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Serous otitis media, better known as middle ear fluid, is the most common condition causing hearing loss in children. Because children need hearing to learn speech, hearing loss from fluid in the middle ear can result in speech delay. Since the words sound distorted to the child, pronunciation of these words by the child will also be distorted. Additional antibiotics may be prescribed, if fluid is still present at the follow-up visit.
Other tests should be taken in addition to the hearing tests: impedance tympanometry, better known as a tympanogram, should be obtained to measure the movement of the eardrum when pressure is applied to it. After the specialist confirms that fluid is present behind both eardrums, further medical treatment is often advised. Surgery which drains fluid involves a small incision in the eardrum, so that the fluid can be gently removed and a tube can be inserted.
The procedure, medically termed a myringotomy and tubes, or tympanostomy and tubes, is performed on children under general anesthesia. In addition to the insertion of a longer lasting tube, a careful search for underlying causes of Eustachian tube function should be sought, particularly in a child who has recurrent infections and requires a second set of tubes. One way of estimating the size of the adenoids is to obtain a soft tissue X-ray of the back of the nose, called a nasopharyngeal X-ray. Research indicates that, in children with persistent ear infections and fluid problems, an adenoidectomy at the time of tube insertion may improve Eustachian tube function. Most children will eventually outgrow their problems with fluid by late adolescence or the early teens. Short term complications from the insertion of tubes, such as a minor ear infection, can generally be cleared up with antibiotics and drops. If a child has had tubes in place for six months, and suddenly the ear begins to drain, this may indicate a cold, or entry of water in the ear.
If there appears to be a polyp around the base of the tube, it should be removed if possible, or the tube itself should be taken out. Some ear, nose and throat specialists advocate removing the tubes in the operating room, and patching the eardrum at the time of removal. When tubes fall out or are rejected spontaneously, the eardrum almost always heals behind the tube. The proportion of permanent perforations increases directly with the number of tubes inserted in the past and the length that the current tube is left in position. There are instances, after the tube has fallen out or is removed, when the drum may not heal without surgical intervention. Before performing surgery, there should be reasonable expectation that the fluid problems have been cleared and that the patient is beyond the age of having Eustachian tube problems: the so- called maturity of Eustachian tube function. If the opposite ear has persistent infections and fluid problems, it may be advisable to deter the repair of the perforated eardrum until the opposite ear clears fluid and appears to have matured its Eustachian tube function. One significant exception to this situation would be if the perforation is marginal, at the edge of the eardrum.
A combination of decongestants and antibiotics will usually clear up the infection and allow the fluid to drain.
If fluid is still not cleared after medical treatment has been completed, surgical drainage and the insertion of a ventilating tube is often indicated. Once the eardrum is anesthetized, the eardrum is opened, and the fluid is removed with aspiration and suction. During the time the tube is in the ear, and pending confirmation that the drum itself has healed, water precautions are necessary. When fluid develops in one ear only, without the patient having a prior history of ear problems and no evident cause, such as a recent severe cold, the implications may be more serious. After all potentially serious causes for fluid in one ear have been eliminated, a tube is placed in the ear. The objective of permanent tubes is to bypass the poorly functioning Eustachian tube completely.
These individuals should be very carefully examined for all other treatable underlying problems, such as chronic sinusitis, nasal obstruction from a deviated septum or chronic allergies. Patients who have had cancer of the nasopharynx, or other areas of the head and neck, may require radiation as part of their treatment. After radiation, fluid often builds up in one or both ears, due to the radiation-induced swelling and inflammation of the Eustachian tube.
