Middle Ear Infection and Grommets

What is a middle ear infection?

A middle ear infection (otitis media) is inflammation of the air-filled space behind the eardrum. It is very common in children and usually develops after a cold or an upper respiratory tract infection.

There are two main types:

• Acute otitis media: an infection with fever, ear pain, irritability and sometimes discharge from the ear. Most cases settle with watchful waiting and painkillers, or with antibiotics.
• Otitis media with effusion (glue ear): fluid collects in the middle ear, but there are no signs of infection such as fever or pain. Because it is silent, it is often noticed only through reduced hearing. If it lasts three months or longer, it is considered chronic.

Why does fluid collect in the middle ear?

The Eustachian tube, which ventilates the middle ear and balances its pressure, opens into the area behind the nose (the nasopharynx). When this tube is blocked by an infection or enlarged adenoids, the middle ear cannot be ventilated and fluid builds up.

Factors that increase the risk:

• Frequent upper respiratory tract infections at nursery and pre-school
• Enlarged adenoids and allergic rhinitis
• Exposure to cigarette smoke at home
• Not being breastfed
• Congenital differences in the structure of the face and skull

Which signs should you look out for?

Fluid in the middle ear is often painless; parents usually notice a change in the child’s hearing.

• Responding late or not at all when called
• Watching television at a high volume
• Delayed speech or unclear pronunciation
• Frequently recurring ear pain or ear infections
• Unsteadiness, poor attention, difficulties at school

How is it diagnosed?

The diagnosis is made with an ear examination and simple tests.

• Otoscopic or endoscopic examination: in an acute infection the eardrum is red and bulging; when fluid is present the eardrum looks dull and does not move.
• Tympanometry: a short test that measures the movement of the eardrum; if fluid is present, a flat curve (type B) is obtained.
• Hearing test: shows the degree of hearing loss caused by the fluid.
• Examination of the nose and nasopharynx: checks whether the adenoids are enlarged.

In adults, if hearing slowly declines over the years while the eardrum is intact and there are no signs of inflammation, the cause may be otosclerosis rather than fluid. The assessment and treatment of this condition are described on the stapes surgery (stapedotomy) page.

Treatment options

Most acute middle ear infections settle on their own or, when needed, with antibiotics. Fluid in the middle ear clears by itself within three months in most children; during this time it is monitored with regular check-ups. According to current guidelines, antibiotics, steroids, allergy medicines and decongestants are not routinely recommended for otitis media with effusion, as they do not make the fluid clear; if there is an underlying cause such as allergy or enlarged adenoids, that cause is treated.

If fluid lasting longer than three months leads to problems such as hearing loss, delayed speech or retraction of the eardrum, placement of a ventilation tube (grommet) in the eardrum is recommended.

Does long-standing fluid affect hearing and speech?

Yes. Studies have shown that fluid persisting in the middle ear for months causes a noticeable conductive hearing loss. This hearing loss is temporary and usually improves once the fluid is drained; however, if it lasts a long time it can affect aspects of language development such as pronunciation, vocabulary and sound awareness. For this reason, follow-up should not be postponed in children of speech-learning age.

How is the grommet operation performed?

The procedure is performed under general anaesthesia with an operating microscope and takes 15–20 minutes in total for both ears; there is no cut in the skin.

1. A small opening of 0.5–1 mm is made in the eardrum.
2. The fluid in the middle ear is drained.
3. A small ventilation tube is placed in the opening.

If enlarged adenoids are the cause of the fluid, adenoid removal and, if there is also chronic tonsillitis, tonsil surgery can be carried out under the same anaesthetic.

After the grommets are inserted

• The grommet usually stays in the ear for between 3 months and 2 years; in most cases it falls out into the ear canal by itself and the opening in the eardrum closes on its own.
• Current guidelines do not recommend routine water precautions for children with grommets; even so, protecting the ear is advised while there is discharge, for deep diving and in unclean water such as lakes or rivers. Advice suited to your child is given at the check-up.
• Flying is possible; the grommet makes it easier for the ear to adapt to changes in cabin pressure.
• If there is discharge from the ear, see your doctor; it is usually treated with drops.
• At the check-ups, the eardrum and the grommet are examined regularly.

Hearing loss caused by the fluid usually improves after the grommets are inserted; if the middle ear infection does not recur, this improvement is generally lasting.

What are the risks?

• Discharge from the ear
• Early loss or blockage of the grommet
• A small permanent hole in the eardrum after the grommet comes out (rare)
• Fluid returning in some children, requiring a second set of grommets
• Risks related to anaesthesia

How does the process work with Prof. Dr. Öner Çelik?

1. Consultation: at the clinic in Suadiye, the ear, nose and nasopharynx are assessed together; tympanometry and a hearing test are planned.
2. Decision: the duration of the fluid, its effect on hearing and speech, and the response to medical treatment are considered together.
3. Procedure: if needed, grommet insertion is performed at Maltepe University Hospital, together with adenoid or tonsil surgery where appropriate.
4. Follow-up: grommet and hearing check-ups take place at the clinic in Suadiye.

You will find the details on the your treatment in Istanbul page.