Middle Ear Inflammation (Otitis Media)

Where is the Middle Ear?
Ear; It is examined by dividing it into 3 parts as the outer, middle and inner ear. At the end of the outer ear canal is the eardrum. The eardrum separates the outer and middle ear. In other words, the middle ear is located on the inner side of the eardrum and consists of a cavity. Inside this cavity are ossicles called anvil, hammer and stirrup. These ossicles serve to transmit the sound from the outer ear to the inner ear. The middle ear is connected to the nasal cavity through a canal (eustachian tube). This channel regulates the pressure of the middle ear.

How many types of otitis media are there?
Middle ear infections are usually caused by bacteria. If this inflammation is newly formed, it is called acute otitis media, if it has been present for a long time and shows itself with a hole in the eardrum, it is called chronic otitis media. However, sometimes middle ear inflammation may develop due to obstruction of the Eustachian tube (related to allergy or adenoid) and this is called serous otitis media.

How Does Inflammation Occur?
Middle ear inflammation occurs when bacteria settle in the middle ear and multiply enough to cause disease. Microbes in the middle ear usually come from the nasal and throat via the Eustachian tube. Because the Eustachian tube is straighter and shorter in children, otitis media is more common in children. As long as the eardrum is intact, bacteria that will cause inflammation cannot enter the middle ear from the outer ear. Sometimes, non-bacterial inflammation may develop in the middle ear. This is usually due to the obstruction of the Eustachian tube for reasons such as allergies or adenoids, pressure problems in the middle ear and collection of sticky fluid. This condition, called serous otitis media, gives different symptoms from bacterial otitis media and its treatment is different. Bacterial inflammation usually resolves with medication, while serous otitis media sometimes requires surgery in the form of scratching the eardrum or inserting a tube.

What Kind of Symptoms Does It Give?
The most common symptom of otitis media is pain. Especially children feel pain more. Apart from this, complaints such as hearing loss, fever, restlessness and fullness in babies are seen. If the inflammation pierces the eardrum, bloody or inflamed discharge occurs. In serous otitis media, hearing loss is seen without pain. In chronic otitis media, there are symptoms such as hearing loss, intermittent or continuous discharge or bad odor.

What is seen in the examination?
Examination findings vary according to the type of otitis media. In inflammation due to bacteria, the eardrum is very red and cambered. The most important finding in the eardrum in serousotitismedia is the inward collapse of the membrane. Redness can still be seen. In chronic inflammation, there is a hole in the eardrum and discharge, if any.

Which Tests Are Done?
Since the diagnosis is made by examination in a newly formed otitis media, examination is usually not required. However, hearing tests are necessary in serous and chronic middle ear infections. This serves both to determine the degree of hearing loss and to evaluate the results of treatment. In serous inflammations, an examination called tympanometry is performed to determine middle ear pressure. In chronic middle ear infections, it may be necessary to take normal films or computed tomography, especially if surgery is considered for treatment.

How Is It Treated?
Acute otitis media is usually treated appropriately with antibiotics and pain medications. Rarely, in cases where there is no response to antibiotics, it may be necessary to scratch the eardrum. In serousotitismedia, drug treatment is also applied first. Particularly, serous middle ear infections due to allergies respond well to drug therapy. However, surgical intervention in the form of scratching the eardrum or inserting a tube is required many times. Drug therapy rarely provides adequate treatment in chronic middle ear infections. Treatment of chronic middle ear infections is usually surgery.

In Which Situations Is Surgery Performed?
In serous otitis media, if the patient has hearing loss and this does not improve with medication, the treatment is surgery. In chronic otitis media, if the inflammation has begun to dissolve the ossicles in the middle ear and has begun to spread to the surrounding tissues, surgery is also required.

What Dangers Are There?
Acute middle ear infections usually do not pose a danger when treated in the appropriate dose and for the appropriate duration. In serous middle ear infections, severe collapse of the eardrum and hearing loss due to melting of the middle ear ossicles may develop. Sometimes, in severe membranous ruptures, a tissue called cholesteatoma may develop in the middle ear, which causes melting of the bones and may cause the inflammation to spread to the surrounding tissues. Chronic middle ear infections are the most dangerous type of inflammation. Cholesteatoma occurs mostly in chronic inflammations. If there is no cholesteatoma and there is acceptable hearing loss, surgery may not be necessary. However, especially cholesteatoma can cause the spread of inflammation, resulting in the following complications:
Complete hearing loss and dizziness as a result of spread to the inner ear
Brain abscesses as a result of spread to the brain
·Facial paralysis
·Meningitis

How is the surgery done?
The procedure performed in serousotitismedia is either to scratch the eardrum or to insert a tube. The fluid accumulated in the middle ear is drained by scratching (ie piercing) the eardrum. If the liquid is low and not sticky, there is no need to insert a tube. However, if the liquid cannot be drained due to its stickiness, a tube is inserted into the scratched area on the eardrum. These tubes, called ventilation tubes, are devices with one mouth facing the outer ear and the other opening towards the middle ear, and allowing the middle ear to receive air from the outside. Although it is sometimes applied with local anesthesia, general anesthesia is usually required, especially in children. Operations for chronic middle ear infections are generally larger operations. If no complications have occurred, the procedure is to drain the inflammation in the middle ear, destroy the ruptures due to melting in the ossicles (this sometimes requires putting a prosthesis) and close the hole in the eardrum. It is usually used by removing the membrane of the muscle behind the ear to close the hole in the membrane. If complications occur in chronic middle ear infections, the first and sometimes the only purpose is to clear the inflammation. For this, the bones around the ear are opened more and the provision of hearing is pushed into the background. Sometimes even hearing is sacrificed. In surgeries related to chronic inflammation, surgery is usually performed with an incision made behind the ear.

What Happens If I Don't Have the Surgery?
If no surgery is performed in serous middle ear infections, the collapse and fluid accumulation in the membrane will increase. Hearing loss comes to a level that makes daily life difficult and the chance of success of the surgery to be applied later decreases. In chronic middle ear infections, if the hearing loss is low and the inflammation is passive and does not leak frequently, life can continue without surgery. In this case, the patient should try not to get water in his ear and not to have an upper respiratory tract infection as much as possible. However, if the inflammation is frequently active and there is discharge, hearing loss progresses, melting of the ear ossicles is increasing and complications due to middle ear inflammation have occurred, the treatment is definitely surgery.

What Kind of Risks Does the Surgery Have?
As with any surgery, middle ear surgeries have risks and complications. Since general anesthesia is often used for these surgeries, there are anesthesia risks. Apart from that, scratching the eardrum does not usually cause problems, but sometimes the inner ear can be damaged. It may cause some problems in tube insertion. While inserting the tube, the eardrum may be damaged or the tube may escape into the middle ear. After the tube is inserted, permanent hole in the membrane, calcification, infection and related discharge may occur. Surgery for chronic middle ear infections are larger surgeries and they have some complications. Complete hearing loss, facial paralysis, injury to the surrounding vessels and nerves due to damage to the inner ear are among the important complications.

What should I pay attention to after the operation?
The most important issue that patients who have a tube in their ear should pay attention to is to prevent water from entering the ear. Other than that, a check-up once a month is usually sufficient. In chronic middle ear infections, the most important issue is to comply with the dressings as the doctor deems appropriate and to use the drugs given appropriately. Patients who have surgery for otitis media do not have important issues regarding food and drink. In patients with chronic otitis media, where the bone around the ear has to be excavated excessively, earwax can often accumulate in the formed cavity. These should be cleaned periodically.