It may be prudent after radiation to wait several months for all inflammation to subside before inserting tubes. Fluid in the ear can occur after surgery of the head and neck, particularly radical operations on the maxillary sinus and palate for cancer. Consultation between the surgeon and the radiologist is often useful in determining the appropriate post-operative timing for the insertion of tubes. DISCLAIMER: The Ear Surgery Information Center offers and maintains this web site to provide information of a general nature about the conditions requiring the services of an ear surgeon. All other information contained within this web site is © 2016 Ear Surgery Information Center. Hailing from Kuching Sarawak, Leona Lim is a freelance writer and blogger now stationed in the Klang Valley. Enter your email address to subscribe to this blog and receive notifications of new posts by email. Yet, if one was to consider being completely deaf, that too poses an enormous challenge due to the hearing impaired person being very largely cut off from the normal personal and social interaction of daily life. Not only does a severely hearing impaired person become socially disadvantaged but they withdraw from society and often lose confidence with provocative changes in personality. So let’s look at the ear and hearing taking you through not only the anatomy but also discussing how hearing works and the various conditions which can and do affect hearing and what help can be offered. Once the wax has been removed, only then can you see the appearance of the eardrum. But one regularly sees patients who have damage to the ear by burns or even perforations of the eardrum. There are various degrees of Bat Ears but in the most common form there’s a lack of certain cartilage folds in the external ear causing the ears to stand out, some times to such a degree that enormous embarrassment is caused.
It’s a condition which in most cases is easily correctable by an out-patient procedure called Otoplasty where new folds are formed allowing the ear to be repositioned in a much more natural manner. The sad thing is that many parents and often family doctors don’t appreciate the negative impact this can have on a developing personality and the fact that in the vast majority of cases correction can be done, as mentioned, as an out-patient day procedure.
There are various techniques but the one we use removes no tissue from the ear relying solely on a re-fashioning and re-positioning of the natural external ear cartilage.
So recall that Bat Ear deformities can cause significant psychological problems and can often be easily corrected.
The canal leading from the Pinna to the Ear Drum is important not only as regards its shape being a factor in conducting the sound waves to the ear drum, but also in that it’s rich collection of cerumen producing glands can be a factor in the production and collection of wax which can produce canal blockage. In most cases it is reasonably easily controlled by cleaning the ear with microscope and suction and application of creams or dressings but in very difficult cases there is surgery available where the canal is widened and this can produce a significant improvement in reducing the occurrence. With the enormous popularity of surfing in South Africa this is a condition one is seeing with increasing frequency. Walking along a beach with many surfers you’ll often, when they come out of the water, see them shaking their heads, rather like a frustrated dog, trying to clear the ear because of water trapped behind the osteomata.


When osteomata cause significant symptoms they can be removed by a surgical procedure where the osteomata are drilled away re-fashioning the canal and reducing the chance of obstruction.
The middle ear comprises the eardrum and the 3 hearing bones – the malleus, incus and stapes. The middle ear is air filled but with a lining of mucus membrane so mucus is produced and this drains from the ear via the eustachian tube to just behind your nose. There are cases where fluid collects in the middle ear and this again will usually resolve but on occasion will need be drained surgically. In many it resolves spontaneously but one issues a severe word of warning that unless the doctor you’re seeing understands ears and is able to appreciate and recognise the complications which can occur in mis-diagnosed glue ear, long term and permanent problems can occur with little hope of them being satisfactorily resolved. Children with glue ear are much more susceptible to infections because of the pool of mucus trapped providing a wonderful culture medium for bacteria entering the ear via the eustachian tube opening up behind the nose.
Common symptoms drawing ones attention to the condition are recurrent ear infections, suspicion that there is a hearing problem and then quite commonly the child being irritable. These are very difficult cases to help resolve and are often the result of misdiagnosis and mis-assessment. Another complication of misdiagnosed chronic middle ear problems occurring from glue ear is formation of cholesteotoma. Up to 70% of normal glue ear cases are said resolve spontaneously without any medical treatment. What we sometimes do in conservative treatment is to give a course of oral cortisone, and let me reassure parents that, used in the correct regime, oral cortisones are a wonderful treatment and can produce spectacularly good results. As there is in essence nothing we can do to really improve eustachian tube function what one does is bypass eustachian tube by inserting a grommet tube. There are many different types of grommet tubes but in essence one divides them into short, medium and long term. The average tube will last 6 months whereas the long-term tubes can last a number of years. The procedure’s done on an out-patient basis and in adults under local anaesthesia in the consulting rooms.
This can be done in the rooms not involving the expense of going to the operating theatre.
Should there be middle ear infection despite the grommet, this is usually easily treated by topical eardrops. Once the tube comes out, which it does pontaneously, the eardrum closes and it’s only in the rare exceptions that a permanent perforation can be left.
