About the Middle Ear – How It Works
The middle ear is a pea-sized, air-filled cavity separated from the outer ear by the paper-thin eardrum. Three tiny ear bones are attached to the eardrum. When sound waves strike the eardrum, it vibrates and set the bones in motion that transmit sound to the inner ear.
A healthy middle ear keeps air at the same pressure as outside the ear, allowing free vibration. Air enters the middle ear through the Eustachian tube, which connects the back of the nose to the ear. The “pop” you hear when you yawn means your Eustachian tube has sent a tiny air bubble to your middle ear to equalize the air pressure.
Fluid in the Ears
Blockage of the Eustachian tube during a cold, allergy or upper respiratory infection and the presence of bacteria or viruses lead to fluid behind the ear (a build-up of pus and mucus). This infection – called “Acute Otitis Media” – is the most frequent diagnosis for children who visit physicians for illness. It’s also the most frequent cause of hearing loss in children.
It can cause earache, swelling and redness, as well as hearing problems.
Symptoms & Signs in Infants & Toddlers
- Pulling or Scratching at the ear (especially if accompanied by the following)
- Hearing Problems
- Crying, Irritability
- Ear Drainage
Symptoms in Young Children, Adolescents & Adults
- Feeling of Fullness or Pressure
- Hearing Problems
- Dizziness or Loss of Balance
- Nausea and/or Vomiting
- Ear Drainage
Serous Otitis Media (Middle Ear Effusion)
With this infection, it’s possible for the eardrum to rupture causing pus to drain out of the ear. More often, the pus and mucus remain in the ear because of the swollen and inflamed Eustachian tube. This is called “Middle Ear Effusion” or “Serious Otitis Media.” Even after the infection has passed, with this disease, the effusion may remain and become chronic – lasting for weeks, months or even years. In that case, patients may have frequent recurrences of the acute infection and may cause difficulty in hearing.
Diagnosis of Middle Ear Disease
During an exam, our doctors use an otoscope to determine the ear’s condition. The doctor checks for redness in the ear and/or fluid behind the eardrum and to see if the eardrum moves. An infection is likely present if the eardrum is red and/or doesn’t move.
An audiogram then determines is there if a hearing loss. A tympanogram measures the air pressure in the middle ear to see if the Eustachian tube is working and if the eardrum is moving.
Your doctor may prescribe medications to treat your condition. It’s important to take all medications and keep all follow-up visits. Antibiotics may be used to fight ear infections, and they may cause ear aches to go away. However, infections may need more time to clear up completely, so be sure to take your medication for the full time as prescribed, even if you start to feel better. Other medications that may be prescribed include: antihistamine (for allergies), decongestants (especially with a cold) or both.
Call your doctor if you have any questions about medications or if symptoms don’t clear.
Most of the time Otitis Media clears up with the proper medication and treatment at home. If not, your doctor may recommend an operation called a Myringotomy. In this procedure, a small surgical opening into the eardrum allows drainage of fluid to relieve pain. The incision heals within a few days. If it closes before all of the infection and fluid are gone, a ventilation tube can be placed in the incision, which prevents fluid accumulation and improves hearing.
At this point, a tube will be placed in the ear for as long as needed for the infection to improve and the Eustachian tube to return to normal, which could take several weeks or months. During this time, it’s important to keep water out of the ears as it could start an infection. With this approach, you should notice great improvement in hearing and a decrease in the frequency of ear infections.
A perforated eardrum is a hole or rupture in the eardrum itself. Symptoms can include decreased hearing and occasional discharge. Pain is usually not persistent.
The size and location of the perforation, as well as the extent of the trauma causing it, will determine the amount of hearing loss that may occur. If a sudden traumatic or explosive event causes the perforation, hearing loss can be significant and ringing in the ear may be severe. If this is the case, hearing usually returns at least partially and ringing usually goes away in a few days. If there is chronic infection caused by the perforation, major hearing loss can be the result.
Most perforations will heal on their own within a few weeks, although some may take up to several months. During the healing process, the ear must be protected from water and trauma.
If needed, your doctor my touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. If this patch won’t provide prompt or adequate closure of the hole in the eardrum however, surgery may be considered to correct the problem.