Fluid retention in the ear: causes and how is it diagnosed and treated?

imhjournal.com

21 March، 2024

Fluid retention in the ear occurs due to blockage of the channel responsible for draining these fluids, which is called the Eustachian tube, which leads to fluid accumulation in the middle ear. This may lead to complications unless the necessary measures are taken. What are the causes of Eustachian tube blockage and what are the symptoms of fluid retention in the ear? How is this condition diagnosed and treated?

How does fluid retention in the ear occur?

Excess fluid and mucus drain from the middle ear naturally through the Eustachian tube. The Eustachian tubes extend on both sides of the face from the middle ear to the back of the nose and throat, which is called the nasopharynx. The Eustachian tubes are closed most of the time and only open when chewing, swallowing, or yawning.

The Eustachian tubes play an important role in regulating the pressure inside the ears and making it similar to the outside air pressure, and draining excess fluid from the middle ear. Infection and blockages can disrupt this drainage process and may lead to complications.

Blockage of the Eustachian tube leads to inflammation of the middle ear with fluid retention in it (Otitis media with effusion OME). The middle ear is an air-filled space located behind the eardrum . It contains the three hearing ossicles that vibrate and convert sound into nerve signals that the brain understands.

Blockage of the Eustachian tube and the presence of excess fluid in the middle ear provides an ideal environment for bacteria to grow and multiply, leading to ear infection .

There are several disorders that may affect the Eustachian tubes, which lead to them becoming blocked or remaining open. These disorders are called ETD (Eustachian Tube Dysfunction).

What are the causes of Eustachian tube blockage?

Enlarged adenoids block the Eustachian tube and lead to the growth of bacteria, causing ear infections.
Allergies and seasonal diseases such as influenza or colds that cause inflammation of the Eustachian tubes.
Sinusitis, which also causes the Eustachian tubes to become inflamed or filled with mucus.
Changes in air pressure occur, such as riding a plane, driving over a mountain, or even just riding an elevator in a tall building.

What types of ear infections cause fluid retention?

An ear infection is a bacterial or viral infection that infects the middle ear, causing inflammation and fluid accumulation in it. Ear infection is accompanied by pain due to increased pressure on the eardrum due to inflammation and accumulated fluid. Ear infections can be acute or chronic. Chronic infections may lead to permanent damage to the middle ear. Ear infections are divided into three categories.

Acute otitis media (AOM).

It is the most common and least serious form of ear infection in which the middle ear becomes inflamed and fluid accumulates behind the eardrum. It may also be accompanied by fever.

Otitis media with effusion OME

Also called secretory otitis media, fluid collects behind the eardrum. A person with OME may not experience symptoms.

Chronic otitis media with effusion COME

Fluid retention occurs frequently in the middle ear, and may be associated with infection, has a negative impact on the sense of hearing, and leads to a decreased ability to fight other infections.

Why is fluid retention in the ear more common in children?

Fluid retention in the ear is a common condition in children, as it affects 5 out of every 6 children in the first 3 years of their lives. It affects 90% of children at least once before the age of 10, and it is more common among young boys than girls.

The reason for this is the shape of the Eustachian tubes in children. Where the direction of the canal is horizontal, the tube is shorter and the openings are smaller, this will increase the risk of blockage and infection as it becomes difficult to drain fluids from the middle ear.

This condition often does not need treatment and gets better on its own, and vaccinating your child against influenza can help prevent recurrent ear infections.

Symptoms

Symptoms may vary from one person to another and may be mild or severe and include:

Feeling of fullness or blockage in the ears.
Ringing in the ears.
Hearing impairment or temporary hearing loss.
A tingling or tickling sensation.
Feeling pain.
Crackling sound.
Balance problem.

The severity and duration of symptoms depend on the causative agent. For example, if the cause is a change in pressure due to a change in altitude, the symptoms often disappear when the body adapts to the new pressure or moves to a lower altitude. However, if the cause is a disease or infection, the symptoms may last for a longer period, and a doctor should be consulted here. Symptoms of ear infections appear quickly and differ in children from adults and include the following:

Symptoms of ear infections in children

Feeling pain in the ear, especially when lying down.
Ear tug
Crying more than usual
Headache
Sleep problems
Loss of balance
Anorexia
Trouble responding to or hearing sounds.
Fever 38°C or higher
Fluid coming out of the ear

Symptoms of ear infection in adults

Ear pain.
Hearing problem.
Fluid coming out of the ear.

