Children who suffer from repeated ear infections (otitis media) or chronic ear fluid may benefit from placement of pressure equalization ear tubes (vent tubes). At Trimble ENT, our Otolaryngology team, specializes in diagnosing, treating, and managing an extensive scope of pediatric conditions and disorders of the ears, nose, throat, and sinuses. Our specialists specifically and commonly treat issues such as hearing loss, ear infections (otitis media), ruptured eardrums, and cholesteatoma (skin cyst occurring in middle ear), to name a few. Our group of experts will provide comprehensive care for your child in order to increase both their health and comfort in dealing with such issues.
Ear Disorders In Children
- Ear infections – Otitis media and tympanostomy (vent) tube placement
- Ruptured eardrum
- Cholesteatoma – Skin cyst in the middle ear
- Swimmer's Ear – Otitis externa
- Hearing loss
If your child suffers from repeated ear infections or chronic ear fluid, then pressure equalization ear tubes (vent tubes for short) can help to improve hearing, decrease ear infections, and prevent complications of ear infections. Most importantly, they can keep your child off potentially harmful antibiotics. If your child has 3 or more ear infections in 6 months or 4 or more in a year, ear tubes should be considered. If ear fluid remains for more than 3 months, they should also be considered. Antibiotics only decrease infection caused by bacteria. Most ear infections begin with a viral upper respiratory infection.
Ear Infections In Kids Explained
Simply defined, an ear infection is an inflammation of the middle ear, commonly caused by bacteria, that transpires when fluid accumulates behind the eardrum. The medical term for ear infection is otitis media. It is extremely common and can occur in anyone, although it is much more prevalent in young children. In fact, approximately 86% of kids will have at least one ear infection by the age of three. Ear infections are clearly a big deal, as they continue to be the most frequent reason parents bring a child to the doctor.
Anatomy of the Middle Ear in Children
The middle ear (tympanic cavity) is a hollow between the eardrum and the oval window of the inner ear. There are three middle ear bones (ossicles), which transfer the vibrations of the eardrum into waves in the fluid and membranes of the inner ear. The purpose of the middle ear is to transfer sound waves to the (cochlea) inner ear. The eustachian tube joins the middle ear with the nasopharynx (nasal cavity), allowing pressure to equalize between the middle ear and throat. Children are more prone to ear infections because their small eustachian tubes do not drain fluid as well as adult ears do and their immune systems are also immature. Children will get an ear infection in two out of three colds they experience.
Common Ear Infections
Standard variations of otitis media include:
- Acute otitis media (AOM): This is the most common ear infection. With this type of infection, the middle ear is swollen with fluid trapped behind the eardrum. This causes ear pain and sometimes a fever.
- Otitis media with effusion (OME): This is when fluid remains trapped behind the eardrum after an ear infection has run its course. Symptoms may not accompany OME, but a doctor will be able to see with an instrument if there is fluid behind the eardrum.
- Chronic otitis media with effusion (COME): This occurs when fluid stays trapped in the middle ear for a lengthy period or when it frequently returns, even when no infection exists. This can be detrimental to hearing and cause difficulty fighting off new infections.
Why Kids Are High Risk For Ear Infections
There are a number of reasons children have a higher likelihood of developing an ear infection than adults. The tubes in the ear of a young child are much smaller and flatter than an adult’s, which makes it more difficult for fluid to drain, even when a child is completely healthy. The immune system of a young child is much weaker than an adult’s, because the process of immune development takes years and years. Therefore, it can be more difficult for a child to fight off an infection than for a healthy adult.
Ear Infection Causes
Typically, an ear infection is caused by bacteria and frequently originates after a child develops a cold, sore throat, or an upper respiratory infection. The bacteria from an upper respiratory infection may, in fact, just spread to the middle ear. If the upper respiratory infection is viral, this may too attract bacteria to the already infected environment and move to the middle ear secondarily. The bacterial infection is what causes fluid to accrue behind the eardrum.
Signs and Symptoms Of Ear Infections In Kids
Most ear infections occur in children at a very young age, often before they are able to communicate something is wrong verbally. If your child is not old enough to tell you he or she is having ear pain, look for signs and symptoms like pulling or tugging at the ears, increased crying or fussiness, fever (particularly in infants and young children), difficulty sleeping, difficulty with balance or clumsiness, fluid draining from one or both ears, problems hearing or non-responsiveness to quiet noises. If a child is old enough to tell you their ear has been hurting, it is likely they have developed a form of otitis media.
Diagnosing A Middle Ear Infection
First, a doctor will ask a series of related questions and then use a special instrument that is lighted called an otoscope to take a look behind the child’s ear drum/s. An erythematous (red) and edematous (swollen) eardrum clearly denotes an ear infection.
