Otitis media with effusion - Ventilation tubes (grommets)

Otitis media with effusion (glue ear) is the accumulation of fluid in the tympanic cavity, the area behind the eardrum.

The accumulation of fluid affects the movement of the tympanic membrane and the auditory ossicles, which are surrounded by thick mucus.

The placement of ventilation tubes (grommets) is the surgical treatment of otitis media.

What is glue ear?

Otitis media with effusion (glue ear) is the accumulation of fluid in the tympanic cavity, the area behind the eardrum. The accumulation of fluid affects the movement of the tympanic membrane and the auditory ossicles, which are surrounded by thick mucus.

What causes glue ear?

The main cause of glue ear is the dysfunction of the Eustachian tube. The Eustachian tube is a tube that connects the tympanic cavity to the nose, allowing air to pass into the cavity. It also helps to equalize pressure. There is evidence that repeated inflammation in this area contributes to the development of otitis media with effusion.

Who usually suffers from otitis media?

This condition affects a large majority of children, but it can also affect older people. It is not hereditary, but there are some categories of patients with an increased rate of otitis media, such as in cases of cystic fibrosis or Down syndrome.

What are the effects of glue ear?

Young children with glue ear can often suffer from communication problems with an additional burden on language learning. Otitis media with effusion always causes hearing loss, while it is rarely associated with pain or a feeling of heaviness/fullness in the ear.

How is the diagnosis made?

The diagnosis is made by otomicroscopy, i.e. examination of the ears with a microscope. Tympanometry also contributes to the diagnosis. This examination assesses the mobility of the tympanic membrane and detects the presence of fluid within the tympanic cavity. Finally, audiometry can determine the degree of hearing loss caused.

Treatment

In mild cases with a low degree of hearing loss, no surgical intervention is required. On the contrary, the patient must be monitored at regular intervals until the condition heals on its own. However, in cases where the amount of fluid is large with concomitant high-grade hearing loss, the treatment is either pharmaceutical or surgical.

Conservative treatment

Antihistamines, antibiotics or corticosteroids (nasal sprays or syrups) or a combination of these may be administered, depending on the severity of the condition and the preferences of the treating physician. Also, sometimes the use of the Otovent (ear ventilation device) is recommended, with which the patient essentially pushes air through the Eustachian tube into the tympanic cavity.

Surgical treatment

In cases of failure of conservative treatment or in severe cases (degeneration, atelectasis/ aspiration of the tympanic membrane), surgical intervention is recommended. Tympanotomy is performed, suction of the fluid and placement of ventilation tubes (grommets). The operation is performed under local anesthesia in adults, while in children under general anesthesia. It can also be combined with removal of the adenoids/adenoidectomy. The ventilation tubes remain in place for a period of 6 to 12 months. Rarely, after their removal, glue ear may develop again, in which case the tubes must be reinserted (revision surgery).

Postoperative instructions

Following the operation, it is very important to avoid into the ear. When bathing, it is recommended to use earplugs or a piece of cotton wool soaked in olive oil or Vaseline, which is placed in the ear canal. Special earplugs can be used for swimming. Flying is not a problem. On the contrary, the ventilation tube allows for better equalization of atmospheric pressures. It is advisable for regular follow-ups (every 3 months) until the tubes are removed. It is also recommended to place antibiotic ear drops once a week.