GLUE EAR Normal ear drum Glue ear with fluid level behind the ear drum Glue ear with bubbles in fluid behind the ear drum Otitis Media with Effusion (OME), which is commonly known as “glue ear.” Following an episode of Acute Middle Ear Infection (Acute Otitis Media), fluid may remain in the middle ear for several weeks, leading to a condition known as Otitis Media with Effusion (OME). While not an acute infection, OME can still impair hearing and requires monitoring. It is particularly prevalent among children but can also affect adults. The fluid is often thick and sticky, resembling glue, hence the colloquial term. DIAGNOSIS Diagnosing OME usually involves a combination of clinical history, physical examination, and sometimes additional tests: CLINICAL HISTORY The patient often presents with hearing difficulties, a feeling of fullness in the ear, and sometimes, balance issues. However, pain is usually not a prominent symptom in OME. PHYSICAL EXAMINATION Dr Sandeep Uppal would typically use an otoscope or a microscope to examine the ear. Signs of fluid or an immobile or retracted eardrum are indicative of OME. TYMPANOMETRY This test can be performed to assess how well the eardrum is moving and to confirm the presence of fluid in the middle ear. AUDIOMETRY A hearing test might be recommended to assess the level of hearing loss, if any. TREATMENT Treatment for OME often varies depending on the severity of the condition, patient age, and associated symptoms. Here are some common treatment options: WATCHFUL WAITING In many cases, especially in children, the condition resolves on its own. Dr Sandeep and his team may adopt a ‘watch and wait’ approach, monitoring the situation over time. MEDICAL TREATMENT In some cases, a course of nasal decongestants or antihistamines may be prescribed to alleviate symptoms. However, the efficacy of these medications in treating OME is debated. VENTILATION TUBES (GROMMETS) Various kinds of ventilation tubes Size of typical ventilation tube Ventilation tube in the ear drum to treat glue ear For persistent or severe cases, Dr Sandeep may recommend the insertion of ventilation tubes, known as grommets, into the eardrum. This allows the fluid to drain, alleviating symptoms and preventing complications. ADENOIDECTOMY Sometimes large adenoids at the back of the nose block the Eustachian tubes, which in turn contributes to glue ear. In such patient’s removal of the adenoids is advised, especially if the patient has recurring episodes of OME and/or other nasal symptoms. HEARING AIDS In cases where OME leads to significant hearing loss, hearing aids may be recommended to improve auditory function. Often this is a temporary measure to give the ear enough time to recover spontaneously. POTENTIAL COMPLICATIONS OF OTITIS MEDIA WITH EFFUSION Dr Sandeep is particularly vigilant when it comes to managing complications that may arise from Otitis Media with Effusion (OME). While OME is often a self-limiting condition that may resolve on its own, there are instances where it can lead to complications. Understanding these potential complications is crucial for providing effective patient care. HEARING LOSS One of the most immediate complications is a temporary reduction in hearing. This can be particularly problematic for children in developmental stages, affecting speech and academic performance. SPEECH AND DEVELOPMENTAL DELAYS In children, prolonged OME and resultant hearing loss can lead to delays in speech development, as well as other developmental milestones. BALANCE ISSUES The accumulation of fluid in the middle ear can affect the equilibrium, leading to balance problems or dizziness. TYMPANIC MEMBRANE RETRACTION OR ATROPHY Over time, the pressure from the accumulated fluid can cause the eardrum to retract or become thin, which could potentially result in permanent damage. CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) Normal ear drum CSOM In some cases, OME can progress to a more severe form of ear infection that involves persistent drainage from the ear. CHOLESTEATOMA Rarely, chronic OME can lead to the formation of a cholesteatoma, a skin cyst that can grow and destroy the bones of the middle ear, leading to hearing loss and other serious complications. Learn more about cholesteatoma>> SOCIAL AND BEHAVIOURAL IMPACT Especially in children, recurrent episodes of OME and associated hearing loss can result in behavioural issues or decreased social interaction. CLEAR EARS, BRIGHT FUTURES! Glue ear doesn’t have to stick around. Dr. Sandeep Uppal and our team are experts at making ears clear and healthy. We check ears early to catch any gooey problems and fix them with the best care, like tiny tubes (grommets) or other helpful treatments. Our team, including hearing and speech pros, works together like a superhero squad for your ears, making sure you hear well and learn sounds and words just right. If you think glue ear is messing with hearing or talking, come see us. We’re all about keeping ears and speech clear as a bell. Book your spot with Dr Sandeep’s team now and get ready for clear hearing!

