The eardrum is in the form of a wall that separates the outer ear from the middle ear. The outer ear canal is located on the outer side of the eardrum and is open to the outside air. On the inside of the eardrum is the middle ear. The middle ear should also normally be filled with air. The air of the middle ear is formed with the help of the Eustachian tube connecting the middle ear to the nasal passage. One end of the Eustachian tube is in the nasal cavity and the other is in the middle ear. As the person breathes, swallows and yawns, the Eustachian tube opens and closes for a very short time, allowing the middle ear pressure to be balanced according to the external atmospheric pressure. It has a continuously active function because the outside air pressure is constantly changing. On hot summer days, the pressure decreases. The pressure increases on rainy cloudy days.
Even in a period when the temperature is always constant, the air pressure changes according to the sea level and the place where the person is. As you go up to the top of the mountains, the air pressure decreases because the thickness of the atmosphere above becomes thinner as you rise by plane. When descending from the top of the mountain to lower sea level than the plane, the pressure increases. Against all kinds of pressure changes, the pressure of the middle ear on the back of the membrane should be adjusted.
For example, when you go to the top of a mountain from the seaside, when the pressure outside decreases, the pressure in the middle ear becomes high. In this case, the excess pressure of the middle ear is discharged from the Eustachian tube to the nasal passage. This is a very easy, spontaneous process. Conversely, when traveling by plane or descending from a high altitude to sea level, the middle ear pressure remains low when the atmospheric pressure outside begins to increase gradually. The pressure on the outside of the membrane gradually increases, pushing the membrane towards the middle ear. As a result of this pushing, ear congestion occurs first and then pain. The middle ear should take air from the nose by swallowing or yawning at this time. If this is not the job of taking air from the nose, problems begin to occur.
In upper respiratory tract infections, the eustachian tube has become inoperable because the tissues in the nose and nasal region swell due to the disease. There is no problem only in times of flu or cold. Also, if there is a disease that covers the mouth of the place where this Eustachian tube, which occupies space in the nasal region, is connected to the nasal cavity, a problem occurs. This is a more common picture in childhood diseases caused by adenoids. The adenoid grows exactly in the region of the Eustachian tube. It creates a mass in a way that prevents the air flow between the middle ear and the nasal passage.
Sometimes this can also be seen in nasal cancers. If there is cancer tissue occupying space in the nasal cavity, this disease prevents the middle ear from aeration. This condition can sometimes develop due to reasons such as cleft palate, syndromes arising from some bone anomalies, muscle disease. For whatever reason, if the Eustachian tube is not working and there is not enough air passage to the middle ear, the middle ear will be chronically stuffy. In cases where there is no ventilation for any reason, the negative pressure in the middle ear is perceived by the brain because there are special sensor cell networks in the ear. These cell networks are affected by pressure changes, and when they carry this information to the brain, the brain instructs the salivary glands to secrete. Thus, while the secretion accumulated in the mouth is swallowed, the Eustachian tube muscles work. While these muscles are working, the middle ear is ventilated.
However, if air is not carried to the middle ear despite salivation and swallowing by a mechanical obstacle and this situation continues for days or weeks, this time the second mechanism comes into play. The tissues in the middle ear turn into a secretory state, and the middle ear region, which is not ventilated after a fluid is produced, is filled with the secretion produced by the ear itself. This reaction may also develop as a result of inflammatory reactions. This fluid, which accumulates in the middle ear, begins to support the membrane from the inside, against the pressure exerted by the atmosphere from the outside. Thus, the eardrum and middle ear structures are protected for a while. If the aeration problem of the middle ear continues for a long time, this liquid, which is formed over time, increases in consistency, thickens and starts to disrupt other structures in the middle ear. In the middle ear, there are ossicles that carry sound energy from the membrane to the inner ear, such as hammer, anvil, and drumstick. In the condensed middle ear fluid, both the eardrum and the mobility of these ossicles are restricted, resulting in a decrease in hearing function.
In such a picture, if there is no hope for the nose to be lifted from the nasal cavity, then the eardrum is scratched from the outside and the integrity of the eardrum is broken in a controlled way. That is, a hole is made in the eardrum. The water accumulating in the middle ear through this hole is drawn with absorbent instruments that provide vacuum. The outside air is allowed to fill the middle ear through the scratch made on the eardrum. Thus, the middle ear is ventilated in an alternative way. This process provides the instantaneous air intake, but if no action is taken to interfere with the original airway and the scratch is left to itself, this scratch will heal, close and the disease will recur within a maximum of 2 days. Fluid begins to accumulate in the middle ear again. For this reason, a channel is placed between the eardrum so that the hole caused by the controlled scratch on the eardrum is not closed, and to prevent the healing of the eardrum. This is called a tube.