With Timpani effusion is a collection of fluid in the middle ear around the eardrum. The consistency of the liquid ranges from serous (watery) to slimy 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 timpani effusion?
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The middle ear is bounded on the outside by the eardrum and on the inside by the cochlea. In the upper area of the middle ear, the ossicles are located, 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 expands at the level of the eardrum to form the tympanic cavity, which opens into the Eustachian tube.
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 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 favors the escape of tissue fluid that collects in the tympanic cavity and as Timpani effusion referred to as.
Since it is usually a serum-like liquid at the beginning, the consistency is usually watery at the beginning. The consistency can change significantly if it is prolonged or chronic. The liquid becomes slimy and viscous, can also contain blood and, in the case of bacterial infections, mix with pus.
causes
Dysfunction of the Eustachi tube leads to a lack of pressure compensation between the middle and outer ear. This often creates a slight negative pressure in the middle ear, which favors the secretion of tissue fluid through the mucosal 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 Eustachi tube continues, the consistency and composition of the tympanic effusion changes in the direction of slimy, viscous.
Because of the lack of ventilation of the tympanic cavity, bacterial infections often set in, which lead to otitis media and exacerbate the problem. In children who are prone to otitis media, bacterial infections can also cause effusion and not the other way around. A blockage of the Eustachi tube and the associated lack of ventilation of the tympanic cavity can have many causes.
Most often, the blockage is triggered by a runny nose, colds, sinus infections, nasal polyps or enlarged tonsils. Even in children with Down syndrome (trisomy 21) and a cleft lip and palate, the function of the eustachian tube can be restricted.
Symptoms, ailments & signs
An incipient tympanic effusion is usually symptom-free, so that it is only discovered in very few cases. If the progression is more severe, hearing impairment occurs in the form of a reduction in sound conduction. It is not uncommon for dizziness to occur. In addition, there is usually an uncomfortable feeling of pressure on the affected ear.
Pain usually only occurs when an otitis media occurs, which, if the tympanic effusion is severe, can lead to a rupture of the eardrum. If the eardrum ruptures, some of the fluid can pour 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
An easy-to-use diagnostic method that is frequently used is an otoscopy. An accumulation of fluid in the tympanic cavity can usually be recognized through the eardrum, because the eardrum is semitransparent as a thin skin and accumulations of fluid on the other side show through a little.
For example, if the tympanic effusion also contains blood, the eardrum has a slightly bluish shimmer. 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 temporary or permanent hearing loss can be determined using audiometry.
Complications
Children are primarily affected by complications from a tympanic effusion. Although an acute effusion heals by itself in most cases, there is a risk of unpleasant sequelae if the disease is not noticed in time and treated accordingly.
One of the most common negative effects of tympanic effusion is hearing loss. It is considered particularly problematic because the affected children often go unnoticed. This in turn can lead to disorders in the child's development. Sometimes those affected are even wrongly classified as mentally retarded.
In order to prevent hearing damage from a tympanic effusion, it is advisable to attend preventive examinations. If the child is suspected of having difficulty hearing, an ear, nose and throat doctor should be examined. If the tympanic effusion takes a chronic course, further complications are possible. Scarring of the middle ear mucosa or otitis media often occurs.
In addition, there is a risk of damage to the ossicles due to the effusion. If these are even destroyed, they must be replaced by an implant.In addition, cholesteatomas can form, which must be removed surgically.
Some patients also have the serious effects of an ear effusion such as mastoiditis (inflammation of the mastoid process) or meningitis (inflammation of the meninges). The sequelae of a tympanic effusion can also become noticeable in adults. These are mostly complaints 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 ear effusion occur, a doctor should be consulted immediately. Pain and dizziness in the ear are also clear warning signs that need to be clarified. Affected people are best advised to consult their family doctor or an ear specialist. The doctor can make the diagnosis on the basis of a physical examination and treat the effusion with medication or a tube rupture. People who suffer from sinusitis, rhinitis or a metabolic disease are particularly at risk.
