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Ear infection. History of dysfunctional eustachian tubes. Adenoids removed. How is this affecting hearing?

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ENT Specialist
Practicing since : 2001
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I have a 13 year old son with a history of dysfunctional eustation tubes, chronic hypercompliant eardrums with retraction, He had tubes placed bilaterally at 9 months after fluid sat on his eardrums from 3-9 months and did not spontaneously resolve. Antibiotics were given this entire time. One of his eardrums bursts due to an ear infection. A second tube was placed in one ear at age 4 anad adenoids were removed. He has had speech therapy for "r" sounds during 1st and 2nd grades and does poorly on standardized language tests. His recent tympanogram reveals the following:
Right ear: Ear volume: 1.70ml Left ear: Ear volume: 1.27 ml
compliance: 3.72 ml compliance: 2.79 ml
pressure: -47 pressure: -180
gradient: 3.20 gradient: 2.13

Reflexes are normal and hearing is within the normal range. Bone conduction is better than the air conduction.

My question is how is this effecting his hearing and is there anything I can do to improve this condition?

Thank you
Posted Tue, 8 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Naveen Kumar 7 hours later

Thanks for the query

The tympanogram report is almost normal except for the pressure gradient which is bad in the left ear. The negative pressure in the ears indicates chronic Eustachian tube dysfunction.

Eustachian tube is a connection between the nose and the middle ear which helps in maintaining the pressure between the nose and the ear. Any dysfunction in this tube due to various reasons such as recurring sinus infection, adenoid hypertrophy, neuro-muscular problems, etc. can hamper the hearing and speech process.

Also, you have mentioned that the hearing sensitivity is within the normal limits, but the bone conduction is better than the air conduction, this means there is some amount of conduction problems which could be probably due to the negative pressure developed in the middle ear.

It so happens, when the child is having some amount of hearing disability certain phonemes will not be heard clearly or nothing at all. This is evidenced by a speech curve called as speech banana, ( where various phonemes are charted which can be heard up to certain frequencies and the effect on the hearing when there is conduction problems in those frequencies. This is the reason your child is not faring well in the school.

Finally, it is difficult to treat Eustachian tube dysfunction; the best treatment of this condition is to do steam inhalation 2-3 times a day and use saline nasal spray, so that the congestion around the tube reduces. Once the congestion around the tube reduces the pressure in the middle ear and the nose can be neutralized.

Hope I have answered your query; I will be available for the follow-up queries.

Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
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