Middle Ear Infections

Your child may be referred to us for management of recurrent middle ear infections or “recurrent acute otitis media.”  Otitis media means there is an infection of the middle ear.  The middle ear is normally a air-filled space between the ear drum and the inner ear.  Sounds travel down the ear canal and vibrate the ear drum, which in turn vibrate the middle ear bones called “ossicles.”  These bones then vibrate and transmit the sound through a tiny membrane in the hearing organ, the cochlea.  When an infection is present in the middle ear, the fluid prevents movement of the ear drum and therefore a conductive hearing loss occurs.  In addition, there is pressure placed on the ear drum that causes pain.  Your child may become irritable and start tugging at his or her ears.  Ear infections can be viral or bacterial.  Often, ear infections will resolve without any antibiotic treatment because they are viral.  But if symptoms do not improve with supportive therapy, then oral antibiotics may be needed.

Otitis Media

Why does my child get frequent ear infections?

There are many factors including anatomic, genetic, developmental, and environmental factors that play a role in recurrent ear infections. If you had frequent ear infections as a child, it is possible your child may have the same problem as well. Children in daycare have an increased risk of ear infections because they are exposed to other children who may harbor viruses. Children who are exposed to cigarette smoke at home also have increased risks of developing ear infections.

The function of the Eustachian Tube also puts children at risk for ear infections. The Eustachian tube connects from the middle ear to the back of the nasal cavity called the nasopharynx. This tube allows the middle ear to be ventilated with air and also allows for fluid to drain out of the middle ear. You may have noticed that every time you swallow; you hear a crackling sound in your ears. That’s the Eustachian tube opening and ventilating the middle ear! In some patients, dysfunction of the tube causes them a lot of ear pain when there are extreme changes in elevation (for example, descending on an airplane). This occurs because the Eustachian tube does not open to alleviate the air pressure change.

In children, the Eustachian tube is shorter and oriented in a more horizontal position compared to adults. This makes it easier for the passage of pathogens like bacteria and viruses from the back of the nose and into the middle ear causing an ear infection. This is why it is not as common for adults to have a middle ear infection.

How are frequent ear infections treated?

Based on the current American Academy of Otolaryngology guidelines, ear tubes are recommended when there are more than 3 ear infections in 6 months or more than 4 infections in 1 year AND if there is currently fluid present in the middle ear. Children with frequent ear infections without fluid at the time of evaluation have a more favorable prognosis since there is evidence that the Eustachian tube is functioning properly.

After ear tubes are placed, the middle ear maintains ventilation through the tube. This decreases the possibility of fluid accumulation in the middle ear and may reduce the likelihood of an infection.  Children can still get ear infections, however instead of building up and causing pain, the fluid can drain out of the ear tube.  Antibiotic ear drops can then be started rather than oral antibiotics.  Ear drops are more effective than oral antibiotics because a high concentration of antibiotic is delivered directly to the site of infection. In addition, oral antibiotics can be associated with systemic side effects.

Persistent Fluid and Hearing Loss

Your child may also be referred for persistent fluid in the middle ear or “Chronic otitis media with effusion.” Sometimes after an infection has been treated, there may be persistent fluid. The pain, fever, and irritability may resolve, however fluid continues to impede the movement of the ear drum. This can have significant impact on hearing. Hearing in young children is very important for proper language development. If the fluid is persistent for longer than 3 months, then ear tubes are recommended to remove the fluid and prevent recurrence of the fluid.

How are ear tubes placed in the ear drum?

In children, placement of ear tubes is an outpatient procedure. It is done under general gas anesthesia. The procedure only takes a few minutes. The ear drums are visualized under a high powered microscope. A tiny incision is made in the ear drum. Fluid is suctioned out and a tube is placed where the incision was made. For a day or two, there may be some bloody drainage and the child may be irritable.

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