In the evening of the Lantern Festival, the street outside the clinic was crowded with cheerful people and beutiful lanterns. Winnie, a five-year-old sat quietly on the clinic chair, her dad waited nervously for me to disclose the result. As always, I first checked first Winnie’s ears with otoscope, both of her eardrums turn back to the normal gray color; I then picked up the otitis media checker to check her middle ear pressure, as the normal pressure green light turned on, the dad finally relaxed and said: “great! we are finally relieved.” Rest assured, I believe they will have a wonderful festive evening.
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Before Winnie came to the clinic, she had already been treated with antibiotics for her chronic sinusitis for over six months. In addition, she also had otitis media with effusion. Since her parents did not want her to have a ventilation tube placement surgery to treat the effusion, so I suggested her to try using pulsating nasal irrigation with warm saline and additional drugs to treat her chronic sinusitis and effusion. After one month of therapy treatment, her thick yellow-greenish pus symptoms of chronic sinusitis had shown great improvement. However, the progess of her middle ear effusion was not ideal. Her ear drums were still amberish and slightly depressed. The other two children who started the treatment about the same time had already been cured, so I jokingly told her that the others have graudated, you have to continue your effort. I suggested her to continue using nasal irrigation for two to three weeks before returning for diagnosis, and finally she graduated too.
Whenever I saw middle ear effusion or acute otitis media patients, I would carefully examine their nose. In addition to taking the appropriate medication on time, I often recommend the patients not to blow their nose too hard. Instead frequent use of saline nasal spray or nasal irrigation to rinse the nose. Patients often feel strange, and some patients even remind me that their children are here to examine their ears.
In fact, otitis media in children is a complication of common cold and/or sinusitis. The complication has a very high probability of occurrence. According to research statistics, 1/3 of children at the age of three have had three or more otitis media. It is in fact the second most common complication (after upper respiratory tract infection) seen in the clinic. The main cause of otitis media is due to the nasal cavity bacteria travel through the eustachian tube (connecting the nasopharynx and middle ear cavity tube) to the middle ear cavity. Therefore, the real cause of the otitis media or otitis media with effusion is in the nasal cavity. If your rhinitis is treated, nasal passage is clear, eustachian tube is functioning well, then your middle ear effusion will be cured.
After most appropriate treatment of acute otitis media, it can be cured within two weeks, but there is still a small number of patients who show no improvement, and the condition even worsen and middle ear effusion pus become thicker, the color of the eardrum turns amber and depressed. If the child’s middle ear effusion last more than a month and pus thickens, it is usually caused by sinusitis or nasopharyngeal adenoidal thickening (adenoidalhypertrophy). At this time, one should be focusing on the sinusitis treatment, which often solves otitis media effusion subsequently. If the middle ear effusion continues after three months of treatment with no improvement, it is usually recommended to insert the ventilation tube to restore hearing and avoid affecting the children’s ability to learn and interact with others.
Many patients often find it very strange, when a child obviously has ear pain, hearing issues, but the ENTs (otolaryngologists) keep asking if the child has nasal congestion, streaming yellow pus and spend a lot of time doing the local treatment of nasal and forget to prescribe ear medications. In fact, for general acute otitis media, if the eardrum has no perforated hole and leaks pus out, using ear medication has no meaning in treating otitis media (because the medication will only be in the ear canal but does not go through the eardrum into the middle ear intact.) So when I suggest patients with otitis media to use saline water to spray the nose, or use the pulsating nasal irrigation to wash the nose, the patients often wonder if the saline water is going into the nose or the ears. After a detailed explanation, many patients then realize that blowing your nose too hard may affect the middle ear, and using nasal irrigation with saline water is one way of treating otitis media with effusion.
Shyhung Clinic, Dr. Tseng Hung-cheng