The middle ear cavity
consists of an extensive pneumatic system aerated by the Eustachian
tube. The area starts
under the eardrum (tympanic membrane), and consists of the tympanic
cavity which houses the 3 middle ear bones (malleus, incus, stapes),
the mastoid, and the Eustachian tube.
The Eustachian tube is 2/3 cartilage, and 1/3 bone (the skull
base). It lies next to the internal carotid artery. The area
where cartilage meets bone is very narrow and this is what causes
problems with the Eustachian tube opening in some instances.
The tube opens and closes in response to movements of muscles
of the palate, and differences of pressure between the nasopharynx
(back of nose) and middle ear. Swallowing or yawning opens the
tube. In young children the angle of the tube is fairly flat
which decreases drainage.
There are two narrow areas leading out of the middle ear which
can cause mastoiditis and above the 3 bones which can cause collapse
of the eardrum and the formation of a destructive skin sac in
the middle ear known as a cholesteatoma.
If the Eustachian tube does not
open, or malfunctions because of anatomic problems (cleft
palate) – negative pressure under the eardrum causes transudation
of fluid into the middle ear and mastoid. This causes hearing
loss and then the fluid can become secondarily infected,
leading to ear infections. If the fluid is left alone for
a long time, it can thicken and pull the eardrum in, possibly
leading to cholesteatoma.
Treatments include watchful waiting, topical and oral
decongestants (not antihistamines!). Antibiotics are
not effective for non-infected ears. If there is pain,
fever, and hearing loss, antibiotics are effective to
rid the infection, but the fluid under the eardrum will
still take approximately 2-4 weeks to clear. Ear problems
statistically occur most often in children 0-3 years
old, then at age 6, and during the late fall through
early spring (October thru April).
for PE (pressure equalizing) tubes
Persistence of fluid beyond 3 months
can cause speech delays, as well as the development of
other problems. Three infections in 6 months, or four infections
in 12 months are also indications for PE (pressure equalizing)
tubes. PE tubes are also placed for chronic tympanic membrane
retractions, in both children and adults.
Unilateral ear fluid in an adult always causes some concern
for the Otolaryngologist (ENT Surgeon). Examining the
Nasopharynx (back of nose by the Eustachian tube) with
a telescope is necessary to rule out a possible growth
Placement of PE tubes requires
a general anesthesia for young children. Adults can have
the procedure in the office. The ear microscope is used
to clean the ear canal, and a tiny incision is made in
the eardrum. Fluid is removed and the tube is placed through
the eardrum to allow the ear to ‘breathe’.
Pain post–op is rare. Advil or Tylenol can be used. Sometimes
drainage occurs post-op. Dr Wladecki usually gives/prescribes
ear drops post –op for this problem.
If drainage occurs after the tubes are placed drops are
the first line of treatment. Oral antibiotics are rarely
needed. Dr. Wladecki also suggests using topical nasal
decongestants (Afrin, Neosynephrine) for up to 3 days
if there is drainage. If drainage persists over 4 days
please call the office.
Dr. Wladecki uses a tube with a
protective gel. Earplugs are rarely needed unless drainage
is known to occur after contamination with water. Tubes
stay in the eardrum for about 3- 12 months and then ‘grow
out’ with the skin of the eardrum. Never use Q-tips in
the ear- it goes against the flow of traffic!