Middle Ear Problems
(Otitis Media, Ear infections, Eustachian Tube Dysfunction)

Description

The middle ear cavity consists of an extensive pneumatic system aerated by the Eustachian tube. The area starts under the eardrum (tympanic membrane), and consists of the tympanic cavity which houses the 3 middle ear bones (malleus, incus, stapes), the mastoid, and the Eustachian tube.

The Eustachian tube is 2/3 cartilage, and 1/3 bone (the skull base).
It lies next to the internal carotid artery. The area where cartilage meets bone is very narrow and this is what causes problems with the Eustachian tube opening in some instances. The tube opens and closes in response to movements of muscles of the palate, and differences of pressure between the nasopharynx (back of nose) and middle ear. Swallowing or yawning opens the tube. In young children the angle of the tube is fairly flat which decreases drainage.

There are two narrow areas leading out of the middle ear which can cause mastoiditis and above the 3 bones which can cause collapse of the eardrum and the formation of a destructive skin sac in the middle ear known as a cholesteatoma.
 
Malfunctions of the Eustachian tube

If the Eustachian tube does not open, or malfunctions because of anatomic problems (cleft palate) – negative pressure under the eardrum causes transudation of fluid into the middle ear and mastoid. This causes hearing loss and then the fluid can become secondarily infected, leading to ear infections. If the fluid is left alone for a long time, it can thicken and pull the eardrum in, possibly leading to cholesteatoma.

Treatments include watchful waiting, topical and oral decongestants
(not antihistamines!). Antibiotics are not effective for non-infected ears. If there is pain, fever, and hearing loss, antibiotics are effective to rid the infection, but the fluid under the eardrum will still take approximately 2-4 weeks to clear. Ear problems statistically occur most often in children 0-3 years old, then at age 6, and during the late fall through early spring (October thru April).

Indications for PE (pressure equalizing) tubes

Persistence of fluid beyond 3 months can cause speech delays, as well as the development of other problems. Three infections in 6 months, or four infections in 12 months are also indications for PE (pressure equalizing) tubes. PE tubes are also placed for chronic tympanic membrane retractions, in both children and adults.

Unilateral ear fluid in an adult always causes some concern for the Otolaryngologist (ENT Surgeon). Examining the Nasopharynx (back of nose by the Eustachian tube) with a telescope is necessary to rule out a possible growth or tumor.

Surgical Procedure

Placement of PE tubes requires a general anesthesia for young children. Adults can have the procedure in the office. The ear microscope is used to clean the ear canal, and a tiny incision is made in the eardrum. Fluid is removed and the tube is placed through the eardrum to allow the ear to ‘breathe’.

Pain post–op is rare. Advil or Tylenol can be used. Sometimes drainage occurs post-op. Dr Wladecki usually gives/prescribes ear drops post –op for this problem.

If drainage occurs after the tubes are placed drops are the first line of treatment. Oral antibiotics are rarely needed. Dr. Wladecki also suggests using topical nasal decongestants (Afrin, Neosynephrine) for up to 3 days if there is drainage. If drainage persists over 4 days please call the office.

Care of tubes

Dr. Wladecki uses a tube with a protective gel. Earplugs are rarely needed unless drainage is known to occur after contamination with water. Tubes stay in the eardrum for about 3- 12 months and then ‘grow out’ with the skin of the eardrum. Never use Q-tips in the ear- it goes against the flow of traffic!
 

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