And as regards swimming, the bulk of children with grommets can swim without any protection. It’s most unusual for young children not to have intermittent middle ear infections.
This occurs particularly in winter with all the winter nose infections.What happens is that fluid or pus is trapped behind the eardrum and, if pressure builds up, this can cause considerable pain. The pressure may be such that the eardrum actually bursts and the pus released and with this the pain often dramatically subsides.
In fact there are some interesting surveys questioning whether an antibiotic really does change the natural history of otitis media. But in essence one suggests that, in a severe case of otitis media, antibiotic is certainly useful and many of us will use it earlier rather than later in these cases.
So the bottom line will be that for mild cases of otitis media pain killer and decongestants are likely all you’ll need while for the more severe cases an antibiotic and review and possibly drainage and grommet tubes. Perforations of the eardrum occur because of a significant number of past bouts of middle ear infection. The aim of surgery will be to close this perforation, prevent infection coming in from the outside, and in many cases also improving the hearing loss which can occur with the eardrum perforation. In this operation the lining of the muscle which runs up the side of the skull is used as a graft to repair the perforation. In essence a graft is fashioned from your own tissue to close the perforation and relies on the blood supply of your remaining eardrum and adjacent structures to give it nourishment and allow it to grow.
It’s only in rare occasions that the graft will not pick up sufficient blood supply, break down and need to be redone.
In many cases the very delicate joints around the hearing bones will have been affected and thus one can never guarantee that although a new eardrum has been created that the hearing will return to normal. One needs remember that the eardrum and the 3 hearing bones are all intimately connected and that scarring can occur around these hearing bones affecting their incredibly delicate joints. From the discomfort point of view it’s nice to say that there really is very little pain involved in Tympanoplasty. This of course is very hard to ask young children to do but fortunately because of the excellent blood supply the results are very good for closure. Leading off the middle ear and behind it is a series of cells forming the mastoid process. This is a condition which we see rarely nowadays but in the past it was very common for patients to have operations on the mastoid bone. This is a condition with a fairly strong family history.In general it occurs more in women than men. If the stapes is involved the joint becomes fixed because of new bone formation and the stapes bone is no longer able to move and transmit sound from the eardrum to the inner ear. If the hearing isn’t causing too much concern the condition can simply be watched and reviewed on an annual basis. If the hearing is causing concern there’s an operation called a stapedectomy where the stirrup, the stapes, is removed and replaced by a titanium prosthesis. In our practice there are 3 Audiologists and we work together as a team which is essential.
The new hearing aids, apart from being very sophisticated, are small and cosmetically acceptable with many options available.
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Licence fees: A licence fee will be charged for any media (low or high resolution) used in your project. Normally, the space behind the eardrum which contains the bones of hearing is filled with air. Mark Levenson was elected by his peers for inclusion in Best Doctors in America┬« from 2001 to 2002 and 2015 to 2016. The information is provided with the understanding that ESIC is not engaged in rendering surgical or medical advice or recommendations. I know medically, you’re not supposed to pop the blister as the water or serum beneath the pillow like blister is there to protect the wound and not cause infection. Gosh, hopefully there won’t be an obvious scar on my arm, I have enough scars already. To be blind means a massive dependence on others with a great challenge to one’s independence.
In fact when I see a patient with Bat Ears, in literally every case you’ll find either a parent or grand-parent with the same condition.


The success rate is extremely high with minimal complications and it is indeed exceedingly seldom that one needs to revise the surgery. What happens is that, due to cold water exposure, overgrowths of bone occurs in the external ear canal. Yes there is a possibility they can re-grow and revision surgery may be needed but this is very unusual. It certainly can take time to do but the procedure is neither dangerous nor painful and has a very high success rate if done by an ENT Surgeon with experience and expertise in this field. As sound waves hit the eardrum it vibrates and, due to an incredibly complex sequence of transmission, sound is transferred from the stapes (the stirrup bone) to the inner ear and then the brain. And that’s why when you get a cold the eustachian tube, which drains the middle ear to behind your nose and which has a very small diameter, easily blocks causing the sensation of deafness which will usually resolve as your cold disappears.
What happens is that mucus fluid collects behind the eardrum because of inability of the eustachian tube to drain this fluid away.
