Ear infections in children are very common problem next to common cold. It is said that 3 out of 4 kids have ear infection atleast once before they reach 3 years. To know more about ear infections, it is better to start with brushing up with our understanding about structure and function of ears. The human ear consists of three parts:
- Outer ear: The part of ear that is visible, Pinna. The sound waves travels through the air and reaches the pinna and then to the next region of the ear.
- Middle ear: Includes the ear drum and 3 tiny bones called ossicles. When the sound waves reach the eardrum, it vibrates and the ossicles amplify the sound waves, and send it to the inner ear. Another very important part of the middle ear is the Eustachian tube, which maintains pressure in the ear equal to the outer environmental pressure. This tube connects the middle ear to the throat.
- Inner ear: In the inner ear, the sound vibrations are converted into electrical signals, and are sent to the brain through the auditory nerve.
In case of cold and allergy affecting the nasal passage, the Eustachian tube is blocked either by congestion or by mucus formation within the tube in the middle ear, which over time allows bacteria and other germs to grow there, resulting in an ear infection.
Infection of the middle ear
Ear infection is usually an inflammation of the middle ear that occurs when fluid builds up behind the ear drum due to bacterial infection. The inflammation in the middle ear is called as otitis media. In some kids, after an otitis media has run its course, the infection and inflammation goes away, but the fluid remains in the middle ear. When ear inflammation is associated with fluid retention, it is called as otitis media with effusion (OME). The accumulated fluid mostly does not create any trouble in children. In many, it goes away after few days or weeks or few months without any treatment. But in kids who does not get rid of the fluid, needs medical attention.
Causes of otitis media with effusion
Ear infection with fluid or pus building up in it may be due to various reasons.
When a kid is affected with cold, the middle ear secretes a fluid just like the nose. This fluid is usually drained out into the throat through the Eustachian tube. However, if there is a bacterial or viral infection, it can results in swelling of the Eustachian tube or the adenoids (glands near ear) glands may become larger, both these condition results in blocking of the Eustachian tube and result in trapping of the fluid in the middle ear. This causes effusion and middle ear infection. Secondly, a previous ear infection that has been cured, but the fluid remains in the middle ear paving way for second otitis media with effusion. Allergies, irritants, and respiratory infections may cause the Eustachian tube to swell. In addition, drinking while lying on the back and sudden change of outside pressure (while the plane is landing etc,.) the Eustachian tube is almost closed, may also result in OME.
Symptoms
OME usually do not cause any symptoms, but some kids exhibits symptoms, which include muffled hearing and feeling fullness in the ear. There may be fluid or pus draining from the ear. The child may complain of mild pain in the ear, headache, runny nose, cough, and diarrhea. The parents may notice that the child is irritable has difficulty in sleeping. The child may also have fever.
Diagnosis
OME may be diagnosed either accidentally, when the physician is checking for some other problem or while examining the ears after an ear infection is treated. Physical examination of the ear includes looking for few changes in the ear that helps the physician diagnose OME
- Air bubble sitting on the ear drum
- Opaque/dullness of ear drum when light is passed through
- No vibration in the ear drum when air is blown in the ears
- Presence of fluid behind the ear drum
A very effective method to diagnose OME is tympanometry, where a small device is placed into the infected ear; the device makes the ear drum move back and forth by changing the ear pressure. The movement of the ear drum is recorded as graphs called as tymponograms.
Another portable device called as acoustic otoscope or reflectometer helps to detect the presence of fluid in the ear. A simple hearing test is also conducted to decide, which treatment option suits the affected kid.
Treatment
Treating an OME has many options, before deciding the one that best suits the affected kid, the doctor has to consider many factors like- the type of infection and the severity, how often and how long the infection lasts, age of the kid, and the effect of the infection on hearing. If the kid is very young and has mild OME, then doctors usually go for “wait and watch” approach, as in many kids the infection fades away on its own. Sometimes during the wait and watch period, the doctor may prescribe mild painkillers, usually acetaminophen, without any antibiotics.
Mild, smaller, daily dosage of antibiotics is prescribed to kids who have frequent ear infection. Further treatments if the fluid is present even after months of infection includes
- Presence of fluid after 6 weeks: More observation, a hearing test is done to see whether there is any hearing loss, and a single dosage of antibiotic is given
- Fluid at 8-12 weeks: Antibiotics (though not useful in many), hearing test – if hearing loss detected then an antibiotic or ear tube (tiny cylinders placed through the ear drum to allow air flow into the middle ear) will be recommended
- Fluid at 4-6 months: Ear tube (even if there is no problem hearing) , sometime adenoids are surgically removed to clear the blockage of Eustachian tube
Few parents think that giving antibiotics at the early stage might be helpful. But it is not true, antibiotics are not safe. After administering antibiotics, the germs usually develops resistance to it and a normal antibiotic may not prove effective. Therefore, a higher dosage antibiotic is required to kill the germs, which at times results in serious side effects. Since OME doesn’t bother kids much, it is better to wait and watch than to start antibiotics in the initial stage.
Outlook
OME in kids is not a condition to bother much, but this doesn’t mean that parents can relax over it. Consulting a doctor is always better as he will be able to diagnose it accurately and provide treatment at the earliest. If the kid had already suffered from an otitis media infection, extra care and attention is needed for few months after the treatment as an early ear infection increases the risk of OME.