Fluid Accumulation in the Middle Ear Is the Most Important Cause of Hearing Loss in Children

Here we learned what parents want to know about fluid accumulation in the middle ear, a condition more common in school-age children, for which parents seek care due to complaints such as ‘My child doesn’t hear me, gives irrelevant answers to my questions, and has recently started watching television much more closely.’ from Prof. Dr. Tayfun Apuhan, Ear, Nose and Throat (ENT) and Head and Neck Surgery Specialist at Hisar Hospital Intercontinental…

What is fluid accumulation in the middle ear?

It is a type of middle ear inflammation characterized by fluid collecting behind an intact eardrum, without general or local signs and symptoms of infection.

How is fluid accumulation in the middle ear distinguished from otitis media?

After recovery from acute otitis media, fluid may remain in the middle ear behind an intact eardrum. 52% of the fluid disappears within four weeks and 80% within eight weeks. Therefore, fluid accumulating in the middle ear after an episode of otitis media is considered fluid accumulation in the middle ear, and the treatment process begins, only if it persists beyond the critical period of three months. In other words, the patient does not report ear pain and discharge, fever, or similar complaints.

What are the symptoms of fluid accumulation in the middle ear?

Parents’ greatest complaints are that their children do not respond to them, deflect questions with irrelevant answers, and watch television very closely. The child’s reaction to sound decreases. Teachers at nurseries and kindergartens notice that the child does not hear. Families report that recurrent upper respiratory tract infections and hearing loss have increased. In bilateral cases, hearing loss is more severe, so it is noticed earlier.

What are the risk factors for fluid accumulation in the middle ear?

Upper respiratory tract infections occurring 6-7 times or more often in children aged 2-6 years,

Enlargement of the adenoids, which obstructs the area called the nasopharynx and causes breathing difficulty,

Presence of any allergic disease in the child, general and local immune system disorders,

Premature birth,

Facial developmental anomalies,

Body weight below normal,

Early weaning from breast milk,

Frequent presence in crowded environments,

Regional and climatic conditions,

Humidity level,

Improvement of children who frequently have upper respiratory tract infections during the summer months, and receiving inadequate treatment, may also cause fluid accumulation in the middle ear.

What are the consequences if the disease is not treated?

The milk and play childhood period, when the disease is common, is also the period when children learn to speak and become familiar with their surroundings. Researchers show that such children’s abilities to learn and use language and their social adjustment are poorer than those of normal children. For patients to recover from this condition, known as a childhood illness, effective treatment methods must be applied, such as waiting for age to progress, medication, tube insertion, and adenoidectomy (removal of the adenoids). If it frequently recurs and progresses, it can lead to calcification in the ear, inner ear type hearing loss, and cholesteatoma (a disease that develops in the ear), which cause major problems in the future and necessarily require surgeries that impair hearing.

How is the disease treated?

In treatment, the first step is determining the individual risk factors. These are age, the presence of chronic upper respiratory tract infections, adenoids, allergies, facial developmental anomalies, and immune system disorders. Environmental risk factors, especially the season, also play an important role in the treatment plan. If fluid accumulation is bilateral and has persisted for more than three weeks, the likelihood of it becoming chronic is high. A younger age both reduces the success of treatment and increases the likelihood of recurrence. The same applies across seasons. Although a certain degree of improvement is achieved with antibiotics, it frequently recurs. For this reason, patients receiving antibiotic treatment should be checked periodically, and the possibility of recurrence should be kept in mind. Sinusitis and similar infections, as well as enlarged adenoids, adversely affect treatment. If the tonsils are very large and there are enlarged adenoids, there is no point in wasting time with medication; surgical treatment should be performed immediately. The adenoids are removed and a ventilation tube is placed in the ear. Ventilation tubes ventilate the middle ear with air at normal gas concentrations and allow the pressure in the middle ear to reach atmospheric values. This allows the fluid accumulation in the middle ear and the hearing loss caused by negative pressure to resolve. However, it should not be forgotten that in such children the condition may recur after the tube is expelled. The main factor affecting the recurrence rate is, again, the patient’s age. In addition, impairments in the function of the Eustachian tube and inadequate removal of the adenoids further increase this risk. In children with ventilation tubes, protecting the ear from water is recommended. The tube may occasionally become blocked and cause hearing reduction. Sometimes bleeding that occurs after tube placement can also cause the tube to become blocked. In this case, earwax should be softened and removed using special drops recommended by your physician. If discharge is seen while the tube is in place, either otitis media has recurred or infection has entered the middle ear from the outside. It is very rare for the tube to fall into the middle ear, so care should be taken in this regard. Ventilation tubes stay in place for between two months and two years.