Tympanic effusion refers to an accumulation of fluid in the middle ear in the area of the eardrum. The consistency of the fluid ranges from serous (watery) to mucous or even purulent. Tympanic effusion is usually caused by a blocked Eustachi tube. This causes a slight negative pressure in the middle ear, causing tissue fluid to leak out and collect in the tympanic cavity below the ossicles.
What is a tympanic effusion?
The middle ear is bounded on the outside by the eardrum and on the inside by the cochlea. At the top of the middle ear are the ossicles, which transmit vibrations from the eardrum through the oval window to the cochlea in the inner ear. In the lower region, the middle ear widens at the level of the tympanic membrane to form the tympanic cavity, which opens into the Eustachian tube. Normally, the middle ear is filled with air, and the Eustachi tube, with its connection to the nasopharynx, provides the necessary pressure equalization so that the same air pressure prevails in the outer and middle ear. If the Eustachi tube is blocked due to a cold or other causes, there may be a slight negative pressure in the tympanic cavity, which promotes the leakage of tissue fluid that accumulates in the tympanic cavity and is called a tympanic effusion. Since it is usually a serum-like fluid at the beginning, the consistency is usually watery at first. With prolonged or chronic progression, the consistency may change significantly. The fluid becomes mucousy and viscous, may also contain blood, and may mix with pus in the case of bacterial infections.
Causes
Dysfunction of the Eustachi tube results in a lack of pressure equalization between the middle and outer ear. This often creates a slight negative pressure in the middle ear, which promotes the secretion of tissue fluid by the mucosal epithelium of the middle ear. The fluid then accumulates in the lower part of the tympanic cavity as a tympanic effusion. If the blockage of the eustachian tube persists, the consistency and composition of the tympanic effusion changes toward mucous, viscous. Because of the lack of ventilation of the tympanic cavity, bacterial infections often set in, leading to middle ear infection and exacerbating the problem. In children who are prone to middle ear infections, bacterial infections can also cause the tympanic effusion, rather than the other way around. Blockage of the eustachian tube and the resulting lack of ventilation of the tympanic cavity can have many causes. Most commonly, the blockage is caused by colds, sinusitis, nasal polyps, or enlarged palatine tonsils. Children with Down syndrome (trisomy 21) and cleft lip and palate may also have functional restrictions of the Eustachi tube.
Symptoms, complaints, and signs
An incipient tympanic effusion is usually asymptomatic, so it is discovered in very few cases. If more severe, hearing impairment in the form of a reduction in sound conduction sets in. It is not uncommon for dizziness to occur as well. In addition, there is usually an unpleasant feeling of pressure on the affected ear. Pain usually sets in only when a middle ear infection occurs, which can lead to a rupture of the eardrum if the tympanic effusion is severe. If the eardrum is ruptured, some of the fluid may spill into the external auditory canal and visibly drain outward from the ear. If the tympanic effusion progresses chronically for more than three months, the mucosa of the middle ear is stimulated to develop a cylindrical epithelium with so-called goblet cells. The goblet cells are integrated into the epithelium and produce mucus.
Diagnosis and course of the disease
A commonly used and easy-to-use diagnostic procedure is otoscopy. Fluid accumulation in the tympanic cavity can then usually be detected through the eardrum, because the eardrum is semitransparent as thin skin, and fluid accumulation on the other side shows through a little. For example, if the tympanic effusion also contains blood, the eardrum will have a slightly bluish glow. Another diagnostic option is tympanometry, which is used to measure the mobility and elasticity of the eardrum. The extent to which the tympanic effusion has caused a temporary or permanent hearing loss can be determined by means of audiometry.
Complications
Complications of a tympanic effusion primarily affect children. Although an acute effusion heals on its own in most cases, there is a risk of unpleasant sequelae if the condition is not noticed in time and treated appropriately. One of the most common negative effects of tympanic effusion is hearing loss. It is considered particularly problematic because it is often not even noticed by the affected children. This, in turn, can result in disturbances in the child’s development. Sometimes those affected are even wrongly classified as mentally retarded. In order to prevent hearing damage caused by a tympanic effusion, it is advisable to attend preventive check-ups. If there is a suspicion that the child has difficulty hearing, an examination by an ear, nose and throat specialist should be performed. If the tympanic effusion takes a chronic course, further complications are possible. For example, scarring of the middle ear mucosa or otitis media often occur. In addition, there is a risk of impairment of the ossicles due to the effusion. If these are even destroyed, their replacement with an implant is necessary. Furthermore, cholesteatoma can form, which must be surgically removed. Some patients also suffer from serious effects of a tympanic effusion such as mastoiditis (inflammation of the mastoid process) or meningitis (meningitis). Adults may also experience the sequelae of a tympanic effusion. These are mostly complaints such as dizziness, pressure sensations and headaches.
When should you go to the doctor?