Complications

Fluid retention in the ear can cause many complications that may lead to dysfunction that causes hearing loss, such as:

Ear infection.
Retraction of the eardrum, which leads to middle ear atelectasis.
Chronic otitis media.
An abnormal skin growth in the middle ear called a cholesteatoma.

Diagnosis

Doctors diagnose fluid retention in the ear based on symptoms and a physical examination. The doctor inquires whether the patient suffers from:

Hearing changes.
Pain in the ears.
Feeling stressed.

He then examines the eardrum and middle ear using an otoscope to confirm the presence of infection or blockage. The doctor may view a tympanogram, which shows the function of the eardrum, and an audiogram, which shows the results of a hearing test. Additional imaging tests may be requested if cholesterol tumors are present.

treatment

Treatment depends on the severity of the symptoms. Treatment may be done through simple steps taken at home, or through medications that are dispensed without a prescription, or treatment may require an antibiotic prescribed by a doctor, or all of the above may not work and require surgical intervention.

First, home treatment

If the symptoms are mild and are caused by a change in air pressure, such as when climbing hills or riding a plane, a person can treat a blocked Eustachian tube by chewing gum or yawning. Also, drinking a drink or eating a snack may help open and close the Eustachian tube and relieve pressure.

Children with mild or temporary symptoms can eat a snack or chew a piece of gum. This will help the symptoms go away. Giving the infant his own bottle or pacifier may help relieve symptoms.

Secondly, drug treatment that does not require a prescription

Saline nasal spray

Mild to moderate symptoms can be alleviated by using a saline nasal spray, as the blockage may be caused by dried mucus accumulating in or near the Eustachian tube. Therefore, the saline spray will help clear the passages and get rid of any blockage.

Antihistamines

If the blockage is caused by an allergy, antihistamines such as cetirizine, diphenhydramine, loratadine, or nasal steroid sprays can be used.

Non-steroidal anti-inflammatory drugs

NSAIDs, such as ibuprofen, help relieve pain and swelling. If the patient is using other medications, it is best to consult a doctor or pharmacist to ensure that these medications will not interact with any other medication.

Third, antibiotics

They are prescribed by a doctor if fluid retention in the ear and blockage are caused by a bacterial infection. The doctor may prescribe a topical or oral antibiotic.

Fourth, surgical treatment

In some cases where drug treatment is not effective, the doctor performs surgical intervention to get rid of the fluid accumulated behind the eardrum. The most important of these procedures are

Ear tubes

An ear tube is used to treat fluid accumulation in the middle ear and prevent this problem. Also known as tympanostomy tubes, ventilation tubes, tympanocentesis tubes, or pressure equalization tubes, they are small, hollow cylinders made of metal or plastic that are surgically inserted into the eardrum. It allows fluids to drain from the middle ear, allows air to flow into it, and prevents fluids from accumulating behind the eardrum.

Doctors often recommend ear tubes for children if they have concerns about delayed speech due to persistent fluid buildup behind the eardrum, if the fluid is negatively affecting their hearing, or if the child gets frequent ear infections.

Most ear tubes fall out within four to 18 months, and the holes heal spontaneously. But there are some tubes that need to be removed by the doctor and some openings that need to be closed surgically.

Dilatation of the Eustachian tube using a catheterinto which a balloon filled with saline is inserted .
Passing fluids into the middle ear by using a microscopic rhinoscope to apply fluids through the Eustachian tube. This helps regulate ear pressure.
Eustachian tube plastery uses a laser cutting tool to remove obstructions from the Eustachian tube such as mucous membranes or cartilage.

In conclusion, fluid retention in the ear is a common condition that has many causes that may be accidental and resolve spontaneously, or may be the result of another disease and require drug treatment or surgical intervention. Fluid retention is more common in children, so it is important to know the symptoms well in order to take the necessary measures if they develop them to prevent complications.

References

Medical news today, Jon Johnson and Alina Sharon, Updated on February 9, 2023

What’s to know about eustachian tube dysfunction?

https://www.medicalnewstoday.com/articles/319602#symptoms

Healthline, By Rachel Nall, MSN, CRNA, Updated on September 17, 2018

Otitis Media with Effusion

https://www.healthline.com/health/otitis-media-with-effusion

Mayo Clinic,By Mayo Clinic Staff,Jun 23,

Ear infection (middle ear)

https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616

Medical news today, By Tim Newman on October 25, 2017

How to treat ear infections