The doctor may also use an instrument called a pneumatic otoscope. This instrument blows a puff of air into the ear canal to look for fluid behind the eardrum. An infected eardrum will not move back and forth as easily as a normal eardrum. If the diagnosis is not clear, a physician may also use tympanometry, which employs air pressure and tones, to vary the air pressure in the ear and assess how pliant the eardrum is at different pressures.
Treating Middle Ear Infections
Typically, a middle ear infection will be treated with antibiotics, like amoxicillin, which the child will take for seven to ten days. The physician may also suggest over-the-counter pain relievers to help the child manage the current pain and sleep at night. If the doctor is not able to definitely diagnose otitis media, he or she may want to wait to see if the pain will resolve within a couple days before prescribing antibiotics. Antibiotics should always be used cautiously due to the body’s ability to become resistant to antibiotics if exposed too often. The physician will also likely want to schedule a follow-up check after the child has completed the full course of antibiotics, to ensure no infection remains. Generally, children start feeling better within just a few days of visiting the doctor. If a child’s symptoms persist several days past their visit and start of antibiotics, the parent should call the doctor.
Recurrent Ear Infections In Kids
Some children may recurrently develop ear infections of the middle ear, sometimes even five or six per year. The physician may want to observe the child for several months to make sure the frequency of the problem is consistent enough to take action besides prescribing antibiotics. If these infections persist, surgical intervention may be best for the child and his or her current and future health.
A tympanostomy tube (other names include: grommet, T-tube, ear tube, pressure equalization tube, PE tube, myringotomy tube, and vent) is a tiny tube surgically inserted into the eardrum to hinder fluid from building up in the middle ear and to keep the middle ear aerated for an extended period of time. The tube itself is manufactured in many different selections and designs. Specifically, “T-tubes” can be placed to stay for two to four years. Most tubes are made out of plastics like silicone or Teflon.
Ear Tube Placement in Children
The surgical procedure to insert tympanostomy tubes is commonly done in the operating room with your child asleep. An anesthesiologist who is fellowship trained in the care of pediatric patients will put your child to sleep. The surgery usually lasts for all of 5 minutes or less. Older children may be candidates for tube placement in the office. Children have minimal to no pain after surgery or are up and about almost immediately.
The procedure of inserting tubes is called a myringotomy with tube insertion and is one of the most frequent surgical procedures performed on children. In fact, in the United States, this procedure is the most frequent reason for a child to be put under general anesthetic. The tubes usually remain in the eardrum between six months and two years, with T-tubes lasting up to four years. Most of the time, the tubes eventually will fall out of the ear canal without warning as children grow and develop, and the eardrum typically closes without leaving any enduring hole at the site of tube insertion.
Preventing Ear Infections
To help prevent ear infections, take action to reduce the risk factors related to them. This includes:
- Vaccinating your child against the flu yearly
- Vaccinating your child with 13-valent pneumococcal conjugate vaccine (PCV13), which protects against infection causing bacteria
- Wash hands regularly and often through the course of a day
- Do not expose a baby or child to cigarette smoke
- Never put a baby to bed for the night or down for a nap with a bottle
- Keep sick children away from other children
Tympanic Perforation – Ruptured eardrum
A tympanic membrane perforation, or ruptured eardrum, is a hole in your eardrum, the thin membrane that separates your external ear canal from your middle ear. A tympanic membrane perforation can result in increased ear infections and hearing loss. A ruptured eardrum may require a surgical repair if it doesn’t heal and close off within a few weeks.
Cholesteatoma – Middle Ear Cyst
A cholesteatoma is a non-cancerous skin cyst that develops in the middle section of your ear. More commonly, an acquired cholesteatoma is the result of chronic ear infections, but one can also be born with a congenital cholesteatoma.
Cholesteatoma can occur in infants through the elderly. However, they are more common in ages of 10 to 20 years. The symptoms of a cholesteatoma usually present as ear discharge or hearing loss or both. It can also present as otitis externa (external ear canal infection) and less commonly: ear ache, headaches pain, balance disruption, tinnitus, and bleeding from the ear.
A cholesteatoma will not go away without surgery under general anesthesia. A small percentage of cholesteatomas may recur. It is important that the patient schedule periodic follow-up exams with his or her ENT doctor. Such recurrence may arise many years, or even decades, after treatment.
Swimmer's Ear – Otitis externa
Swimmer's Ear (Otitis externa) is a painful ear condition as a result of inflammation, irritation, or infection of the skin lining the outer ear canal. The ear pain occurs after water gets trapped in your outer ear, with subsequent spread of bacteria or fungal organisms. It is known as swimmers ear because it often affects children and teenagers who are frequent swimmers.
Please contact our office to schedule an appointment with Dr. Trimble or Dr. Wu.