Ear Infection and Grommets

What is the most common ENT ailment prevalent in children?
Otitis Media is the most commonly diagnosed childhood infection after the common colds and flu. This is an infection of the middle ear, that can occur with or without     any fever or pain. Statistics tell us that more than 3 out of 4 children have had at least one ear infection before the age of three years.

How does the ear system work?The ear is broken up into three different parts: the outer ear, the middle ear and the inner ear. The outer ear collects the sound and sends it through to the t ear canal to the eardrum. The sound is then passed via the eardrum, to the bones behind the eardrum, called ossicles. The sound, which is in the form of vibrations, is then sent through to the inner ear, which is responsible for both hearing and balance. The inner ear turns these vibrations into electrical signals and then sends them to the auditory nerve, which is connected to the brain.  When the nerve impulses reach the brain, the brain interprets it as sound and various parts of the brain work together to assign meaning to the incoming signal. 

 How does the system responsible for ear infections work?The Eustachian tube is a small tube that connects the middle ear to the back of the throat, behind the nose. The normal middle ear works with the Eustachian tube  to ensure that pressure on the outside canal of the ear is equal to pressure on the inside of the ear (the middle ear canal). When yawning or “unblocking” the ears, (hearing the pop) is actually the Eustachian tube working to equalise pressure. In addition to equalising air pressure, the Eustachian tube also helps with the drainage of fluid from the middle ear to the throat.

How does one get ear infections?The Eustachian tube may not be adequately working when it becomes blocked, either by congestion or fluid. The blockage allows fluid to build up in the middle ear cavity, which should be normally air – filled. Bacteria and viruses that also enter the middle ear from the Eustachian tube can get trapped in the fluid, leading to middle ear infections. 

What are the symptoms of ear infections?Pain, fever, fluid leaking from the ear, loss of appetite, difficulty sleeping, irritability, sense of fullness. The ear infection may present with one, some, all or none of these symptoms dependent on the type of otitis media and the severity.

Are there different types of middle ear infections and how do they  present?When your doctor talks about otitis media, he or she is talking about infections of the middle ear cavity. Acute Otitis Media is the presence of fluid in the middle ear with pain, redness of eardrum and possible fever. Chronic otitis media is when these symptoms persist for  longer than 6 weeks. Otitis media with effusion is fluid in the middle ear  that is not necessarily infected.

What are some of the most common ways to pick up ear infections?
Bacterial or viral upper respiratory tract infections start and sometimes spread to the middle ear, causing middle ear infections. Uncommonly, a hole a in the ear drum can also lead to middle ear infections through swimming etc. Crowded surroundings where children are exposed to other sick children such as in crèches are common ways to pick up ear infections. Genetics also play a huge part in the occurrence on middle ear infections. Families that have a predisposition for middle ear infections usually pass this on to their children.

What are some of the causes of ear infections?In young children and especially babies, the Eustachian tube is lying at a different angle to those of adults. This makes it easier for bacteria and viruses to find their way into the middle ear. The size of the tubes also makes them more prone to getting blocked.  For young babies the manner or rather angle in which they are bottle – fed also impacts on the fluid moving up to the middle ear. The adenoids, which are found at the back of the throat, are often large in children and this could also lead to the blocking of the Eustachian tube.

What can be done to prevent infections?
We need to control, reduce  and manage the underlying risk factors such as  passive smoking (someone in the home smokes), allergy, reflux, child exposed to multiple upper respiratory infections, often in crèche like settings.  Breastfeeding for at least 6 months has been shown to protect children from early episodes of ear infections. If babies are bottle- fed they should be fed at an angle rather than lying down. Good hygiene habits within the home, such as regularly washing the hands etc will also prevent the transfer of germs that can cause colds and flus which are in turn responsible for middle ear infections.

What is the treatment for middle ear infections?As most ear infections are recurring, the treatment is best decided by your doctor. Whether you see your paediatrician, GP or ENT, the date and duration of the infection needs to be noted. This is imperative as it’s a good tool to guide us to the best possible treatment. Some episodes of middle ear infections will resolve themselves without any treatment, while other episodes may require a course of antibiotics.  Recurrent middle ear infection may necessitate the need for grommet insertion.

What is a grommet?
It is a ventilation tube responsible for draining middle ear fluid and allowing air to enter the middle ear cavity. This tube is very small in size and is surgically placed on the eardrum. This procedure is done under anaesthetic in a hospital theatre.

Does a grommet prevent further ear infections?
A grommet mostly prevents complications caused by ear infections but does improve Eustachian tube dysfunction. It does not prevent ear infections.

 Is a grommet permanent?
No, most fall out within a year as they are meant to.

Will my child need more than one set of grommets?
This is dependent on the child and the recurrence of middle ear infections. Your ENT will be able to decide this and inform you accordingly.

Is it safe to travel by car or plane if my child has  grommets?
It is safer to travel with grommets rather than without, as the grommets assist with equalisation of pressure.

Should I be concerned about my child’s hearing with middle ear infections?When a child has a middle ear infection, they often feel the sensation of fullness and being blocked. They present with a temporary hearing loss called a conductive hearing loss. This sounds about the same as if you were listening with your hands placed flat over your ears. Although they are able to hear, the sound comes through very muffled and unclear. With younger children, it makes it very difficult for them to focus on the incoming signal and they choose to rather ignore it. A study done in the USA showed that at any given time at least 43% of school going children in a class, presented with a conductive hearing loss. This impacted on spelling, reading and writing, which in turn affected all their academic abilities. Recurrent middle ear infections that go untreated may cause a permanent hearing problem. It is therefore imperative to diagnose and correctly treat the middle ear infections.

As a parent, what can I do for my child regarding middle ear infections
Teaching good hygiene habits will assist with more than just the prevention of middle ear infections and is necessary from a very young age. Children should be made aware of what everything sounds like when they are infection free. If they feel that the ears are blocked, feeling full or hearing is unclear they need to let you know so that you can have it seen to. Not all children will complain of pain. Manage the underlying risk factors with your doctor’s help. Talk to the teachers and be aware of any changes in your child’s behaviour, such as difficulty concentrating, being disruptive in class, work not being completed adequately etc. The timeous treating of middle ear infections, in whatever form deemed by necessary by your doctors, will assist with the prevention of complications.

Ear,Nose and Throat Specialists