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Is surgery advisable for fluid presence in the ear of a child?

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Posted on Tue, 10 Jan 2017
Question: My 7 year old son had been recently complaining of occasional mild pain in one of his ears in the last 2 weeks. He missed school one of the days. And then 2 or 3 times he had complained of mild pain again.
At the moment he is active and has not complained of any pain or sensation.
He is otherwise an active and energetic child. We also dont believe that there is any hearing issue.

On a causal visit to the hospital today, we asked the doctar to remove the wax from my son's ears and mentioned about the recent complain he had made about the pain in the right year.

When we consulted a doctor, an Impedence audiometry test was conducted. The report is attached. It was informed that this is a Type B result in right ear.

Based on the diagnosis, it has been proposed to conduct a "minor" procedure of incision into the middle drum to remove the fluid and place tubes. If i got the technical name correct - It is called myringotomy?

I am seeking your opinion on the following:
(a) Is this process very necessary or can be delayed untill we know that the fluid is not clearing up on its own.

(b) What are the long term impact of making an incision in the ear drum and placing a tube. Is it going to cause any impact on hearing capacity? Are there any side effects.

(c) Do you recommend if a hearing capacity test should be also conducted.

Thanks in advance. The report is attached.


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Answered by Dr. Sumit Bhatti (9 hours later)
Brief Answer:
There is no need to rush into surgery.

Detailed Answer:
Hi,

Thank you for your query.

1. The most common cause for fluid in the middle ear in his age group is Eustachian Tube Dysfunction (ETD) following repeated colds due to enlarged adenoids. An X-ray skull, lateral view for adenoids should be done. The adenoids usually start regressing after the age of 7 to 8 years and respond to medical therapy including nasal steroids.

2. Repeat the Impedance Audiogram on an automated Impedance Audiometer since in the current report the middle ear pressure (in daPa) is missing. In my experience, pressures less than -150 daPa respond to medical treatment that includes short term pediatric nasal decongestant drops (containing 0.05% Xylometazoline), anti-allergic, mucolytic (such as Relent) anti-inflammatory medication and (supervised) steam inhalation.

3. If a hearing test (PTA or Pure Tone Audiometry) is normal, then the fluid build-up id minimal. If there is a conductive hearing loss, the fluid is more. Longstanding middle ear fluid thickens to a glue like consistency and does not drain despite medical treatment. in such cases a myringotomy with grommet (ventilation tube) insertion is advised. This is a common, safe procedure with no long lasting side effects on the ear drum in almost all cases. The aim of the grommet is to lead to ventilation of the middle ear and not primarily to drain fluid, which settles down when the middle ear is adequately ventilated.

4. Glue ear can also damage the hearing over many years hence the decision is based on response to medical therapy. I recommend to wait for a couple of months with at least two repeat set of tests before going in for surgery.

5. Upload the results of the tests (including the X-ray image, ear drum findings) for further discussion on treatment options.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
Dr.
Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2601 Questions

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Is surgery advisable for fluid presence in the ear of a child?

Brief Answer: There is no need to rush into surgery. Detailed Answer: Hi, Thank you for your query. 1. The most common cause for fluid in the middle ear in his age group is Eustachian Tube Dysfunction (ETD) following repeated colds due to enlarged adenoids. An X-ray skull, lateral view for adenoids should be done. The adenoids usually start regressing after the age of 7 to 8 years and respond to medical therapy including nasal steroids. 2. Repeat the Impedance Audiogram on an automated Impedance Audiometer since in the current report the middle ear pressure (in daPa) is missing. In my experience, pressures less than -150 daPa respond to medical treatment that includes short term pediatric nasal decongestant drops (containing 0.05% Xylometazoline), anti-allergic, mucolytic (such as Relent) anti-inflammatory medication and (supervised) steam inhalation. 3. If a hearing test (PTA or Pure Tone Audiometry) is normal, then the fluid build-up id minimal. If there is a conductive hearing loss, the fluid is more. Longstanding middle ear fluid thickens to a glue like consistency and does not drain despite medical treatment. in such cases a myringotomy with grommet (ventilation tube) insertion is advised. This is a common, safe procedure with no long lasting side effects on the ear drum in almost all cases. The aim of the grommet is to lead to ventilation of the middle ear and not primarily to drain fluid, which settles down when the middle ear is adequately ventilated. 4. Glue ear can also damage the hearing over many years hence the decision is based on response to medical therapy. I recommend to wait for a couple of months with at least two repeat set of tests before going in for surgery. 5. Upload the results of the tests (including the X-ray image, ear drum findings) for further discussion on treatment options. I hope that I have answered your queries. If you have any further questions, I will be available to answer them. Regards.