The child is irritable, just not behaving normally and provoking people, and what has been missed is glue ear. So what one is saying is that glue ear is very important, is easily mis-diagnosed and needs be carefully followed up if complications are to be avoided. This involves making a small incision through the eardrum and inserting the grommet after aspirating the mucus from the middle ear. Should your child require grommets, your ENT Surgeon will discuss which type of tube is to be used. It has an enormous success rate and because of grommet tubes we, as Ear Surgeons, are seeing increasingly less cases which require major reconstructive ear surgery nowadays. These need to be pumped through the grommet into the middle ear and in most cases this settles the infection.
This is due to bacteria or viruses entering the ear through the back of the nose and entering the eustachian tube to the middle ear.
One certainly doesn’t want to have ongoing bouts of recurrent otitis media since this can produce scarring not only of the eardrum but also the very sensitive joints around the hearing bones. Although the eardrum is a strong membrane, particularly as regards the middle of its 3 layers, recurrent infections often predispose to by a eustachian tube which is dysfunctional, can cause a permanent hole in the eardrum.
Where you have a large perforation there is in fact no chance of a spontaneous closure and surgery needs to be discussed. In some cases work has to be done on the hearing bone either at the first or subsequent operation should the hearing loss be bad enough to warrant this. These cells can become infected in cases of recurrent middle ear infections producing what is called Mastoiditis. Hearing aid technology has improved dramatically, and continues to do so, and it certainly is an option which can be considered providing you’re going to an honest and experienced Audiologist. I’m of the firm opinion that no ENT Surgeon should work without an Audiologist nor should any Audiologist work without an ENT Surgeon in close proximity. Raising your credit score can lead to savings of hundreds of thousands of dollars over the life of a mortgage. We educate you every step of the way so you know how you can continue to manage your credit long after your time with Credit Strategies. On average, we are able to remove 70 percent of negative items from your credit report thereby increasing your score. Coloured scanning electron micrograph (SEM) of hair cells in the cochlea, the inner ear's auditory sense organ. Any information in the publications, messages, postings or articles on the web site should not be considered a substitute for consultation with a board-certified otolaryngologist (ear, nose and throat specialist) to address individual medical needs. Each play a vital role in enabling us to not only function but enjoy the daily stimuli and challenges of life. We’ve all seen this in animals where external ear mobility in identifying sounds is still retained.
It lubricates, has antibacterial and antiviral qualities and can be an important factor in protecting the integrity of the ear canal. It’s a natural product not only lubricating the external ear but also reducing chances of infection. If these become large, and they’re usually multiple, recurrent infections and obstruction and deafness can occur.
Recall the lining of the ear is made of mucus membrane which means mucus is always produced as a lubricant. But in more extreme cases up to 40% of hearing can be temporarily lost because of very thick tenacious mucus. If that does happen you could end up with either a weakened eardrum or a permanent perforation that might need to be surgically closed. The operation will include the Surgeon examining the hearing bones to see if they have been affected by the recurrent infections causing the perforation. There is of course, like in any operation, the small print that there is a small failure rate and cases have been reported where the ear has gone deaf after the operation. The procedure is literally painless but there’s often some dizziness after the operation. But their competence is spectacular and I have nothing but the fullest confidence in what they are doing. In addition, a higher credit score can help you with credit card rates, auto loans, and help you get that job you wanted. The three rows of crescent-shaped areas across top are the stereocilia, and are located on top of supporting hair cells. Individuals' particular facts and circumstances will determine the treatment which is most appropriate. There can be cases where a foreign body reaction occurs to the tube and in this case the ear can be unstable and discharge or quite often bleed.
One stresses again that this is a rare occurrence nowadays except in our more deprived communities. Sound waves entering the inner ear displace the fluid that surrounds the stereocilia, causing them to bend.
Once the cold clears, the fluid will generally drain out of the ear through a tube that connects the middle ear to the nose: the Eustachian tube. It’s usually easily resolved with local treatment but there are occasions when one will need remove the tube. In essence a stapedectomy is usually a very successful operation with a delighted patient.
This triggers a response in the hair cells, which release neurotransmitter chemicals that generate nerve impulses. Although efforts are made to maintain quality advertisements, ESIC does not endorse or recommend the content or claims made in the advertisements.



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