A tympanic effusion is 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. The tympanic effusion is usually caused by a blocked Eustachian tube. This leads to a slight negative pressure in the middle ear, so that tissue fluid escapes and collects 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. The upper part of the middle ear contains the ossicles, which transmit the vibrations of the eardrum to the cochlea in the inner ear via the oval window. In the lower area, the middle ear widens at the level of the eardrum to form the tympanic cavity, which opens into the Eustachian tube. See foodanddrinkjournal for Hysteria Dictionary Definitions.
Normally, the middle ear is filled with air, and the Eustachian tube, with its connection to the nasopharynx, ensures the necessary pressure equalization so that the air pressure in the outer and middle ear is the same. If the Eustachian tube is blocked due to a cold or other causes, there may be a slight negative pressure in the tympanic cavity, which promotes the escape of tissue fluid that collects in the tympanic cavity and is called tympanic effusion.
Since it is mostly a serum-like liquid at the beginning, the consistency is mostly watery at the beginning. In the case of a longer-lasting or chronic course, the consistency can change significantly. The fluid becomes slimy and viscous, may also contain blood, and may mix with pus in the case of bacterial infections.
Causes
Dysfunction of the Eustachian tube leads to insufficient 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 through the mucous membrane epithelium of the middle ear. The fluid then collects 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 towards mucous, viscous.
Due to the lack of ventilation in the tympanic cavity, bacterial infections often occur, which lead to middle ear infections and exacerbate the problem. In children who are prone to middle ear infections, bacterial infections can also cause tympanic effusion and not the other way around. A blockage of the Eustachian tube and the associated lack of ventilation of the tympanic cavity can have many causes.
The most common causes of blockage are a runny nose, colds, sinus infections, nasal polyps or enlarged tonsils. Functional restrictions of the Eustachian tube can also occur in children with Down syndrome (trisomy 21) and with a cleft lip and palate.
Symptoms, Ailments & Signs
An incipient tympanic effusion is usually symptomless, so that it is discovered in very few cases. If the course is more severe, hearing impairment occurs in the form of a reduction in sound conduction. Dizziness is also not uncommon. In addition, there is usually an uncomfortable feeling of pressure on the affected ear.
Pain usually only occurs when a middle ear infection occurs, which can lead to a perforation of the eardrum if the tympanic effusion is severe. If the eardrum ruptures, some of the fluid can spill into the external auditory canal and visibly flow out of the ear. If the tympanic effusion is chronic for more than three months, the mucous membrane of the middle ear is stimulated to develop a columnar epithelium with so-called goblet cells. The goblet cells are integrated into the epithelium and produce mucus.
Diagnosis & course of disease
A frequently used and easy-to-use diagnostic method is the ear mirroring (otoscopy). An accumulation of fluid in the tympanic cavity can then usually be recognized through the eardrum, because the eardrum is semi-transparent as a thin skin and fluid accumulations on the other side show through a little.
For example, if the tympanic effusion also contains blood, the eardrum will shimmer slightly bluish. Another diagnostic option is tympanometry, which is used to measure the mobility and elasticity of the eardrum. Audiometry can be used to determine the extent to which the tympanic effusion has caused a temporary or permanent hearing loss.
Complications
Complications from tympanic effusion primarily affect children. Although an acute effusion heals on its own in most cases, there is a risk of unpleasant consequences if the disease is not noticed in good time and treated accordingly.
One of the most common negative effects of tympanic effusion is hearing loss. It is considered to be particularly problematic because it is often not even noticed by the children affected. This in turn can lead to disruptions in the development of the child. Sometimes those affected are even wrongly classified as mentally retarded.
In order to prevent hearing damage from a tympanic effusion, it is advisable to have preventive medical check-ups. If there is a suspicion that the child has hearing difficulties, an examination by an ear, nose and throat doctor should be carried out. If the tympanic effusion takes a chronic course, further complications are possible. Scarring of the mucous membrane of the middle ear or inflammation of the middle ear (otitis media) often occurs.
There is also a risk of damage to the auditory ossicles due to the effusion. If these are even destroyed, they must be replaced by an implant. Furthermore, cholesteatomas can form, which must be surgically removed.
Some patients also suffer from serious effects of a tympanic effusion such as mastoiditis (inflammation of the mastoids) or meningitis (inflammation of the meninges). The consequences of a tympanic effusion can also be felt in adults. These are usually symptoms such as dizziness, feelings of pressure and headaches.
