this purpose.
What should be watched out after the operation?
By placing a tube to the eardrum, a hole is created in the eardrum and the integrity of the membrane is broken. In this case, with water escaping into the external auditory canal, it becomes possible to pass water to the middle ear, which causes otitis media. In order to prevent such situations, water leakage should be prevented with earplugs, and the head should not be put into the water while swimming in the pool or the sea. Or, special earplugs and headbands that can prevent water leakage can be used.
The tubes should be checked every 2 months to see if they fall or not. These follow-ups are important because the tubes will need to be reinserted in cases where eustachian dysfunction continues or fluid accumulation recurs, even if the tubes dropped on time.
