Chronic Middle Ear Effusion
Middle ear effusion is a common ear problem among young children. It is characterized by accumulation of serous or mucoid secretion in the middle ear cleft. It results from either an alteration of the eustachian tube function or the mucociliary system or both. The disease, which produces a conductive hearing loss, presents as an educational or behavioral problem. It may also present as speech and language delay. Treatment varies widely and is naturally dependent on the duration and severity of the condition. It is accepted that mild forms of the disease resolve spontaneously. The remaining cases will be treated either conservatively or surgically.
Sometimes after an infection has been treated, there may be persistent fluid. The pain, fever, and irritability may resolve, however fluid continues to impede the movement of the ear drum. This can have significant impact on hearing. Hearing in young children is very important for proper language development. If the fluid is persistent for longer than 3 months, then ear tubes are recommended to remove the fluid and prevent recurrence of the fluid.
How is Chronic Middle Ear Effusion Treated?
Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum.
Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife), but it can also be accomplished with a laser. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).
In children, placement of ear tubes is an outpatient procedure. It is done under general gas anesthesia. The procedure only takes a few minutes. The ear drums are visualized under a high powered microscope. A tiny incision is made in the ear drum. Fluid is suctioned out and a tube is placed where the incision was made. For a day or two, there may be some bloody drainage and the child may be irritable.