HEAD AND NECK

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Fluid accumulation behind the tympanic membrane (ear drum) is called secretary otitis and is characterized by low or medium intensity hearing loss and also by a feeling of congestion in the ear. Parents can detect it in children by noticing that the child cannot hear very well or it can also be detected during a random physical examination.

Normally there is a medical history of upper respiratory track infection and in this case both ears may be affected. If there is not a previous infection and only the one ear is affected, the doctor must be particularly careful in his/her diagnostic approach.

Included among other causes of the disease can also be whatever may affect the ear ventilation such as hypertrophied adenoids, tumors of the nasopharynx, tumors of the middle ear, etc. The permanent malfunction of Eustachian tube results in relapsing incidents of this kind, as in congenital face dysplasias. Regarding the causes of the disease in children, we must also include their anatomic and immune system immaturity.

An ear examination with a microscope is the main diagnostic method allowing to find out whether there is fluid accumulation in the tympanic cavity and to determine its composition. The gel texture of the fluid or the presence of dangerous retractions of the tympanic membrane require a more aggressive treatment. Additionally, a tympanographic study may be performed. On suspicion of tumors the patient must undergo an axial tomography or a magnetic tomography (MRI).

Initially, monitoring and medical attendance is our approach to the treatment of these incidents. It is often the case that in these kind of situations the problem heals by itself without any specific medical or surgical treatment.

The doctor should reassure the patient or the child’s parents with regard to the danger of the child’s health and inform them about the fact that the unpleasant feeling may last several days or that in some cases, a more radical treatment may be necessary.

In most cases a short antibiotic treatment to prevent infection is administered. Other types of medicines such as mucosolvents and antihistaminics have also been recommended but their efficiency has not been proven.

At the same time, the patient is shown the Valsalva maneuver which the patient is encouraged to do periodically so that ear ventilation can be restored while the child’s parents are given similar instructions placing emphasis on the acute phase of the cold.

If the problem persists we can repeat the antibiotic regimen while a low dose of cortisone is also prescribed for adults. In more persistent cases when the fluid composition becomes more gelatin or if there is danger of chronic alteration of the tympanic cavity surgical intervention may be the appropriate treatment.

In particular, these cases may require that small ventilation tubes be placed. The same approach is suggested for the cases of malfunction of the Eustachian tube such as in congenital facial deformations.

The placing of small ventilation tubes does not aim to drain liquid but to restore ventilation. In children and in some adults the above medical intervention is performed under general anesthesia. The operation is performed in a very limited anatomical area and there is no reason for unnecessary risks. At the same time, other disorders such as the hypertrophied adenoids may be treated.

In the rest of the cases intervention is performed under local anesthesia. The placement of the tube must be done under sterile conditions. The patient leaves the hospital on the same day and receives antibiotic treatment for a few days.

Postoperative ear care is of great importance. After a period which may last three to six months, the small tubes are removed from the body. Sometimes it may take more time. Until then precautions must be taken so that the ear is not infected and mainly during hair washing, water should not enter the ear. This is also a reason why we avoid placing the tubes before summer vacations. The tube, being a foreign body, can become inflamed and this may be difficult to deal with. Finally in the case of nasopharyngeal or middle ear tumors the treatment must be immediate radical and the main disease must be dealt with.