When should you go to the doctor?
If hearing loss, a feeling of pressure in the ear and other signs of 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 people should consult their family doctor or an ear specialist. The doctor can diagnose the effusion with a physical exam and treat the effusion with drugs or a tube burst. People suffering from sinusitis, rhinitis or a metabolic disease are particularly at risk.
People with Down syndrome, a cleft lip and palate or adenoids are also among the risk groups and must have the symptoms mentioned immediately checked out by a specialist. In addition to the ear doctor, an internist or the general practitioner can be consulted. Children should be seen by the pediatrician if they experience ear pain or hearing problems. If the tympanic effusion occurs in connection with a surgical procedure (e.g. after a Eustachian tube has been inserted), the doctor responsible must be informed. The treatment is usually inpatient, whereby the tympanic effusion can usually be remedied with a routine procedure.
Treatment & Therapy
Treatment of tympanic effusion depends on the causative factors. As a rule, diseases that have caused a tympanic effusion are easily treatable. If the fluid accumulation is diagnosed early enough, it is usually sufficient to restore the Eustachian tube’s function. If the pressure equalization works again, there is a good chance that the tympanic effusion will recede on its own and that hearing will regenerate, provided the eardrum has not been damaged.
In simple cases, nasal sprays to decongest the nasal mucosa and inhalations are sufficient. In more stubborn cases, drugs are given to liquefy the effusion and antibiotics may be given to treat the bacterial infection. In severe cases, a paracentesis, a cut in the eardrum, may be indicated to drain the secretion.
The incision in the eardrum can be designed in such a way that it grows back together without leaving permanent hearing damage. In a few cases in which the Eustachian tube cannot equalize the pressure, a so-called tympanostomy tube is used, which ensures permanent pressure equalization between the middle ear and the external pressure. The ventilation tube remains in the ear for a maximum of twelve months and is then removed again.
Outlook & Forecast
A tympanic effusion can take different courses. The prognosis depends, among other things, on the age of the patient and the time of diagnosis. In children, tympanic effusions sometimes develop into a chronic disease. 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 mucous membrane or the auditory ossicles.
In adults, tympanic effusions usually resolve completely. Long-term consequences are rare. Hearing may be impaired in some patients. A tympanic effusion is initially associated with pain and discomfort. After treatment, the symptoms should have subsided. Restrictions in the quality of life are not to be 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 doctor or general practitioner 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 primarily of ensuring a functioning pressure equalization through the Eustachian tube. Especially in the case of colds, care should be taken to ensure that the pressure can be equalized again as soon as possible.
Aftercare
In most cases, those affected with a tympanic effusion have only a few and usually only limited options and measures for aftercare. The person concerned should first and foremost consult a doctor quickly and, above all, at an early stage in order to prevent the occurrence of further complications and symptoms. Since it cannot heal on its own, the patient is always dependent on a medical examination by a doctor.
As a rule, the tympanic effusion can be treated relatively well with simple means. The affected person should use a nasal spray to relieve the symptoms. In some cases, antibiotics may also be necessary to limit the symptoms. The person concerned should always ensure that they are taken regularly and that the dosage is correct.
If you have any questions or severe side effects, you should always consult a doctor first. Antibiotics should not be taken together with alcohol, otherwise their effect will be significantly reduced. Further follow-up measures are usually not available to those affected by this disease. The life expectancy of the affected person is not reduced.
You can do that yourself
A tympanic effusion can cause severe pain. These are usually better if good ventilation of the ear is guaranteed. In this respect, it is advisable to use decongestant nose drops and decongestant nasal sprays in the event of an acute tympanic effusion. These keep the connection between the nose and ear open. This allows the tympanic effusion to heal faster and the pressure pain in the ear to subside. The pain caused by a tympanic effusion can be very severe, especially when lying down. That’s why decongestant sprays or drops are particularly advisable before going to bed.
Pain-relieving drugs such as ibuprofen and paracetamol can also help to relieve the pain during an acute infection. Both painkillers and nose drops can be bought over the counter in moderate doses and should always be available at home, especially if you tend to have repeated tympanic effusions. Since a tympanic effusion usually heals uncomplicatedly and is often caused by a virus, one can initially wait for the healing process to take place if the patient is in good general condition, even while resting.
Proven home remedies such as onion bags can also relieve the pain. Especially with children, however, parents should carefully monitor whether the pain gets worse as the infection progresses or whether high or repeated fever occurs. This can 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 an appropriate examination.
