Overview: What is a tympanic effusion?
A tympanic effusion is a collection of non-purulent fluid in the middle ear, more specifically behind the eardrum. A thin-bodied tympanic effusion is technically called a serotympanum, while a thick-bodied tympanic effusion is technically called a mucotympanum. Because mixed forms are common and the nature of the fluid in the ear is difficult to assess, experts also commonly refer to tympanic effusion as seromucotympanum.
Tympanic effusion – frequency and duration
A tympanic effusion is most common in childhood. Overall, about 80 percent of all children develop a tympanic effusion at least once by the age of six. There are several reasons for this. First, infants have a short and rather horizontal eustachian tube. In addition, the opening in the nose and eustachian tube is still narrow in the child. As a result, children’s ears are generally less well ventilated and the ear trumpets can become blocked more easily.
A tympanic effusion may occur suddenly and be short-lived, recur at intervals, or be chronic. In most cases, the fluid in the ear recedes within several months.
Tympanic effusion: causes
The cause of a tympanic effusion is a narrowed or blocked eustachian tube. A blocked eustachian tube leads to a ventilation disorder in the middle ear, which in turn causes negative pressure in the middle ear. Due to the negative pressure in the middle ear, a secretion is secreted that cannot flow out because of the blocked eustachian tube. With prolonged negative pressure, the mucosa in the middle ear transforms to form more and more mucus. In addition, cilia are lost during mucosal remodeling, which further complicates the removal of fluid in the ear.
There are many reasons for a narrowed or even blocked eustachian tube. Possible causes include:
- Upper respiratory tract infection (e.g., common cold)
- Otitis media
- enlarged pharyngeal tonsil
- Nasal polyps
- crooked nasal septum
- short, rather horizontal eustachian tube
- enlarged palatine tonsils
- Deformities in the craniofacial region (such as cleft lip and palate)
Symptoms: Tympanic effusion leads to hearing loss
Since a tympanic effusion is basically not an inflammation but an accumulation of fluid in the ear, a tympanic effusion usually leads to reduced hearing – especially in children. Earache rarely occurs.
Other typical symptoms are:
- Feeling of pressure (feeling like absorbent cotton) in the ear
- Ear noise
If the effusion in the ear persists for a longer period of time, the hearing loss in babies and young children can lead to impairments in speech and hearing development. Balance problems, behavioral problems and a drop in academic performance are also possible.
Tympanic effusion: diagnosis with us
For diagnosis, we will first carefully examine the ear with a microscope. In doing so, we can sometimes already see if a clear or yellowish fluid has collected behind the eardrum. A bulge in the eardrum (due to negative pressure) can sometimes also be detected with the aid of a microscope. If the result of the ear examination is unclear, a hearing test and tympanogram can help. In the case of a tympanic effusion, a sometimes considerable hearing loss and a lack of mobility of the eardrum are shown in the tympanogram.
To get to the bottom of the cause of the tympanic effusion, further investigations may be necessary. For example:
- Examination of the oral cavity and pharynx and a nasal endoscopy
- Allergy testing for signs of allergy
- Computed tomography for evaluation of the paranasal sinuses
- Endoscopic examination of the nasopharynx to exclude a tumor
In some cases, imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI ) may also be used.
Tympanic effusion: prognosis
In about 80 percent of all cases, a tympanic effusion heals on its own. However, the longer the tympanic effusion persists, the lower the chances of self-healing. A tympanic effusion lasting six to twelve months heals on its own in only about 30% of cases.
Only in rare cases is a tympanic effusion associated with complications. Possible complications include, but are not limited to
- Middle ear infections
- Changes in the eardrum
- or damage to the ossicles.
It is very rare for a tympanic effusion to cause permanent hearing damage.