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Fluid collection in the middle ear and frequent ear inflammation is a common condition in children. Ear and Nose Throat Specialist from Anadolu Medical Center Example: Anil Gungor answers frequently asked questions about middle ear inflammation and ear tubes.
: What is middle ear inflammation?
Dr. Anil Gungor: Fluid collection in the middle ear and frequent ear inflammation is a common condition in children. It is usually due to the incompatible functioning of the Eustachian tube, frequent upper respiratory infections due to childhood conditions, and the inadequacy of the developing immune system. Most children between six months and 6 years of age have one or several times otitis media. Older children are less likely to have otitis media. If the otitis media is left untreated and persists for a long time, permanent hearing loss in children may result in difficult-to-correct damage to the eardrum and middle ear. Bacteria and viruses can reach the middle ear through eustachian tube as well as through droplet infection. As a result, inflammation fluid is collected in the middle ear. Accumulation of fluid in the middle ear may become continuous if the otitis media is not treated or if there are recurrent inflammations.
: Why is it more common in children?
Dr. Anil Gungor: Eustachian tube function in children is slower and more inadequate than in adults. The shape, slope and length of the Eustachian tube are very different from the adult. The Eustachian tube is either insufficiently opened or frequently does not close if necessary. This improper function of the Eustachian tube is further impaired in the inflammation and growth of nasal flesh in children. Allergy, sinusitis, and exposure to cigarette smoke often cause deterioration of the Eustachian tube function. If this condition is persistent, the inflammatory fluid in the middle ear becomes permanent, thickens, and can reach glue consistency. This fluid can damage the eardrum, middle and inner ear in the long term due to by-products resulting from metabolic activity. In addition, up to 30% loss of hearing may be present in the presence of fluid. Since this fluid contains protein and sugar, it is easier for germs to grow in the middle ear, and often to develop new middle ear infections.
: What are the causes of otitis media?
Dr. Anil Gungor: Very young children may not be able to express exactly where they are paining, and therefore ear pain. Most middle ear infections develop after a child has a cold in the last 10 days.
Your child may have otitis media if you have the following symptoms:
• Perpetually tugging and scratching the ears, restlessness
• Decreased appetite and changes in sleep patterns
• Ear discharge
• Hearing difficulty
• In case of long-term
o Balance disorders, frequent falls, impact, clumsiness, delay in walking
o Delay in speech, failure to understand child's speech
: When should I consult a doctor?
Dr. Anil Gungor: If you suspect an otitis media in your child, you should consult your ENT doctor.
: How is it examined?
Dr. Anil Gungor: Your doctor will look at your child's ear with an illuminated instrument called an otoscope, evaluate the mobility of the middle ear and eardrum by pneumatic otoscopy, and if necessary measure middle ear pressure and function with a test called tympanometry. A hearing test may also be ordered if deemed necessary. Appropriate treatment will be initiated according to the condition detected in your child's ear.
: How is the treatment performed?
Dr. Anil Gungor: Surgical treatment is not the first choice of treatment for otitis media. 70% of middle ear infections heal themselves, without any intervention because most of them are due to viruses or the body's normal immune system overcomes these infections. Antibiotic treatment is often successful in middle ear infections caused by bacteria.
It has been repeatedly shown in the world literature that drugs in the decongestants and antihistamines group used in colds (in the form of nasal drops or pill-syrups) do not have the benefit of opening the eustachian tube and allowing it to drain from the middle ear fluid when collected. Especially oral decongestants have serious side effects. However, they are often and incorrectly recommended, with the belief that they will be useful. The use of an unhealthy drug puts your child unnecessarily at risk and exposes them to serious drug side effects. Medication can improve middle ear inflammation and middle ear fluid. Because of the inadequate function of the Eustachian tube until these ages pass, inflammation or fluid collection in the middle ear may occur in a new cold.
: When do I need surgery?
Dr. Anil Gungor: If your child's otitis media does not respond to appropriate medical treatment, fluid accumulation becomes continuous and hearing loss is high, surgical treatment may be recommended. The following criteria are used in the decision to install a tube:
• 4 or more otitis media over a 6-month period
• 6 or more otitis media over a 12-month period
• Fluid in one ear for more than 6 months
• Presence of fluid in both ears for more than 3 months
• Moderate hearing loss
• Complications during otitis media (meningitis, brain abscess, facial paralysis)
• Children with severe and widespread allergies to antibiotics
• Middle ear inflammation with high fever in the newborn
• Middle ear inflammation in immunocompromised infants
: Can you tell us about ear tube surgery?
Dr. Anil Gungor: During surgery, a small tube is placed on the eardrum and left there to allow air to flow through the tube to the middle ear. Ear tubes come in various forms and usually prevent the development of middle ear inflammation once they are inserted. Thanks to the tube, the fluid in the middle ear is discharged through the eustachian tube and tube. Generally, the total length of stay in the hospital is not longer than a few hours unless nasal surgery or tonsil surgery is performed at the same time.
: Do I need special care after ear tube surgery?
Dr. Anil Gungor: Ear tubes provide air to the middle ear and usually prevent recurrent otitis media. However, there is a possibility of water entering the middle ear through the ear canal after the ear tube has been inserted. In this case, it is possible that bacteria and viruses in the water can cause inflammation in the middle ear. Therefore, after some ear-related activities (such as swimming, bathing, showering, etc.), it is best to protect your child's ear canal and use a plug if necessary.
In the presence of an ear tube, the risk of ear inflammation is reduced but continues. Ear inflammation is easily diagnosed by parents or carers-teachers because painless discharge from the ear. In this case, treatment of ear inflammation starts with antibiotic ear drops. If it does not respond to treatment within 3-4 days, antibiotics are given orally. Very rarely, the tube may need to be replaced if the discharge does not respond to medication.
: How long will the ear tube stay in the ear?
Dr. Anil Gungor: The ear tube usually remains in the eardrum for 12-18 months; then it falls spontaneously into the ear canal and the hole in the eardrum where the tube is inserted closes automatically. If the tube does not fall by itself, your doctor will advise you to take the tube for 18 months to 3 years. Although ear tubes are very effective in preventing middle ear infections, a single application may not be sufficient for definitive treatment. Tubes only benefit during their stay; If the inflammation recurs after the tube has fallen, the tube may need to be re-inserted.