A few words about the ear
In order to carry out its functions, the ear is separated into three parts:
- The outer ear
- The middle ear: separated from the outer ear by the eardrum and consists of three small ossicles (small bones) joined together as in a chain. It is a small airway which can only communicate with its environment through a small tube, the Eustachian tube, which ends at the back part of the nose, next to the adenoids.
- The inner ear: consisting of the hearing organs (cochlea) and balance mechanism (labyrinth).
The Eustachian tube: Ensures proper ventilation of the ear and drains normal discharge. It opens a little, mainly when we chew or yawn.
A few words about otitis media with effusion
What is otitis media?
It is a collection of “uninfected fluid” that has collected in the middle ear due to a malfunction of the Eustachian tube, resulting in moderate hearing loss, which as a rule, is temporary.
How common is it?
15-20% of children at some time have this collection of fluid(effusion) in their middle ear. It often goes unnoticed.
When does the Eustachian tube fail to function properly?
The Eustachian tube in children is horizontal with a wider opening and is more vulnerable to germs. Enlarged adenoids, frequent colds, allergies and certain rare conditions such as Down’s syndrome, and cleft lip and palate are all factors which make children more susceptible to otitis media.
How do we know when a child has it?
A weakened ability to hear is essentially the only symptom of the presence of fluid in the ear. Hearing loss varies, even from day to day and can, for a long period of time, remain undiagnosed, especially as regards small children. Parents usually assume that their child “chooses not to hear” or is ignoring them or is having problems concentrating. Older children usually complain that their ears are plugged up, which worsens during and after a bout with a cold. They may complain about recurring pain, noise or even deafness. These symptoms usually disappear in the summer and may return during the winter.
What problems may arise?
- In pre-school children, weakened hearing may have a lasting effect on their development of speaking skills. It may also affect their behaviour, making them difficult to handle, or they may develop a tendency to withdraw.
- School-age children may fall behind in their schoolwork since they find it difficult to follow the lessons in class. This may also affect their behaviour because they feel at a disadvantage.
What happens to the fluid?
In the majority of cases the middle ear cleans itself within about 4-6 weeks. Sometimes the fluid may remain for a longer period of time. In this case it becomes thick and sticky.
What happens if otitis media remains untreated?
This could causes permanent deformation of the middle ear structure (e.g. adhesions) and finally permanent malfunction, which could require very delicate surgery at some time in the future. Also, we mustn’t underrate the possibility of delayed speech, problems with school and a tendency to withdraw in older children.
1. Non-surgical treatment
Using natural saline solutions and nasal decongestants, antibiotics, as well as chewing gum, baths and so on help drain away the fluid. If it does not go away, despite the above, for over 6 – 8 weeks, then a small surgical intervention is needed to provide a solution.
2. Surgical treatment
Surgery is done under general anaesthesia, lasts about 20 minutes and is performed with the assistance of a microscope. A ventilation tube is placed through the eardrum so that the middle ear comes in permanent contact with the air. This achieves a quicker drainage of the fluid and good ventilation. The child remains in hospital for only a few hours and does not experience pain. The ear itself automatically ejects the ventilation tube in about 6-12 months, leaving an unnoticeable scar.
Practical help for when a child has otitis media.
At home: We must make sure we have the child’s attention before speaking, and then speak clearly and up close. Take care that he/she sees you and there is no other noise, for example the television. We may have to repeat some words or paraphrase what we want to explain. We must show understanding, and explain in simple words what is happening and reassure the child that it will not last for too long. Let’s not forget that some days the child’s hearing will be better and others it will be worse.
At school: The teacher must be informed about the hearing loss. The child should be seated at the front desk and the teacher must make him/herself perfectly visible and clear when addressing the child.
Guidance for children with ventilation tubes
- Although it is not easy for water to go through the tube into the ear, the child must be careful, for example not to dive into the water. No special care needs to be taken when washing hair. If the child begins to complain again about plugged up ears, pain and continuous effusion from the ear, a specialist must be consulted despite the tube.
- Travelling by plane is not forbidden.
Can fluid collect again after the tubes have fallen out?
Over 90% of children answer positive to surgical treatment. Nonetheless, the remaining 10% may develop otitis media again after the removal of the tube and could need to have new ones inserted. Such relapses only affect children with serious allergies, Down’s syndrome or cleft palate.