Op.Dr. Behçet Şahin | KBB Uzmanı
External and Tympanum Otisis Media

External and Tympanum Otisis Media

Ear; It is examined in 3 parts as outer, tympanum and inner ear. At the end of the external auditory 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 bones called anvil, hammer and stirrup. These ossicles serve to transmit the sound from the outer ear to the inner ear. The tympanum is connected to the nasal cavity through a canal (eustachian tube). This channel balances the pressure of the tympanum.

How Many Types of Otitis Media Are There?

Otitis Media is 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 there is a hole in the eardrum, it is called chronic Otitis Media. However, sometimes Otitis Media may occur due to the obstruction of the Eustachian tube (related to allergy or adenoid) and this is called serous otitis media.

How Does Inflammation Occur?

Otitis Media 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 tympanum from the outer ear. Sometimes, non-bacterial inflammation can occur in the tympanum. his is usually due to the fact that the Eustachian tube is blocked due to fluid allergies or adenoids, creating pressure problems in the tympanum and sticky collection.

This condition, called serous otitis media, gives different symptoms from bacterial otitis media and its treatment is different. While sometimes bacterial inflammation usually resolves with medication, serous otitis media requires surgery, such as scratching the eardrum or putting on a tube.

What kind of symptoms are seen?

The most common symptom of otitis media is pain. Especially children feel pain more. Apart from this, complaints such as hearing loss, fever, fullness, restlessness 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 results 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 serous otitis media is the inward collapse of the membrane. Redness can still be seen. In chronic inflammation, holes and discharge can be seen in the eardrum.

Which Tests Are Done?

As a newly formed otitis media is diagnosed with an examination, no examination is usually required. However, hearing tests are necessary in serous and chronic otitis media. This helps 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 tympanum 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 Otitis 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 serous otitis media, drug treatment is also applied first. Serous otitis media, especially due to allergies, responds well to drug therapy. However, surgical intervention in the form of scratching the eardrum or inserting a tube is often required.

Drug therapy rarely provides adequate treatment in chronic otitis media. The treatment of chronic otitis media is usually surgery.

What to Do If Otitis Media Recurs Too Often?

To mean recurrent otitis media, the patient must have had 3 or more otitis media in a 6-month period. Diseases such as cleft palate, nose and sinus allergies, adenoid, sinusitis are investigated in children with recurrent otitis media. If one of these is found, it is treated. If such diseases are not found, preventive treatment is carried out.

For this, the following methods are used:

1- Low-dose antibiotic administration before otitis media

2-Scratching the eardrum or putting on a tube into the eardrum

3-Removal of adenoid

4-Some vaccines

In Which Situations Is Surgery Performed?

In serous otitis media, if the patient has hearing loss and this condition does not heal 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 are the Danger of Otis?

Acute otitis media does not usually pose a danger when treated in the appropriate dose and for the appropriate duration. In serous otitis media, severe collapse of the eardrum and hearing loss due to melting of the middle ear ossicles may develop. Sometimes, a tissue called cholesteatoma may develop in the middle ear in exteremly membranous ruptures, which causes melting of the bones and may cause the inflammation to spread to the surrounding tissues. Chronic otitis media is 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:

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


How Is Ear Inflammation Surgery Performed?

The procedure in serous otitis media is either to scratch the eardrum or to put on a tube. If the liquid is low and not sticky, there is no need to put on 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 tympanum, and allowing the middle ear to receive air from the outside. Although it is sometimes applied with local anesthesia, general anesthesia is required, especially in children. Surgery for chronic otitis media is usually more complex. 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 generally used by taking the membrane of the muscle behind the ear to close the hole in the membrane.

If complications occur in chronic otitis media, 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 otitis media, membrane collapse and fluid accumulation 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 otitis media, if the hearing loss is low and the inflammation is passive and does not flow 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 increases and complications due to otitis media occur, the treatment is definitely surgery.