Otitis Media

Otitis media is an infection of the middle ear, the area behind the eardrum.

Treatment for Otitis Media

Treatment involves antibiotics given by mouth for seven to ten days. The typical course involves the persistence of fluid in the middle ear for up to six weeks following treatment. No further antibiotic treatment is required.

If the pain and fever do not resolve within 48 hours of starting the antibiotics, the medication should be changed. If pain and fever continue despite changing the antibiotics, a myringotomy should be performed, a procedure in which the fluid is surgically drained.

Tympanostomy tubes can be surgically placed to drain accumulated middle ear fluid. An adenoidectomy (removal of the adenoids) may also be useful for patients who have recurrent episodes of otitis media, chronic mouth breathing, and snoring problems.

Tympanostomy Tubes

A Grommet tube can be visualized in the tympanic membrane (ear drum).

A tympanostomy tube is visualized in the tympanic membrane.  The phalanges on the undersurface of the ear drum keep the tube in place.

This illustration offers a different view of a tube in the ear drum.

This procedure can be done as a same-day surgery. This involves a general anesthetic gas that is inhaled by mask. Typically, the procedure lasts about 15 minutes. The eardrum is visualized with an operating microscope, an incision is made, and any middle ear fluid is suctioned away. A tube is then inserted and topical antibiotic drops are added. The child is then awakened from general anesthesia and sent home the same day. These tubes are naturally extruded into the ear canal six months to two years after insertion. In other words, the tubes will come out on their own. The small hole left in the eardrum usually heals spontaneously 95% of the time. On rare occasion, a persistent hole may remain that requires a patch to be placed.

There is no limitation on activity level after having tubes placed, other than to keep water out of the ear. Water entering the middle ear can cause otitis media. A middle ear infection can still occur with the tubes in place, but accumulated middle ear fluid easily drains out. Patients with tubes in place can go swimming as long as an ear mold is worn.

Tympanoplasty

The best form of treatment that can be offered is surgery to repair the eardrum perforation, with or without ossicular reconstruction. There are two techniques that can be used to close a hole in the eardrum:

One involves taking a graft from the covering of the temporalis muscle and placing it underneath the perforation. This is also called an underlay technique.

Step 1: The underlay technique is illustrated. The eardrum and ear canal are magnified.

An alternative is to place the graft over the perforation, a technique called a lateral graft technique.

Step 2: An incision is made in the ear canal. The edges of the hole in the eardrum are removed.

Step 3: The ear canal skin and portion of the eardrum are lifted. A temporalis fascia graft is placed under the hole in the eardrum. The graft is supported by absorbable gelfoam packing.

Step 4: The eardrum and ear canal skin is laid back.

Step 1: The lateral graft technique is illustrated. The eardrum and ear canal are magnified.

Step 2: A circumferential incision is made in the ear canal.

Step 3: The skin of the ear canal is elevated down to the eardrum and is removed along with the skin layer of the eardrum.

Step 4: A temporalis fascia graft is then placed over the eardrum, effectively closing the hole.

Step 5: Pieces of the ear canal skin are then placed over the bare ear canal and temporalis fascia graft.

Experienced surgeons can usually perform this type of surgery in one to two hours in an outpatient surgery center.

Adenoidectomy

This is a surgical procedure to remove the adenoids. This involves general anesthesia delivered via a tube placed in the windpipe. Through the mouth and using a mirror, the adenoids are removed and open blood vessels are cauterized. Patients usually go home the same day.