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Pediatrics
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Why do Children have Ear Aches? |
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To understand earaches you must first know about the Eustachian
tube, a narrow channel connecting the inside of the ear to the back of the
throat, just above the soft palate. The tube allows drainage -- preventing fluid
in the middle ear from building up and bursting the thin ear drum. In a healthy
ear, the fluid drains down the tube, assisted by tiny hair cells, and is
swallowed.
The tube maintains middle ear pressure equal to the air
outside the ear, enabling free eardrum movement. Normally, the tube is collapsed
most of the time in order to protect the middle ear from the many germs residing
in the nose and mouth. Infection occurs when the Eustachian tube fails to do its
job. When the tube becomes partially blocked, fluid accumulates in the middle
ear, trapping bacteria already present, which then multiply. Additionally, as
the air in the middle ear space escapes into the bloodstream, a partial vacuum
is formed that absorbs more bacteria from the nose and mouth into the ear.
Why do children have more ear infections than adults?
Children
have Eustachian tubes that are shorter, more horizontal, and straighter than
those of adults. These factors make the journey for the bacteria quick and
relatively easy. A child’s tube is also floppier, with a smaller opening that
easily clogs.
Inflammation of the middle ear is known as “otitis media.”
When infection occurs, the condition is called "acute otitis media." Acute
otitis media occurs when a cold, allergy or upper respiratory infection, and the
presence of bacteria or viruses lead to the accumulation of pus and mucus behind
the eardrum, blocking the Eustachian tube.
When fluid forms in the
middle ear, the condition is known as "otitis media with effusion," which can
occur with or without infection. This fluid can remain in the ear for weeks to
many months. When infected fluid persists or repeatedly returns, this is
sometimes called “chronic middle ear infection.” If not treated, chronic ear
infections have potentially serious consequences such as temporary or permanent
hearing loss.
How are recurrent acute otitis media and otitis media with
effusion treated?
Some child care advocates suggest doing nothing or
administering antibiotics to treat the infection. More than 30 million
prescriptions are written each year for ear infections, accounting for 25
percent of all antibiotics prescribed in the United States. However, antibiotics
are not effective against viral ear infections (30 to 50 percent of such
disorders), may cause uncomfortable side effects such as upset stomach, and can
contribute to antibiotic resistance. Medical researchers believe that 25 percent
of all pneumococcus strains, the most common bacterial cause of ear infections,
are resistant to penicillin, and ten to 20 percent are resistant to
amoxicillin.
Is surgery effective against recurrent otitis media and otitis
media with effusion?
In some cases, surgery may be the
only effective treatment for chronic ear infections. Some physicians recommend
the use of laser myringotomy, using a laser to create a tiny hole in
the eardrum. The treatment is done in the doctor's office using topical
anesthesia (ear drops). Laser myringotomy works by providing several weeks
of ventilation for the middle ear. Proponents suggest this can reduce the many
courses of antibiotic treatment for severe ear infections and eliminates the
need for surgical insertion of tubes with general anesthesia.
Before surgery: Prior to the procedure, the otolaryngologist
will examine the patient for a description of the tympanic membrane
(eardrum) and the middle ear space. An audiometry may be performed to
assess patient hearing. A tympanometry will be performed that tests
compliance of the tympanic membrane at various levels of air pressure.
This test provides a measurement of the extent of middle ear effusion,
Eustachian tube function, and otitis media.
The surgery: During
the procedure, a small incision is made in the ear drum, the fluid is
suctioned out, and a tube is placed. In young children, this is usually
done under a light, general anesthesia; older patients may have the
procedure performed under local anesthesia. There are over 50 different
tube designs, all in different shapes, color, and composition. In general,
smaller tubes stay in for a shorter duration, while large inner flanges
hold the tube in place for a longer time. Some recent tubes have special
surface coatings or treatments that may reduce the likelihood of
infection.
After the surgery: Immediately after the procedure,
the surgeon will examine the patient for persistent or profuse bleeding or
discharge. After one month, the tube placement will be reviewed, and the
patient’s hearing may be tested. Later, the physician will assess the
tube’s effectiveness in alleviating the ear
infection.
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What is the most
common surgical treatment for ear infections?
The most common
surgical procedure administered to children under general anesthesia is
myringotomy with insertion of tympanostomy tubes (TT). A tube is
inserted in the middle ear to allow continuous drainage of fluid. The procedure
is recommended for treatment of: chronic otitis media with effusion (lasting
longer than three months), recurrent acute otitis media (more than three
episodes in six months or more than four episodes in 12 months), severe acute
otitis media, otitis media with effusion and a hearing loss greater than 30 dB,
non-responsiveness to antibiotics, and impending mastoiditis or intra-cranial
complication due to otitis media.
If the patient is age six or younger,
it is recommended that tubes remain in place for up to two years. Most tubes
will fall out without assistance. Otherwise, the specialist will determine when
the tubes should be removed.
Your ENT physician will recommend the
most effective treatment for your child’s ear
infection.
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