Ear infections are very common in children. By age 5, 90% of children have had at least one ear infection. The medical term for the most common type of ear infection is otitis media. This is an infection in the middle ear space. This space is a small air pocket in back of the ear drum. The air gets there through a connection to the back of the nose known as the Eustachian tube. Middle ear infections often start as infections from the nose or throat. The germs go up the Eustachian tube and get into that middle ear space. Children are more likely than adults to get otitis media because they get more respiratory infections and their Eustachian tubes don’t work as effectively.
Ear infections are usually a painful experience. Young children cannot express this pain so they may pull on their ears, act fussy or stop eating. Hearing loss is also often seen with middle ear infections. In a young child, hearing loss may be manifest by inattention. A child’s balance may also be affected. There may or may not be a fever. If the infected fluid in back of the ear drum builds up enough pressure, the ear drum can rupture and pus mixed with blood may come out of the ear. When this happens, the pain may decrease. Fortunately, most times the hole in the eardrum will heal.
An ear infection is diagnosed by an experienced health care provider examining the ear with a special instrument call an otoscope. Once diagnosed, the treatment will depend on the child’s age, the severity of the symptoms and the child’s other health issues. Sometimes, if the child is age 2 or older and the symptoms are mild, use of a pain medication alone is adequate treatment as many infections will resolve on their own. Often, an antibiotic is prescribed. Whatever treatment is given, if the child doesn’t improve or the symptoms worsen after 48 hours, the health care provider should be contacted as the treatment will likely need to be changed.
Frequent or persistent ear infections can have many undesirable effects on a child and parent aside from the pain and inconvenience. Repeated courses of antibiotics can cause diarrhea, antibiotic allergy and the development of resistant bacteria. While there is fluid in the middle ear space, hearing becomes impaired. Young children need good hearing in order to develop proper speech. Repeated ear infections can also damage the small bones in the middle ear cavity and the ear drum itself could develop changes. These structural changes can result in long-term hearing problems.
There are several things that can be done to decrease the likelihood of ear infections. Children should not be exposed to cigarette smoke and should be kept up to date on the recommended vaccinations. Research also shows that children who have been breast-fed get fewer ear infections.
Surgery may be an option if a child has persistent fluid in the middle ear or frequent ear infections. Bilateral myringotomy with the insertion of ventilation tubes is a procedure done by an Otolaryngologist (Ear, Nose and Throat specialist). Under anesthesia, the doctor uses a microscope to make a small hole in the eardrum. Fluid is suctioned from the middle ear cavity and a small plastic ventilation tube is inserted into the eardrum. Children usually tolerate this procedure very well. The procedure usually results in fewer ear infections and if there has been persistent fluid, hearing will improve. The ventilation tubes also allows another option for treating any future middle ear infections by placing antibiotic drops directly into the ear. In some cases, removal of the adenoids, a small lump of tissue in the back of the nose near the Eustachian tube opening, has been shown to decrease middle ear infections.
Fluid often persists in the middle ear after an ear infection. If the fluid remains for 3 or more months, a child becomes a candidate for myringotomy with tubes. If a decision is made not have the surgery, the child should be followed to see if the fluid resolves. Another indication for this surgery is if a child gets four ear infections in a year or three infections in six months.
These are general guidelines and individual treatment varies depending on the appearance of the eardrum and any risk factors the child may have for speech, language or learning problems.
Dr. Steven Green, MD, FACS, is a Board-Certified Otolaryngologist, a Fellow of the American Academy of Otolaryngology – Head & Neck Surgery and a Fellow of the American College of Surgeons. He is a partner at Eastern Connecticut Ear, Nose & Throat with offices in Norwich, Colchester and Willimantic. Visit www.BreatheEasyCT.com for more information or call 860-886-6610 to schedule an appointment.
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