Middle Ear Effusion

"Glue ear" is common between the ages of three and six years, and uncommonly persists after 11 years. The hearing loss is often slight and varies with colds. The self-limiting nature of the condition calls for conservative treatment, but "glue ears" are not to be ignored.

A marked and persistent hearing loss, interfering with schooling, necessitates surgery. Episodes of transient otalgia are common with "glue ears," and frequent attacks of acute otitis media may occur. The drum may also become retracted and flaccid with prolonged middle-ear fluid. These features may necessitate insertion of a grommet to reventilate the middle ear.

With glue ear associated with upper respiratory tract symptoms or with proven atopy, the use of an antihistamine and nasal steroid spray assist the resolution of the middle-ear effusion.

Picture Middle Ear Effusion

Fig. 2.76 Blue drum. The middle-ear effusion alters in composition, and at some stages in otitis media with effusion the drum appears blue in color—the so-called "blue drum."

A similarly blue appearance of the tympanic membrane is seen following injury when bleeding occurs in the middle ear (hemotympanum). The conductive hearing loss associated with this injury resolves with resorption of the middle-ear hematoma. A persisting conductive hearing loss following injury, however, suggests injury to the ossicles with an ossicular discontinuity (see Fig. 2.88).

Otitis media with effusion often settles spontaneously.

Fig. 2.77 Myringotomy. If otitis media with effusion with poor hearing persists for over three months, myringotomy (under general anesthetic in children) with aspiration of the fluid is often necessary.

An arrow indicates the radial incision of the myringotomy into which the grommet may be inserted. The posterior/superior quadrant of the drum is not used to avoid injury to the underlying incus and stapes.

Myringotomy Grommet

Fig. 2.77 Myringotomy. If otitis media with effusion with poor hearing persists for over three months, myringotomy (under general anesthetic in children) with aspiration of the fluid is often necessary.

An arrow indicates the radial incision of the myringotomy into which the grommet may be inserted. The posterior/superior quadrant of the drum is not used to avoid injury to the underlying incus and stapes.

Myringotomy Grommet

Fig. 2.79 Grommet insertion. A

myringotomy incision in the posterior half of the drum may damage the incud-ostapedial joint or round window, and a grommet inserted posteriorly may cause incus necrosis from pressure on the long process: An anterior or inferior radial myringotomy is a safer incision.

Fig. 2.79 Grommet insertion. A

myringotomy incision in the posterior half of the drum may damage the incud-ostapedial joint or round window, and a grommet inserted posteriorly may cause incus necrosis from pressure on the long process: An anterior or inferior radial myringotomy is a safer incision.

Fig. 2.80 A grommet in place. The grommet tube ventilates the middle ear and acts instead of the eustachian tube. Hearing and the appearance of the drum both return to normal.

The grommet usually extrudes spontaneously between 6-18 months to leave an intact drum, and is found in wax in the meatus. With recurrent middle-ear fluid, repeated grommet insertion may be needed. If normal eustachian tube function has not returned and otitis media with effusion recurs, the grommet is replaced.

Tympanosclerosis and drum scarring ensue. This complication is also seen in untreated "glue ear." Minimal surgical trauma during grommet insertion is advisable. However, with a narrow ear canal, grommet insertion is not always technically easy.

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