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Chronic Otitis Media with effusion is a condition where the middle ear space is chronically infected with a persistent collection of fluid. This frequently causes ear pain, hearing loss and fevers in children.
Common causes of this condition include bacteria or viruses and are usually related to colds or allergy. Risk factors include age less than 5, bottle fed babies, and children in large group (>6) daycare. In adults, a mass in the back of the nose must be ruled out.
The area behind the ear drum equalized air pressure through a tiny tube called the eustachian tube. When one "pops" there ears by blowing hard with their nose pinched, the eustachian tube is the route by which air goes into the ear (see picture below):
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When the eustachian tube first gets blocked, fluid accumulates. This may be reversed with medication and even watchful waiting. |
After a period of time, the fluid can become chronic and will not drain causing pain, hearing loss and may require ear tubes and drainage. |
When this tube gets swollen and blocked (similar to how ears get blocked when a plane descends rapidly), pressure can build up in the ear. If not responsive to medical treatment, this may lead to a chronic condition.
Indications for ear tubes include:
a) Severe acute otitis media (myringotomy).
b) Hearing loss > 30 dB in patient with otitis media with effusion (myringotomy
or tube).
c) Poor response to antibiotic for otitis media (myringotomy or tube).
d) Impending mastoid bone infection or intra-cranial complication due to otitis
media (myringotomy).
e) Otitis media with effusion > 3 months (myringotomy or tympanostomy tube).
f) Recurrent episodes of acute otitis media (more than 3 episodes in 6 months
or more than 4 episodes in 12 months) (tympanostomy tube).
g) Chronic retraction of tympanic membrane or pars flaccida (tympanostomy
tube).
h) Barotitis media control (pressure damage from diving or flying).
i) Autophony (echoing) due to patulous eustachian tube.
j) Craniofacial anomalies that predispose to middle ear dysfunction (e.g.,
cleft palate).
k) Middle ear dysfunction due to head and neck radiation and skull base surgery.
Procedure for Ear TubesThe procedure is performed in an outpatient OR setting for children and often in the office for adults. The procedure is usally quick and takes less than 10 minutes to perform. The goal of ear tubes is to provide adequate ventilation of the middle ear space since blockage of the eustachian tube and subsequent pressure changes caused the problems in the first place. A second benefit is that if another infection is to occur, the fluid can drain out if the tube. One important consideration to remember is that the middle ear space (area behind the ear drum) is supposed to be sterile, that is not contaminated with bacteria. The ear drum functions as a protective barrier to bacteria-laden water from the shower of swimming pool. With an ear tube in place, a route for water to enter the middle ear is present and this can lead to recurrent infections. Thus, it is important to avoid dunking one's head under water and to be sure to wear some sort of occlusive device to protect the ears when around water. |
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Recovery is fairly rapid, rarely even requiring pain medication. Sometimes, residual drainage from chronic fluid will require antibiotic ear drops and/or antibiotics by mouth.
Although ear tube surgery does not make one immune to all bacteria and viruses, it does decrease the frequency and severity of ear infections. The tubes stay in place for 6-18 months at which time the ear drum will naturally push out the tube. Sometimes the holes persist but usually the ear drum heals up the opening within a week or two. Children will usually outgrow the need for tubes after the age of 7 as their skull develops and the eustachian tube resembles its adult configuration.