CHRONIC MIDDLE EAR INFECTION Chronic Suppurative Otitis Media (CSOM) is a persistent infection of the middle ear and mastoid cavity that typically lasts for more than three months. It typically presents with a specific set of signs and symptoms. This condition is characterised by the presence of a perforated tympanic membrane (the membrane separating the external ear from the middle ear) and Cholesteatoma. It is a significant health issue that can lead to various complications if not properly managed. Learn more about management of hole in the ear drum>> COMMON SYMPTOMS EAR DISCHARGE Persistent or intermittent ear discharge (Otorrhoea) that is often purulent. The ear discharge may have a distinct, often foul, smell. HEARING LOSS Gradual loss of hearing, usually conductive but may involve sensorineural elements. Read more about various kinds of hearing loss>> EAR PAIN Occasional pain or discomfort, although less common than in acute forms of otitis media. VERTIGO OR TINNITUS If the infection effects the inner ear balance mechanism, patients may experience dizziness. Rarely there is ringing in the ear. WHAT CAUSES CSOM? RECURRENT ACUTE OTITIS MEDIA Frequent episodes of acute ear infections can evolve into CSOM if not adequately treated. EUSTACHIAN TUBE DYSFUNCTION Poor function of the Eustachian tube can lead to negative middle ear pressure, fluid retention, and subsequent infection. ENVIRONMENTAL FACTORS Living in crowded conditions, poor hygiene, and exposure to smoke can increase the risk. POORLY MANAGED PREVIOUS EAR INFECTIONS Inadequate or incomplete treatment of prior ear infections can set the stage for CSOM. GENETIC FACTORS Some individuals may be genetically predisposed to developing recurrent ear infections, leading to CSOM. HOW IS CSOM DIAGNOSED? Diagnosis of Chronic Suppurative Otitis Media (CSOM) is a multi-step process that involves a combination of clinical evaluation and diagnostic tests. Dr Sandeep Uppal and his team at The ENT Clinic employ a rigorous approach to diagnosing this condition, which usually includes the following elements: CLINICAL EVALUATION A thorough clinical evaluation is crucial to diagnose the condition as well it’s potential complications. Patient History: Collecting a detailed history of symptoms, previous ear infections, and other medical conditions. Physical Examination: An in-depth otoscopic examination to assess the condition of the ear canal, tympanic membrane, and any visible structures in the middle ear. If the ear canal contains discharge or debris, these are cleared with ear toilet under the microscope. DIAGNOSTIC TESTS Otoscopic Findings: A hole or tear in the tympanic membrane is often visible upon otoscopic examination. There may be signs of fluid or pus in the middle ear space behind the perforated tympanic membrane. In chronic cases, granulation tissue or cholesteatoma may be visible in the middle ear or ear canal. Tympanometry: Utilised to measure the movement of the tympanic membrane, which can provide insights into middle ear pressure and fluid presence. Pure Tone Audiometry: Conducted to assess the degree and type of hearing loss. ADVANCED IMAGING CT Scan of the Temporal Bones: This is usually reserved for complicated or atypical cases and is crucial for surgical planning. It can help in assessing the extent of the disease and identifying complications such as mastoiditis, cholesteatoma or intracranial complications. PUS CULTURE Culture and Sensitivity: A sample of the ear discharge may be sent for microbiological analysis to identify the specific bacteria causing the infection and their antibiotic sensitivities. By employing a comprehensive, multi-modal diagnostic approach, Dr Sandeep Uppal and his team ensure an accurate diagnosis of CSOM. This, in turn, enables them to develop a targeted treatment plan tailored to each patient’s unique needs, thereby increasing the likelihood of a successful outcome. TREATMENT OF CSOM We adopt an evidence-based, patient-centric approach for treatment, this often involves a combination of medical and surgical options, tailored to the severity of the disease, the patient’s general health, and any associated complications. Here are the key components of their treatment strategy: EAR CLEANING Micro suction is performed under the microscope for removal of pus and debris. It facilitates better penetration of topical medications. TOPICAL ANTIBIOTICS Often first-line treatment for uncomplicated CSOM when the ear drum is perforated. Corticosteroids may be used to reduce inflammation and are often combined with antibiotics in ear drops. SYSTEMIC ANTIBIOTICS Used in severe cases or when complications are suspected. Usually broad-spectrum until culture results are available. TYMPANOPLASTY Surgical repair of the tympanic membrane. Indicated for persistent perforations and hearing loss. MASTOIDECTOMY Procedure performed for removal of infected mastoid air cells and cholesteatoma. Generally reserved for complicated cases or those not responding to medical treatment. OSSICULOPLASTY Repair or replacement of damaged middle ear bones is performed if ossicular chain is disrupted. HYGIENE MEASURES Patients are educated on how to keep the ear dry and clean. MONITORING Regular appointments are scheduled for symptom review and otoscopic examination. TREATMENT ADJUSTMENT Treatment regimens may be modified based on response and any emerging complications. WHAT ARE THE POTENTIAL COMPLICATIONS OF CSOM? Untreated Chronic Suppurative Otitis Media (CSOM) poses a risk of developing serious complications that can have severe consequences. Dr Sandeep Uppal and his team at The ENT Clinic are vigilant in educating patients and healthcare professionals about these potential complications, which can be categorized as follows: CHOLESTEATOMA FORMATION Microscopic photograph showing ear drum perforation and cholesteatoma. Accumulation of skin cells and debris can erode surrounding structures, including the bones of the middle ear. Read more about cholesteatoma here>> OSSICULAR CHAIN DESTRUCTION Erosion or damage to the tiny bones in the middle ear can result in more severe hearing loss. MASTOIDITIS Infection of the mastoid bone, which can lead to abscess formation and require surgical intervention. FACIAL NERVE PARALYSIS The facial nerve runs through the middle ear, and infection can lead to paralysis, affecting facial movements. MENINGITIS Infection can spread to the membranes covering the brain and spinal cord, becoming a life-threatening condition. BRAIN ABSCESS CT scan showing brain abscess resulting from middle ear infection Accumulation of pus within the brain tissue, requiring immediate surgical intervention. EXTRADURAL ABSCESS Formation of an abscess between the dura mater and skull, also requiring immediate attention. LABYRINTHITIS Infection