Eustachian Tube/Serous Otitis Media/Ventilation
Serous otitis media, also known as “middle ear fluid”, is a common condition which is caused by Eustachian tube dysfunction. When the Eustachian tube, which runs between the back of the throat and the ear, fails to equalize the pressure on both sides of the eardrum it causes fluid accumulation behind the eardrum. This fluid can become infected. The infection causes pain, loss of hearing, and may damage the middle ear bones and mastoid ear bone. The mastoid ear bone is located behind and around the ear and can become infected and abscessed. Occasionally, the infections rupture through the eardrum resulting in a perforation. More serious consequences can occur such as rupture upwards into the brain area or down into the neck.
Most children will outgrow the need for treatment. Between the ages of 5 and 8 years, the head and Eustachian tube growth, as well as the musculature changes, result in a size that allows for the Eustachian tube to become an active passage for air during this time. Thus, treatment for ear infections often resolves during this age.
The mainstay of treatment of otitis media is antibiotics. If four or more episodes of otitis media occur within a year, then ear ventilating tubes are definitely recommended. Some patients receive tubes after one infection and include patients who have a cleft palate, those with strong family histories, or those who have significant allergies. Thus, the medical strategy is to treat the Eustachian tube problems and ear infections by antibiotics and tubes until the Eustachian tubes open on their own. This usually happens between the ages of 5 to 8 years. It is very important to treat the ear infections and Eustachian tube dysfunction to prevent other more serious problems.
There are some special Eustachian tube cases, such as patients who have had irradiation for tumors in the ear area. In these cases, the nasopharynx, which is the area in the back of the throat, may be congested and scarred and impair Eustachian tube function. Such patients often need a tympanostomy ear tube insertion to substitute for the function of the Eustachian tube.
Ventilating ear tubes:
The tympanostomy ear tube insertion surgery is an excellent method of dealing with Eustachian tube dysfunction because it bypasses the Eustachian tube problems and works 24 hours a day. It ventilates the middle ear space by placing a microscopic hole in the eardrum and then placing a small hollow plastic tube into the hole to hold it open. Since the tube is hollow, it allows ventilation through the ear canal rather than through the Eustachian tube.
The two main types of tubes are temporary and semi-permanent. The temporary tube lasts approximately six months, and the semi-permanent “T-tube” lasts for approximately three to five years. Most children receive a temporary ear tube first since most children need only one application of tubes before the ear mucous-membrane heals itself. Once this temporary tube has extruded, if there is recurrence, then a semi-permanent T-tube is inserted. Some patients, such as cleft plate patients, may start with a semi-permanent tube because they have long-term problems.
The role of Eustachian tube dysfunction caused by adenoid hypertrophy is controversial. It appears that some patients’ adenoids are highly obstructive of nasal breathing and cause constant mouth-breathing and some of the obstructive adenoids may also cause Eustachian tube dysfunction. However, the incidence of adenoid hypertrophy causing Eustachian tube dysfunction is not truly known.