Middle ear inflammation : Infection of the mucosa lining the middle ear and the cavities anatomically connected to the middle ear (mastoid cells and Eustachian tube) is called otitis media. The main thing is the presence of inflammatory fluid in the middle ear, which should be completely filled with air.
Classification of middle ear infections: In terms of clinical course, the disease is defined as acute for the first 3 weeks, subacute between 3 weeks and 3 months, chronic if present for more than 3 months
1 - Myringitis: inflammation of the eardrum due to otitis media or alone.
2 - Acute otitis media: Sudden onset, short-term otitis media characterized by pain.
3 - Otitis media with effusion: The accumulation of fluid (effusion) behind the intact eardrum without sudden and severe symptoms. This term describes a long-term middle ear problem that is not of a catarrhal or inflammatory origin.
4 - Chronic otitis media: Describes a long-term infection with a chronic discharge from the middle ear through a perforation in the eardrum.
Age group in which acute otitis media occurs: Middle ear infections are one of the most common diseases of childhood. Considering that 85% of all children have at least one episode of acute otitis media, the importance of the disease becomes clear. There are several reasons why acute otitis media is more common in children: Until the immune system is fully matured, especially children in nursery, kindergarten and primary school frequently encounter upper respiratory tract infections, and these upper respiratory tract infections can easily progress to the middle ear through the Eustachian canal, which is shorter and horizontal compared to adults. In addition to this basic mechanism, feeding children in a lying position (in children who suck a bottle while lying down, milk can easily pass into the middle ear and pave the way for the development of infection), the presence of food allergies, passive smoking and chronic adenoid tissue (adenoid) infections are additional factors that increase the risk.
Symptoms of acute otitis media: In otitis media, which is an acute bacterial infection of the middle ear cavity, symptoms vary according to the stages of the developing inflammation. Initially, earache, fever and a feeling of fullness in the ear occur. As the inflammation progresses, ear pain increases, fever rises and systemic symptoms such as nausea and vomiting may occur. Later, ear discharge occurs as a result of the inflammatory accumulation in the middle ear perforating the eardrum, and the ear discharge may initially be bloody. With the perforation of the eardrum, there is a decrease in pain with the resulting discharge. The disease may regress after this stage or may progress and lead to complications depending on certain factors.
Diagnosis:
Diagnosed by otoscopic examination
Treatment of acute otitis media
It is usually treated with analgesics and antibiotics, local or systemic decongestants may be added. In patients with perforated eardrum and discharge into the external auditory canal, no additional treatment is required and ear drops are not used.
Otitis media with effusion:
This is the presence of fluid in the middle ear behind the eardrum without signs of acute infection. Effusions lasting less than 6 weeks are usually due to acute otitis media; if the middle ear effusion remains in place for more than 3 months, it is called chronic effusion. There is no perforation of the eardrum. Chronic otitis media with effusion is a childhood disease, and is associated with anomalies such as cleft palate, Down syndrome, pharyngolaryngeal reflux, Eustachian tubeFactors such as anatomical position, presence of adenoid vegetation or chronic adenoid tissue infection, frequent upper respiratory tract infections are factors that increase the risk of otitis media with effusion in children.It is related to the seasons; it is more common in the spring months when the frequency of upper respiratory tract infections increases, while its frequency decreases in the summer months.
Symptoms of otitis media with effusion: It is a disease with subtle symptoms. It can be diagnosed by chance without the child having any obvious complaints. Especially the absence of symptoms such as pain, fever and ear discharge prevents the family from focusing attention on the ear. In young children, the frequent placing of the hand to the ear may be the only symptom. The presence of hearing loss often goes unnoticed. Parents often attribute the child's not answering calls to lack of interest, turning up the TV too loudly to curiosity and watching closely to a possible visual defect. In the majority of children, the diagnosis is made by teachers' warnings or when they are taken to the doctor for other ailments.
Diagnosis of otitis media with effusion: The disease is diagnosed by otoscopic examination. Tympanometry is helpful. Negative pressure in the measurement supports otoscopic findings.
Treatment of otitis media with effusion: Poorly treated chronic effusions are one of the most important factors in the development of other chronic ear diseases. When the disease is diagnosed and the accompanying findings affect the treatment. Effusions that occur after acute otitis media should be followed up for at least 3 months to be diagnosed as chronic otitis media with effusion. These patients are only given additional treatment if the effusion lasts longer than 3 months. In patients who are diagnosed for the first time and it is not known whether they have had an effusion before, medical treatment is applied if the patient is seen in spring and winter. Follow-up is more appropriate at the beginning of summer. The most commonly used drugs in medical treatment are antibiotics. It is beneficial for the patient to receive medical treatment at least twice before deciding on surgical treatment. Ventilation tube application is performed in surgical treatment. If patients have complaints of adenoid vegetation or chronic adenoiditis, adenoidectomy is also performed in the same session.
Chronic otitis media: Chronic otitis media is characterized by perforation of the eardrum and purulent discharge from the external auditory canal. For this diagnosis to be made, the otitis media must persist for more than three months or not respond to medical treatment. Ear pain is not common in this disease, the presence of ear pain should suggest that an intracranial or extracranial complication may have developed.
Poor living conditions, crowded families, poor hygiene and nutrition are the main factors that increase the frequency of chronic otitis media. Inadequate health care system is also an important factor. In societies with improved socioeconomic status, the frequency of chronic otitis media decreases while the frequency of otitis media with effusion increases.
Classification of chronic otitis media: Chronic otitis media are clinically classified under two main headings:
1) Mucosal chronic middle ear infections: This is a benign middle ear condition of microbial origin and is confined to the mucosal level. During active phases there is an odorless purulent discharge. Hearing impairment is minimal.
2) Cholesteatoma Cholesteatoma, which can be defined as invasion of the skin epithelium into the middle ear, is considered a malignant chronic otitis media because it causes bone destruction. Since it causes bone resorption, it is a disease that can cause intracranial complications. Ear discharges of the patients are foul smelling and findings related to cholesteatoma are seen on examination.
Treatment of chronic otitis media: In mucosal chronic otitis media, topical drops are primarily used for ear discharge, the main treatment is surgical tympanoplasty, sometimes mastoidectomy may be added. It is preferably useful to perform the operation in a dry ear, but this is not essential, if the discharge persists despite medical treatment, surgical treatment can be started. The treatment of chronic otitis media with cholesteatoma is surgical. The middle ear and mastoid region should be surgically cleared of cholesteatoma without delay.