MIDDLE EAR EFFUSION

Middle ear effusion (MEE) is a condition caused by fluid in the middle ear. The fluid can be thin and serous like, or thick and glue like. Therefore middle ear effusion is also synonymous with others names such as glue ear, otitis media with effusion, secretory otitis media etc.

How does it occur?

The middle ear is normally an air-filled space deep to the ear drum. The pressure in the middle ear is equalized to the atmospheric pressure through the Eustachian tube. The Eustachian tube would open and close when we swallow or yawn. When there is poor function of the Eustachian tube, negative pressure will develop in the middle ear which leads to fluid accumulation.

Risk factors for MEE

Exposure to secondary smoking Frequent upper respiratory tract infections Frequent ear infections Attending daycare centres Allergic rhinitis

MEE is usually common in children especially those with frequent upper respiratory tract infections and allergies.  It can also occur within weeks after an acute middle ear infection, which doctors call acute otitis media.  It is less common in adults and if unilateral, it can be associated with nasopharyngeal carcinoma.

Symptoms of MEE

Ear block

Tinnitus

Reduced hearing- children may become inattentive in classroom or not respond to soft sounds

Ear pain, fever and irritability- if infected

How is MEE diagnosed?

An otoscopic examination by the doctor may show fluid or bubbles behind the ear drum. The ear drum may also take a yellowish hue.

The diagnosis can also be confirmed by performing a tympanometry which shows impaired mobility of the ear drum. A hearing test would also show a conductive type of hearing loss.

Treatment of MEE

Most cases of middle ear effusion will resolve within weeks. However doctors would prescribe medication to treat the underlying conditions. Antibiotics are indicated when there is infection and antihistamines are considered in patients with allergies. Nasal decongestants are sometimes prescribed to treat the nasal congestion.

Unfortunately in some cases the MEE persists despite medical treatment. In these cases a simple procedure such as myringotomy and grommet insertion is performed to remove the fluid and restore ventilation to the middle ear. This surgery is indicated in chronic MEE especially with significant hearing loss.

The hearing loss in MEE can be significant enough to affect the speech development in infants and the learning process of a school going child.