Ask the ENT - Middle Ear Troubles

Middle ear fluid (otitis media with effusion) is a common condition in childhood, often causing a temporary conductive hearing loss. When middle ear fluid persists, treatment may be recommended. Dr. Stan Baker, an ENT specializing in otology and neurotology, recently worked with Hearing First to answer some of the common questions about middle ear fluid and how it affects your child with pre-existing hearing loss. Read along for helpful takeaways and insights straight from the doctor himself!

Q: What is middle ear fluid and why does it matter?
 
A: The air in the middle ear allows the eardrum to vibrate freely in response to sound and when this air in the middle ear is displaced by fluid of sinus congestion, a restriction in the free movement of the eardrum results in a temporary hearing loss. This fluid of sinus congestion in the middle ear is technically known as "otitis media with effusion" but may be more commonly referred to as middle ear fluid (MEF). Adults with MEF complain about the hearing loss and the sense of fullness and pressure. In children who have no other source of hearing loss, MEF and its associated mild-moderate hearing loss may result in discomfort, balance disturbance, behavioral problems at home and at school, and eventually delayed speech and language development - if it persists. In the special case of children with pre-existing hearing loss who are already "at risk" for speech and language delay, we are particularly concerned about the additional hearing loss caused by MEF.
 
 
Q: What causes middle ear fluid and what lets it go away?

A: MEF is usually blamed on eustachian tube dysfunction. The eustachian tube is the connection between the back of the nose and the middle ear sinus space. The eustachian tube has the function of both connecting the ear to the nose (for ventilation) while also isolating the ear from the nose (for protection from infection and congestion). If nasal problems with the inflammation of infection and allergy can be relieved, either by time or treatment, the MEF may pass spontaneously. A temporary opening in the eardrum can allow the eustachian tube to work better and MEF to drain. Such an eardrum opening can occur spontaneously from acute infection and can occur intentionally with ear tube placement.
 

Q: When should middle ear fluid be suspected and how can it be detected and diagnosed?

A: Although MEF often causes obvious symptoms, especially if it is associated with an acute ear infection, in other children MEF may not be so obvious. A tympanogram is a common audiological test of eardrum "compliance" (movement) that can detect the likelihood of MEF. An audiogram may show signs of the typical hearing loss of MEF. Pneumatic otoscopy is a method of physical examination that allows the eardrum to be observed for movement while gently changing the air pressure in the ear canal. When it is feasible, pneumatic otoscopy is the most reliable way to diagnose MEF, short of making a surgical opening in the eardrum for direct inspection of the middle ear sinus space.
 
 
Q: When should middle ear fluid be treated and what treatment options are available.

A: From the perspective of the ENT/otologist, there are basically two options for managing middle ear fluid. If time is not critical, watchful waiting may be recommended and supplemented with minimizing daycare exposure in younger children (if feasible) and addressing allergic exposures in older children.In addition, any exposure to secondhand tobacco smoke must be eliminated in all children. Antibiotics are no longer recommended for treatment of MEF. If MEF persists for three months in a child with no other causes of hearing loss, placement of ear tubes (with or without adenoid removal) should reliably relieve the MEF and its associated hearing loss. In the special case of children with other causes of hearing loss who coincidentally develop MEF, the management of the MEF needs to be customized to each child's unique situation. Consultation with parents, audiologists and other LSL professionals often makes it obvious that MEF hampers hearing aid management and raises additional concerns for speech and language delay. In these "at risk" children, the necessity of maximizing access to spoken language may mandate shortening of the timeline for watchful waiting of MEF.
 
 
Q: How does middle ear fluid affect the use of hearing technology?
 
A: For children using hearing aids, MEF adds an extra, temporary burden of conductive hearing loss that can be relieved by ear tube placement. However, if ear tubes are in place, it is possible for a head cold or allergy flare-up to result in temporary drainage of MEF out through the ear tube and into the ear canal. Treatment of such ear tube drainage may include temporarily removing the hearing aid from the affected ear. Fortunately, for children using bone conduction type hearing devices and cochlear implants, MEF has minimal effect on the hearing that is provided by these technologies. In these special cases, be sure to consult the surgeon involved for specific answers in your child's case.

We’d like to thank our guest author, Dr. Stan Baker for sharing his expertise about middle ear fluid. Dr. Baker practices otology and neurotology in Oklahoma City at the Otologic Medical Clinic, affiliated with the Hough Ear Institute. He has done over 1000 cochlear implant surgeries and is one of the co-founders of Hearts for Hearing.