People with Down syndrome, a cleft lip and palate or adenoids also belong to the risk groups and must have these symptoms clarified by a specialist immediately. In addition to the ear specialist, an internist or general practitioner can be consulted. Children should be presented to 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 responsible doctor must be informed. Treatment is usually inpatient, whereby the tympanic effusion can usually be remedied by a routine intervention.
Therapy & Treatment
Treatment for tympanic effusion depends on the causative factors. As a rule, diseases that have caused a tympanic effusion can be treated well. If the fluid retention is diagnosed early enough, it is usually sufficient to restore the function of the eustachian tube. If the pressure equalization works again, there is a good chance that the tympanic effusion will recede on its own and that the hearing will regenerate again, 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, drugs are given to liquefy the tympanic effusion and possibly antibiotics to treat the bacterial infection. In severe cases, a paracentesis, an incision in the eardrum, may be indicated in order to be able to suck out the secretion.
The incision in the eardrum can be made in such a way that it grows back together without leaving permanent hearing damage. In a few cases, in which the pressure compensation cannot be established through the Eustachi tube, a so-called ventilation tube is used, which ensures permanent pressure compensation between the middle ear and external pressure. The ear tube remains in the ear for a maximum of twelve months and is then removed again.
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➔ Medicines for earache and inflammationOutlook & forecast
A tympanic effusion can take different courses. The prognosis is based, among other things, on the age of the patient and the time of diagnosis. In children, ear effusions can develop into a chronic disease. Basically, the tympanic effusion can be treated by eliminating the cause. Only in individual cases does permanent damage remain in the ear canals, such as damage to the mucous membrane or the ossicles.
In adults, tympanic effusions usually subside completely. Long-term consequences are rare. Some patients may have impaired hearing. A tympanic effusion is initially associated with pain and discomfort. Symptoms should have subsided after treatment. Limitations 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 a few other factors.
The ear doctor or family doctor is responsible. In the case of chronic diseases, the prognosis must be renewed regularly. In general, the prognosis for a tympanic effusion is good and the patient can lead a symptom-free life after treatment.
prevention
Measures to prevent the formation of a tympanic effusion consist primarily of ensuring that the pressure equalization through the Eustachi tube works. Especially in the case of colds, care should be taken to ensure that pressure equalization can be restored as soon as possible.
Aftercare
In most cases, the affected person has only a few and usually only limited options and measures for follow-up care. First and foremost, the person affected should consult a doctor quickly and, above all, early in order to prevent further complications and complaints from occurring. Since there is no independent healing, the patient is always dependent on a medical examination by a doctor.
As a rule, the tympanic effusion can be treated relatively well by simple means. The person concerned should use nasal spray to relieve the symptoms. In some cases it may also be necessary to take antibiotics to reduce the symptoms. The person affected 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 with this disease. The life expectancy of the person affected is not reduced.
You can do that yourself
An effusion from the ear can be very painful. These are usually better if good ventilation of the ear is guaranteed. In this respect, it is advisable to use decongestant nasal drops and decongestant nasal sprays in the event of an acute effusion. These keep the connection between the nose and ear open. This allows the tympanic effusion to heal faster and the pressure pain on the ear subside. The pain caused by a tympanic effusion can be very severe, especially when lying down. Decongestant sprays or drops are therefore particularly advisable before going to bed.
Pain relieving drugs such as ibuprofen and paracetamol can also help in acute infections to subside the pain. Both pain medication and nasal drops are available over-the-counter in moderate doses and should always be available in the house, especially if you are prone to repeated ear effusions. Since a tympanic effusion usually heals uncomplicated and is often caused by a virus, if the general condition is good, you can first wait for the healing process to take place.
Tried and tested home remedies such as onion sachets can also reduce pain. Especially with children, however, parents should carefully monitor whether the pain increases as the infection progresses or whether the fever is high or repeated. 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.
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