Otitis media with effusion (ear fluids)

How otitis media with effusion (fluid) is related to acute otitis media?

On the one hand two completely different processes taking place in the same place. On the other hand, a spectrum of the same process, when sometimes the end of one is the beginning of the other. Complex.
Ear fluids – a chronic inflammatory (non-infectious) process. Seemingly, if we sample the liquid it will be sterile (this is not accurate, but it is more easy to simply). So antibiotic treatment will not help.
Acute otitis media – an infectious process. Therefore, antibiotic treatment can be helpful.
In practice, the relationship between these two is a bit more complicated because there are those who will say that it is actually a spectrum of the same condition. The onset of acute otitis media is often the end of otitis media with effusion and vise versa.
Let’s summarize the connection as follows: Fluids in the ears are a very convenient ground for bacteria to thrive, although in most cases they do not cause any damage and do not lead to acute otitis media.

How do you differentiate between otitis media with effusion and acute otitis media?

Sometimes it is difficult to distinguish between the two and only a skilled eye can help. In both cases, when looking at the eardrum, fluids can be identified behind the eardrum and a slight bulging of the tympanic membrane may occur. But ear fluids is a chronic and painless process while acute otitis media often includes fever, earache and local findings on examination of the eardrum such as redness, bulging of the tympanic membrane and significant turbidity.

Is otitis media with effusion (ear fluids) a contagious disease?

Ear fluids are not contagious and therefore should not interfere with the child in routine activities in kindergarten or school.

Do ear fluids cause hearing loss and who are the children who needs to be examined?

In most cases, ear fluids causes a slight and not prolonged conductive decrease in hearing. This hearing loss in children is insignificant.
However, there are cases where ear fluids can cause hearing loss, even up to 50 decibels, which is considered a moderate hearing loss. If the hearing loss is unilateral, usually no one (including the child) will feel at all that there is a hearing loss. If the decline is bilateral, to a considerable degree and for a prolonged time, then there may be impairment in hearing and language acquisition.
Keep in mind that in children who have some other developmental problem (verbal, behavioral, or developmental), even a slight hearing loss can exacerbate the initial problem, and these children need appropriate follow-up and counseling.
Therefore, in children who may have a hearing loss that leads to a impairments in daily activities or in those who suffer from ear fluids for more than 3 months, there is a place to perform an age-appropriate hearing test with a skilled professional. A good hearing test, is a hearing test at an institute that has experience with small children.
There are those who account to ear fluids (with or without hearing loss) all the troubles in the world. For example, a child with a behavioral or ADHD problem. Potentially and according to the textbooks, ear fluids, especially for an extended period of time, can also cause, besides hearing loss, posture disorders and more. But keep in mind, that in most cases ear fluids come and go, over a period of months, and do not cause any harm to children.

What are the possible treatments in cases of ear fluids in children?

Again, most of the millions of children who have ear fluids do not need any follow-up or treatment.
Any investigation or treatment should be performed only in those cases where:

# There is evidence ear fluids for a prolonged period of more than 3 months

# In cases of hearing loss leading to a additional problems

# Recurrent otitis media.

Possible treatments are:
Different types of nasal sprays that usually contain salt water – can be slightly relieving but are mainly acceptable for use in adults.
Antibiotics – absolutely not. Antibiotics are not a treatment for otitis media with effusion!
Antihistamines (anti-allergy) – in most cases in children there is no value in this treatment.
Steroids (in a systemic use or as a nasal spray) – in the short term, steroids can relieve symptoms but in the long term, they do not change the course of this medical condition. This is also not an acceptable treatment for young children.
Anti congestion drugs – not acceptable for the treatment of children, especially those under the age of two. In addition, have not been proven to be helpful.
Nasal drops with antibiotic or steroids – do not really change in the long run.
Inflating balloons, salt rooms and all sorts of other inventions – does not work.
This is the time to mention, that it is most difficult for an attending physician to stand in front of the parents and say that there is no real solution that works over time.
The only treatment that resolves fluid in the ears is ventilation tubes surgery.

What are the factors to consider when deciding on ventilation tube surgery?

Before coming to surgery, two important points must be considered:
1. The vast majority of the many children who have ear fluids do not need any follow-up or treatment. The fluids do not cause any short- or long-term problem and do not warrant intervention. The fluids will decrease and be gone within weeks or months.
2. Ventilation tubes surgery is one of the most common surgeries done in children, so insurance companies make a nice profit out of it. Therefore, consult with your pediatrician on this subject and at the same time with an ear, nose and throat specialist in pediatrics for whom you have received warm recommendations and who are in no hurry to operate without a clear indication.
Together with the surgeon, consider a number of variables that affect the need for surgery, including: age of the child, season (there is a difference between pre-winter and pre-summer counseling, for example, when the number of viral infections decreases), number and intensity of acute otitis media episodes (if there were any), the presence of fluids in one or both ears, the duration of fluids if known and most importantly, the extent of their impairment in the child’s hearing and developmental problems associated with hearing loss.

What is Ventilation tubes surgery and what does it have to do with the adenoid tonsil?

Ventilation tubes surgery is a surgery in which a small incision is made in the eardrum and through which ventilation tubes (one on each side) are inserted. After placing those tubes, the middle ear cavity is open to the auditory canal, thecavity is ventilated, the fluids evaporate, the hearing loss disappears and often also the tendency for acute middle ear infections decreases.
There are two types of ventilation tubes. There are short-term (usually emitted alone in a period of between six months and a year) or long-term. In the vast majority of cases in children short-term tubes will be inserted.
In many cases, surgery will be performed at the same time to remove the adenoid tonsil that caused the nasal blockage.
But more about that in a separate chapter that will be devoted entirely to the adenoid tonsil.