Conductive deafness due to Chronic Ear infection
Secretory Otitis Media (Otitis media with effusion)
Mechanism of Eustachian tube obstruction
Nature’s mechanism of ventilating the middle ear through the nose to maintain air on the inner side of the ear drum has disadvantages. All nasal diseases and Endoscopic view of fluid conditions can cause infective and obstructive symptoms affecting middle and bubbles behind ear drum ear function – e.g. common colds, viral and bacterial infections of the nose. .
Obstruction at the nasal end of the tube can be caused by by enlarged adenoids, tumours, infected water during swimming, pressure changes during air travel and diving under water. Chronic nasal allergy accounts for a sizeable number of patients suffering from Eustachian tubal obstruction.
When tubal obstruction remains for long, a vacuum forms. Fluid pours into the middle ear (Secretory Otitis Media). The fluid is thin initially and later as days go by, it becomes thick like glue (gum), when the condition is called ‘glue ears’.
How is the diagnosis made?
The patient or relatives notice increasing difficulty in hearing. One’s own voice may sound loud in the affected ear. When fluid is present, head movements can cause a feeling of fluid moving in the ear.
Clinical E.N.T. Examination show the ear drum on the affected side/sides to be moving poorly with some parts of the ear drum/drums drawn in. The nose and throat may show evidence of infection or allergy. Enlarged adenoids or other growth of the nasopharynx may be noted.
Pure Tone Audiometry shows a conductive deafness. Acoustic Impedance Bridge studies confirm a Type B flat curve when fluid is present or a Type C Tympanogram for negative pressure in the middle ear.
Fiberoptic endo laryng pharyngeal nasopharyngoscopy for detailed visualization of the nasopharynx & nose.
For assessing, nose, nasopharynx and paranasal sinus conditions, a C. T. Scan with (usually without injection of contrast dye material) of these areas may be necessary.
What is the treatment?
Treatment is aimed at establishing middle ear ventilation by treating the nasal end of the Eustachian tube.
Any nasal infection or allergy has to be treated. The swelling of the lining of the eustachian tube has to be shrunk up by the use of nose drops. This allows to and fro air passage along the eustachian tube. Attempts are made to force air into the middle ear through the eustachian tube actively by the auto inflation exercise (Valsalva maneuver). explained elsewhere. Nasal steroid sprays on a long-term basis may be required in allergic conditions, swollen (edematous) mucous membrane lining and cases with nasal polyp formation.
In a small percentage of patients if middle ear fluid is present, if the above measures do not give relief, surgical treatment is required – a small incision is made in the ear drum under local anaesthesia and the fluid sucked out. If the fluid is very thick, a small ventilation tube (grommet) is inserted through the incision and left in place. It normally takes 3 to 6 months to extrude spontaneously.
Treatment of the nasopharyngeal condition like removal of enlarged adenoids in children or adequate treatment of nasopharyngeal growth is required. Clearance of nose and paranasal sinus disease by Functional Endoscopic Sinus Surgery (F.E.S.S.) may be required.
Detection of allergies by an allergy test followed by proper treatment may be necessary.