Middle Ear Diseases

In most cases, serous otitis regresses spontaneously without any treatment. In cases that do not regress, treatment is applied by an otolaryngologist, and in cases that do not resolve despite this, a ventilation tube is inserted into the eardrum, which is a surgical procedure.

The purpose of these tubes is to provide ventilation of the middle ear with ventilation problems. The tubes remain in the eardrum for 6 to 12 months, after which they either fall out spontaneously or are removed by the doctor.

Cholesteatoma

Cholesteatoma is the gradual growth of external auditory canal skin cells through holes and/or collapses in the eardrum into the middle ear, where they gradually multiply. If left untreated, it can damage surrounding tissues and bones. They can also create a favorable environment for bacteria, fungi, and other microorganisms in the middle ear and cause persistent infection.

According to the way they appear, they are divided into two as acquired cholesteatoma and congenital cholesteatoma. The acquired one occurs due to holes and/or collapses in the eardrum. Congenital cholesteatoma is congenital and rarely seen.

Symptoms of Cholesteatoma

Cholesteatoma may remain for years without causing any symptoms other than foul-smelling discharge and hearing loss, but then it progresses and pressurizes, spreading to surrounding tissues. Symptoms of cholesteatoma are generally as follows:

• Fullness, blunt pain in the affected ear
• Severe dizziness, lightheadedness
• Recurrent otitis media
• Foul-smelling ear discharge
• Tinnitus
• Hearing loss
• Headache
• Nystagmus (involuntary movement of the eye)

If cholesteatoma is not treated, weakness in facial muscles, weakness in facial nerves, facial paralysis, deafness, and meningitis may develop.

Cholesteatoma Diagnosis

Ear examination, thin-section ear tomography, ear magnetic resonance imaging, and hearing and balance tests are performed to determine the size of the cholesteatoma, its borders, and the condition of adjacent structures.

Cholesteatoma Treatment

The effectiveness of medical treatment in cholesteatoma is limited; the definitive solution is surgical removal of the cholesteatoma. Cholesteatoma areas in the middle ear and inflammation residues are cleaned. In order to restore hearing, membrane and ossicular surgeries can be performed in the same session or in separate sessions depending on the situation.

The surgery is performed under general anesthesia. The patient may need to stay in the hospital for 1-2 days. In the presence of serious infections or complications, the hospital stay may be prolonged. Return to daily life usually takes place within 1-2 weeks after surgery.

There is always a risk of recurrence of cholesteatoma. Therefore, patients are closely monitored after surgery, and some patients may even require lifelong ear follow-up.

Ear Ventilation Tube

Ventilation tubes, also referred to as ear tubes, are small cylindrical devices with a central channel that allows air to flow into the middle ear. They are made from various materials, including metal, plastic, and Teflon. Ear tubes are a commonly performed procedure in both children and adults. They are generally preferred in cases where the eardrum collapses or when the eardrum or Eustachian tube fails to develop properly. In children, most cases of otitis media with effusion lasting less than three months resolve spontaneously. However, if fluid accumulation persists beyond three months and is accompanied by dizziness, pain, or a feeling of fullness in the ear, tube insertion may be recommended.

How Is an Ear Tube Inserted?

While ear tube insertion can be performed under local anesthesia in adults, it is done under general anesthesia in children. The procedure typically takes around 10 minutes. Temporary bleeding in the external ear canal may occur after the tube is inserted, but this resolves on its own. The ear tube is placed in a small hole made in the eardrum and is not permanent.  Depending on the tube’s design, it is naturally expelled by the eardrum within a year or slightly longer.

Ear tubes can also be inserted during tonsillectomy or adenoidectomy procedures.

After Ear Tube Surgery

The most crucial aspect of post-surgery care is preventing water from entering the ear. To ensure this:

• Cover the ear with Vaseline-coated cotton or an earplug while swimming or bathing.
• Use special swim caps to secure the earplugs and prevent them from falling out while swimming.

Protect the ear from any physical impact.

Myringotomy (Paracentesis)

Myringotomy (paracentesis) is a method used when acute otitis media does not resolve completely. In this procedure, the eardrum is incised to drain fluid accumulated in the middle ear, preventing infection.

This method is beneficial not only in acute otitis media but also in cases of fluid accumulation caused by Eustachian tube obstruction. It can also be performed for diagnostic purposes.

How is Myringotomy (Paracentesis) Performed?

Myringotomy (paracentesis) is performed under general anesthesia, and the procedure itself takes only a few minutes. The eardrum is incised, and the fluid in the middle ear is drained using a vacuum. The incision closes spontaneously within a few days without requiring further intervention.

After myringotomy, the patient can return home. Fluid discharge from the ear may occur for a short period, which is normal and resolves on its own. If unexpected symptoms occur after the procedure, such as foul-smelling or bloody discharge, the doctor should be contacted immediately.

Radical Mastoidectomy Surgery

Surgery In cases of chronic otitis media, the mastoid bone may become inflamed or even erode. When this occurs, the ossicles in the middle ear are removed, and the middle ear and mastoid bone are combined into a single cavity.