If hearing loss, a feeling of pressure in the ear and other signs of a tympanic effusion occur, the doctor should be consulted immediately. Pain and dizziness in the ear are also clear warning signs that need to be clarified. Affected individuals are best off consulting their family doctor or an ear specialist. The physician can make the diagnosis based on a physical examination and treat the effusion with medication or tube blasting. Individuals suffering from sinusitis, rhinitis, or metabolic disease are particularly at risk. People with Down syndrome, cleft lip and palate or adenoids also belong to the risk groups and must have said signs clarified immediately by a specialist. In addition to the ear specialist, an internist or the general practitioner may be consulted. Children should be presented to the pediatrician if ear pain or hearing complaints occur. If the tympanic effusion occurs in connection with a surgical procedure (e.g., after a Eustachi tube has been placed), the responsible physician must be informed. Treatment is usually an inpatient procedure, although the tympanic effusion can usually be corrected by routine surgery.
Treatment and therapy
Treatment of tympanic effusion depends on the causative factors. In general, diseases that have caused a tympanic effusion are easily treatable. If the fluid accumulation was diagnosed early enough, it is usually sufficient to provide for the restoration of the functionality of the eustachian tube. Once pressure equalization is restored, there is a good chance that the tympanic effusion will resolve on its own and that hearing will regenerate, provided that the eardrum has not been damaged. In simple cases, nasal sprays to decongest the nasal mucosa and inhalations are sufficient. In more stubborn cases, medications are given to liquefy the tympanic effusion and possibly antibiotics to treat the bacterial infection. In severe cases, paracentesis, an incision into the eardrum, may be indicated to allow the secretions to be suctioned out. The incision in the eardrum may be made so that it grows back together without leaving permanent hearing damage. In a few cases where pressure cannot be equalized through the Eustachi tube, a so-called tympanostomy tube is inserted to provide permanent pressure equalization between the middle ear and the external pressure. The tympanostomy tube remains in the ear for a maximum of twelve months and is then removed.
Outlook and prognosis
A tympanic effusion can take different courses. The prognosis is based on the age of the patient and the time of diagnosis, among other factors. In children, tympanic effusions sometimes develop into a chronic condition. Basically, the tympanic effusion can be treated by eliminating the causes.Only in isolated cases does permanent damage remain in the auditory canals, such as damage to the mucosa or the auditory ossicles. In adults, tympanic effusions usually subside completely. Long-term consequences are rare. In some patients, hearing may be impaired. A tympanic effusion is initially associated with pain and discomfort. After treatment, the symptoms should have subsided. Restrictions in quality of life are not expected for the patient. Life expectancy is also not reduced by a tympanic effusion. The prognosis is made taking into account the course of the disease, the general condition of the patient and some other factors. The ear or family physician is responsible. In chronic diseases, the prognosis must be renewed regularly. In general, the prognosis for tympanic effusion is good and the patient can lead a symptom-free life after treatment.
Prevention
Measures to prevent the development of a tympanic effusion consist mainly of ensuring a functioning pressure equalization through the eustachian tube. Particularly in the case of colds, care should be taken to restore pressure equalization as soon as possible.
Aftercare
In most cases, the person affected by a tympanic effusion has only a few and usually also only limited options and measures of aftercare available. First and foremost, the affected person should consult a physician quickly and, above all, at an early stage in order to prevent the occurrence of further complications and complaints. Since the patient cannot heal on his own, he is always dependent on a medical examination by a physician. As a rule, tympanic effusion can be treated relatively well by simple means. The affected person should use nasal spray to relieve the discomfort. In some cases, it may also be necessary to take antibiotics to limit the discomfort. The affected person should always ensure that the antibiotics are taken regularly and in the correct dosage. In case of questions or severe side effects, a doctor should always be consulted first. Antibiotics should not be taken together with alcohol, as their effect will otherwise be significantly reduced. Further aftercare measures are usually not available to the person affected by this disease. The life expectancy of the affected person is not reduced.
What you can do yourself
A tympanic effusion can cause severe pain. These usually get better when good ventilation of the ear is ensured. In this respect, it is advisable to use decongestant nasal drops and decongestant nasal sprays in the event of an acute tympanic effusion. These keep the connection between the nose and the ear open. This allows the tympanic effusion to heal more quickly and the pressure pain on the ear to subside. Especially when lying down, the pain caused by a tympanic effusion can be very severe. Therefore, decongestant sprays or drops are advisable especially before going to bed. Pain-relieving medications such as ibuprofen and paracetamol can also help the pain subside in acute infections. Both painkillers and nasal drops are available over-the-counter in moderate doses and should always be kept in stock, especially if you are prone to repeated tympanic effusions. Since a tympanic effusion usually heals without complications and is often also caused by a virus, you can wait for the healing process to be completed if you are in a good general condition and take it easy. Tried and tested home remedies such as onion bags can also relieve the pain. However, especially with children, parents should carefully observe whether the pain becomes more severe during the course of the infection or whether a high or repeated fever occurs. This may be a sign that the infection is bacterial. Depending on the individual constitution, self-help is not possible in this case. The body then needs an antibiotic, which a specialist will prescribe after appropriate examination.