One oddity: water in the ears and hearing loss.
”Why is there water in my child’s ears? Did I accidentally let water in when I washed my hair?” Parents ask me this one most often.
”The fluid in the middle ear is generated by the ear itself.” I explain, “It’s from secretory otitis media.”
Secretory otitis media is a non-suppurative, inflammatory disease. Its onset is primarily related to malfunction of the eustachian tube and infection.
When I diagnosed five-year-old Xiao Ming with chronic secretory otitis media, Xiao Ming’s mother asked in confusion, “Xiao Ming has had three recurring earaches since six months ago, and I took him to the local hospital for all of them, and the doctor said it was acute secretory otitis media, and each time he took medicine for 5-6 days, the pain stopped, and we thought it was fine; but this month we noticed that sometimes he didn’t However, this month we noticed that sometimes he did not respond to what we said. We were not sure, so we brought him here to see him.”
”Oh, and does your child usually have a stuffy, runny nose?” I asked.
”Yes, he has allergic rhinitis, and our local doctor also said he has sinusitis.”
As I listened, I understood better in my mind the main reason why Xiao Ming had chronic secretory otitis media. “This is because children have special physiological structure of the eustachian tube: the eustachian tube is short and flat, the pharyngeal opening is lower in children, and lesions in the nose and pharynx tend to affect the middle ear. Furthermore, the local immune function of the middle ear in children is not fully developed, and the resistance is lower. Your child also has been having nasal-sinus lesions, and as a result, on the basis of repeated episodes of acute otitis media, it has been prolonged and turned into chronic secretory otitis media over time.”
I asked Xiao Ming to have further hearing acoustic conductance testing and nasal endoscopy. The results showed that Xiao Ming had sinusitis, but the adenoidal edema only occupied one-half of the posterior nostril, and there was moderate hearing loss in both ears. I recommended that Ming be hospitalized for a tympanotomy tube placement.
The second strange thing: put a “tube”, hearing better.
After the preoperative examination, I performed a bilateral tympanotomy under endotracheal anesthesia. Three days after the operation, Xiao Ming’s hearing was rechecked and showed to be completely normal.
Xiao Ming’s mother was overjoyed and said to the other patients in the ward, “This tube is amazing!”
I explained to them, “Xiao Ming’s disease is caused by the malfunction of the eustachian tube, we cut a small hole in the tympanic membrane and put in a small tube, so that the small tube can temporarily replace the ventilation function of the eustachian tube, so that no more water can accumulate in the ear, and Xiao Ming’s hearing will naturally be fine.”
”Oh! I heard a patient say that he used to just use a needle in his eardrum to draw out the water and he was fine, so why don’t we just put the tube in instead of drawing water?” Xiao Ming’s mother was a bit puzzled.
”Because we estimate that Xiaoming’s eustachian tube function will not recover in a very short time, and if we just puncture and draw fluid, the eardrum will soon grow back and then accumulate water again.”
After hearing my explanation, Xiao Ming’s mother nodded her head and smiled.
The third oddity: it was obviously an ear disease, but the nose had to be treated.
When Xiao Ming was discharged from the hospital, I repeatedly urged the parents to carry out regular treatment for Xiao Ming’s sinusitis, and, the course of treatment must be more than three months.
Hearing me say this, Xiao Ming’s mother was distressed: “My child’s hearing is normal now, why do I need to use such a long time of medicine? I’m worried that his body can’t take it!”
I reassured her, “Because this disease of your child is mainly caused by long-term sinusitis. Although the hearing is better now, it is only the effect of the tube placement. If you don’t treat the sinusitis, you can’t fundamentally restore the function of the eustachian tube, and you can’t really cure the middle ear infection, then your child can’t be removed from the tube.”