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If your child calls him or her several times, makes the TV sound too loud or watches closely, and if his / her success in lessons is decreasing, you should immediately consult a ENT specialist. Stating that fluid collection in the middle ear is very common in children with frequent upper respiratory tract infections, usually nasal congestion problems, or perhaps snoring during sleep. Hisar Intercontinental Hospital Otorhinolaryngology and Head and Neck Surgery Specialist Op. Dr. View Tayfun's Full Profile warns families against serious and permanent sensory loss.
What causes fluid in the middle ear?
Ear; outer, middle and inner ear. Otitis media, which is the inflammation of the middle ear, is the inflammation of the mucosa covering the eustachian tube and the air cavities of the bone in the middle ear and middle ear. It is one of the most common diseases in childhood. There are many clinical features characterized by inflammation of the cavities in contact with the middle ear and nose. These conditions may turn into each other over time. The accumulation of fluid in the middle ear (Serous otitis media (SOM)) is a type of middle ear inflammation characterized by fluid accumulation behind the intact eardrum without signs of general and local infection.
How does the middle ear inflammation separate the accumulation of fluid in the middle ear?
After the healing of acute otitis media, effusion may remain in the middle ear behind the intact eardrum and gradually disappear. 52% of effusions disappear within four weeks and 80% disappear within eight weeks. Therefore, after an episode of otitis media, effusion in the middle ear should be considered as SOM, ie, Accumulation of Fluid in the Middle Ear, if it exceeds the critical period of three months and should be treated. In other words, the patient does not express complaints of ear pain and discharge, fever and the like. To our knowledge, SOM is a transitional form between acute otitis media and chronic otitis media.
What are the symptoms of fluid build-up in the middle ear?
Generally, the only complaint of the parents is that their children do not respond to them, pass the questions with irrelevant answers and watch television very closely. The child's reaction to sound is reduced. For children attending kindergartens and kindergartens, teachers notice that the child does not hear. Families say that hearing loss increases with recurrent upper respiratory tract infections. Because bilateral hearing loss is more severe, it is noticed earlier.
At what age is the risk of fluid accumulation in the middle ear high?
In the USA, the incidence of children in the 6-12 age group was reported as ”. No clear frequency has been reported in our country.
What are the factors that increase the risk of fluid build-up in the middle ear?
Many factors have been identified that increase the risk of fluid build-up in the middle ear. It is known that the risk of upper respiratory infections increases 6-7 times or more frequently in children in the age group of two to six years. Due to the mass effect, the size of the nasal flesh obstructs the so-called nasopharynx, causing difficulty in breathing and forms a continuous reservoir of pathogenic bacteria. Improvement and inadequate treatment of children with frequent upper respiratory tract infections in the summer may also cause fluid accumulation in the middle ear. The presence of any allergic disease in the child, general and local immune system disorders, premature birth, low body weight, early discontinuation of milk, frequent in crowded environments, living area and climatic conditions, moisture level are among the factors directly affecting the risk.
How is fluid accumulation in the middle ear visible during the examination?
The image in the ear examination depends on the type of effusion. In serous effusions, the eardrum is usually transparent. It may have partially collapsed inward. In some cases, fluid levels may occur. The fluid opening is in the form of an up-facing horseshoe-shaped arc. In mucoid effusions, the eardrum may look dull brownish. No illuminated triangles. Some cases of capillaries become apparent in this brownish color.
How is sensory loss measured in patients?
Hearing deficiency in these patients can be detected by audiological tests. If the child is older, it is possible to demonstrate conductive hearing loss by tuning fork. Conductive hearing loss ranging from 25-40 dB audiologically is detected in cases with effusion. Impedance audiometry is the most widely used and common diagnostic method. B-type curves that do not peak indicate effusion. However, the number of false positivity findings has increased up to 30% in some applied studies.
What are the consequences if the disease is not treated?
The infancy and playful childhood, in which the disease is common, is the period in which children learn to speak and recognize their environment. Researchers have reported that such children's ability to learn and use language and social cohesion are worse than normal children. In order to survive this disease, which is known as childhood disease, it is only possible with the advancement of age and the application of effective treatment methods (medication, tube insertion, nasal flesh removal). If it repeats and progresses frequently, it may lead to a condition called calcification of the ear, hearing loss in the inner ear, cholesteatoma, which necessitates surgeries that cause great distress in the future. If the infection progresses towards the brain, meningitis and even death may occur.
How is the disease treated?
In therapy; The first step is to identify inherent risk factors. These include age, presence of chronic upper respiratory tract infections, nasal flesh, allergy, facial developmental anomalies and immune system disorders. Environmental risk factors, especially in the seasons, also play an important role in the treatment plan. If the effusion is bilateral and persists for more than three weeks, this effusion is likely to become chronic.
The younger age reduces the success of the treatment and increases the likelihood of recurrence. The same goes for the seasons. Spontaneous remission has been reported in 20% of patients in whom there is no serious underlying pathology. Antibiotics improve at a certain rate, but frequently recur. Therefore, it is necessary to check the intermittent control of patients on antibiotic therapy and keep in mind the possibility of recurrence.
The family should be careful about this. However, some patients require steroid treatment to prevent active injection. Because the steroid has an effective anti-inflammatory effect. However, contradictory information is available on this subject.
Sinusitis and similar infections and large nasal flesh affect the treatment negatively. If the tonsils are too large and have nasal flesh, then surgical treatment is inevitable. In these cases it is unnecessary to waste time with medication. Adenoid vegetation is taken and a ventilation tube is inserted into the ear. Ventilation tubes ventilate the middle ear with air at normal gas concentrations and allow pressure in the middle ear to reach atmospheric values. It improves hearing loss caused by accumulation of fluid in the middle ear and negative pressure. However, it should be kept in mind that in such children, the tube may recur after the discard. The main factor affecting the recurrence rate is the age of the patient. In addition, impairments in the function of the Eustachian tube and inadequate intake of nasal flesh increase this risk.
In children with ventilation tubes, it is recommended to protect the ear from water. The tube may occasionally become clogged and makes hearing impaired. Sometimes bleeding after insertion of the tube may also cause the tube to clog. In this case, the plug should be softened and aspirated using oxygenated drops prepared with pure oxygen or acid boric. If a discharge is seen while the tube is inserted, either the middle ear inflammation has recurred or external infection has been transmitted to the middle ear. Very rarely, the tube may fall into the middle ear. Care must be taken in this regard. One condition that results from tube insertion is permanent perforation. This possibility is seen in larger and longer tubes and is also related to the duration of the tube stay. The duration of ventilation tubes varies between two months and two years.