Middle ear
infections are extremely common and occur in
all age groups. Middle ear infection is
also known by its medical name, otitis
media. Most commonly, young children are
affected by middle ear infections; however,
adults can be affected too. There are
several theories for the susceptibility of
children to otitis media. These theories
include an immature immune system, immature
development of the Eustachian tube, or
environmental factors such as parents that
smoke or day care facilities.
The ear has three
different parts described as outer, middle,
or inner. The outer ear includes the
auricle (the part of the ear that sticks out
from the head) and ear canal. Swimmer’s ear
is an outer ear infection involving the ear
canal; outer ear infection is also known as
otitis externa and is different from middle
ear infections. Infections that involve the
bony covered sensory structures of the inner
ear produce profound sensorineural hearing
loss and severe dizziness.
The middle ear is
between the outer and inner ears. It is an
air filled space that communicates with the
mastoid bone behind the ear and with the
nose though the Eustachian tube. The
eardrum forms a barrier between the ear
canal and the middle ear. Sound is
conducted into the inner ear by bones that
form a chain between the eardrum and the
inner ear. The Eustachian tube connects the
middle ear with the nasopharynx (the passage
between the nose and the throat) and
functions to equalize the pressure in the
middle ear with the outside pressure. A
good test of the Eustachian tube function
occurs during decent in an airplane flight
when, either through yawning or swallowing,
air pressure is equilibrated and your “ears
pop.”
When the Eustachian
tube does not function normally either
through immaturity or due to blockage from
infection or enlarged adenoids in the
nasopharynx, fluid builds up in the middle
ear. As this fluid builds up it stretches
the tympanic membrane and causes intense
pain. Additionally, the fluid does not
allow the eardrum or the little bones in the
middle to vibrate and produces a mild
conductive hearing loss. This fluid
pressure can so stretch the eardrum that it
can rupture, and the fluid drains from the
ear.
The symptoms of
middle ear infections include hearing loss,
fever, ear pain and occasionally ear
drainage. Your physician can diagnose a
middle ear infection by discovering these
symptoms and by careful inspection of the
ears and eardrums. A normal eardrum is
translucent and mobile when a small puff of
air is placed in the ear canal. Ears with
otitis media usually have eardrums that are
bulging with whitish-yellowish fluid and
that do not move with pressure. A hearing
test or audiogram sometimes helps to
diagnose a middle ear infection.
Antibiotics are the
mainstays of treatment for otitis media.
Occasionally other medications, such as
decongestant, antihistamines or nasal
steroid sprays, are used to control
underlying diseases of the nose. When ear
infections persists or recur in spite of
appropriate treatment, your doctor might
recommend placement of a tube in the
eardrum. An incision, or myringotomy, is
made in the eardrum. This allows the middle
ear fluid to be removed, and a tube is
placed to keep the incision open. This
procedure bypasses the Eustachian tube and
allows the middle ear to heal. This
procedure can be done under local anesthesia
in adults; a short general anesthetic is
required for children. It can be done at
the same setting as a
tonsillectomy/adenoidectomy
if the child has problem with enlarged
tonsils or adenoids.
The tube remains in
place for a few months to a year depending
on the type of tube and the indications for
its placement. Over time the eardrum pushes
the tube out and the hole where the tube was
heals over. As long as a hole or tube is in
the eardrum, the ear must be kept dry.
Water can be kept out of the ear during
bathing or showering by rolling a cotton
ball in Vaseline.
The risks of
tympanostomy tube include infections or
continued perforation of the eardrum. If
this hole remains in a diseased ear, it
allows infections to drain just as a tube
would. If the hole remains and the ear is
without disease, surgery can be done to
repair the hole
(tympanoplasty).
Post-operative instructions
for myringotomy and tube.
