Download Chronic Middle Ear Effusion

PAUL E. HAMMERSCHLAG, MD, FACS
650 FIRST AVENUE
NEW YORK, NEW YORK 10016
(212) 889-2600
Chronic Middle Ear Effusion
The middle ear cleft is normally an air containing space aerated via a function eustachian tube.
The eustachian tube communicates between the back of the nose/throat and the middle ear space.
One can hear the eustachian tube “working” when the ear “pops” while undergoing changes in
air pressure when in an elevator or descending airplane.
When the eustachian tube is not functioning, fluid can accumulate in the middle ear space which
can impair hearing by impeding the vibration of the little bones of hearing, the ossicles, (malleus,
incus, and stapes). Normally the ossicles vibrate in an air containing space (middle ear) to
transmit sound to the hearing nerves. Middle ear fluid can often become infected resulting in an
ear infection called otitis media.
Eustachian tube dysfunction is common in young children and especially so in those with cleft
palate. The muscles that open the eustachian tube are the same as those involved with the cleft
palate. After the palate repair, eustachian tube function can improve to reduce the incidence of
middle ear fluid, hearing loss, and recurrent middle ear infections. Adults can also have chronic
middle ear fluid from known and unknown causes which may require treatment.
Persistent middle ear fluid in children with and without cleft palate and adults is best treated with
pressure equalizing tubes (PE Tubes) also called tympanostomy tubes, which allow for the fluid
to evaporate. Antibiotic/decongestant therapy is usually not effective because the fluid is usually
secondary to “mechanical dysfunction” of the eustachian tubes as opposed to fluid from a
middle ear infection. The PE tubes can be inserted during the time of cleft palate repair which
avoids an additional anesthesia exposure.
After insertion of the PE tubes, the status of the tubes and hearing are monitored with otoscopic
(ear examination) by a physician and an audiological evaluation by an audiologist. Otoscopic
examination should be obtained every four months until the tubes are spontaneously extruded.
If there is evidence of recurrent middle ear fluid, ear infection or decreased hearing, PE tubes are
reinserted, followed by close otoscopic and audiological monitoring. Some children may require
tympanostomy tubes on a long term basis and this will be determined on an individual basis.
There is no way to predict which children will require extended use of tympanostomy tubes.
Persistent middle ear fluid may lead to future problems such as: recurrent infections, scarring of
the middle ear space, and hearing loss. Therefore, it is imperative that children with cleft palate
be carefully followed with otoscopic and audiometric evaluations until it is established that there
is normal eustachian tube and middle ear function.