Middle Ear Fluid & Infection

Common cause: eustachian tube dysfunction

The air within the middle ear is constantly being absorbed in the middle ear. To remain health the middle ear must receive a source of fresh air. The fresh air is supplied by the eustachian (pronounced “U-station”) tube, a soft, collapsible pipeline connecting the middle ear to the back of the nose. Usually the eustachian tube is closed and it must open several times a day to replenish the air in the middle ear.

When the eustachian tube is not opening properly and the air of the middle ear space is absorbed, a vacuum is formed. The eardrum is pulled into the middle ear and fluid collects in the middle ear; this causes a hearing loss. This abnormal environment also favors growth of germs which leads to a middle ear infection. In other words, eustachian tube dysfunction results in two common problems: recurrent ear infections (also called otitis media) and persistent fluid in the middle ear (also called middle ear effusion).

Middle Ear Effusion: Fluid often lingers in the middle ear before and after an infection and needs no specific treatment. Doctors become concerned when the fluid does not disappear within a three month period. In children, prolonged fluid in the middle ear is of particular concern because this problem can lead to delayed learning and speech development, as well as more subtle problems with behavior and lack of coordination. About one out of every three infants has some trouble with ear infections. This is probably because there is a period in many young children’s development when the eustachian tube does not work effectively. Children whose parents had frequent ear infections in their childhood will often inherit this problem.

The yellow color and air bubble are tell-tale evidence of middle ear fluid

Symptoms of a middle ear effusion (fluid)

Hearing loss
Loss of balance
Poor behavior
Maybe tugging or rubbing of the ear
Maybe no sign of a problem

Factors which cause the eustachian tube to swell and malfunction

allergies (such as dust, grass, or pollen, as well as food allergies
a cold (a viral infection)
second-hand smoke
bottle-feeding
day-care centers where children are exposed to more viral infections

Diagnosis

Examination of the ear drum. The ear drum usually looks dull, sometimes air bubbles can be seen. Chronic effusions cause inflammatory changes to the inner surface of the ear drum. This inflammation will result in harmless deposits of calcium-like scar tissue. Tympanosclerosis is a sign of a history of middle ear effusions, but rarely affects the function of the eardrum (except to impede the falling out of ventilation tubes.)
Tympanogram: a hand-held office device that measures the middle ear pressure and fluid.
Hearing test (audiogram)

Treatment of a middle ear effusion (fluid)

Antibiotics
Oral and topical nasal steroids
Oral and topical decongestants
Antihistamines
Myringotomy with or without a ventilation tube

The inflammation associated with a middle ear fluid can leave a hard white scar on an ear drum. This white scar is called tympanosclerosis. Luckily, it is rare for this change to the ear drum to cause any hearing loss or other problem.

Middle Ear Infection

Symptoms

Sudden ear pain
Fever
Hearing loss
Sometimes creamy or bloody ear discharge (when the ear drum ruptures)

Diagnosis

Primarily by examination of the ear drum

Treatment of acute otitis media

Oral antibiotics in children under 2 or if no improvement after observing for several days.
Tylenol or Motrin for pain
Antibiotic drops when there is ear drainage. If the tympanic membrane ruptures, water is kept from the ear until the drum has healed
Occasionally a small incision is made in the ear drum (myringotomy) to relieve the pain or to drain fluid or pus.

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