Nearly everyone can probably remember the pain of their childhood ear infections or can attest to the long, sleepless nights as their child obsessively tugs on their ear wanting relief from the horrible pain. The middle ear infection, also known as otitis media, is the most commonly diagnosed childhood illness—only second to the common cold.
To better understand the problem, it is important to understand the ear. The ear is responsible for hearing and balance and is made up of three parts—the outer ear, middle ear and inner ear.
To function properly, the middle ear must be at the same pressure as the outside world. This is taken care of by the eustachian tube, a small passage that connects the middle ear to the back of the throat behind the nose. By letting air reach the middle ear, the eustachian tube equalizes the air pressure in the middle ear to the outside air pressure. (When your ears “pop” while yawning or swallowing, your eustachian tubes are adjusting the air pressure in your middle ears.) The eustachian tube also allows for drainage of mucus from the middle ear into the throat. Sometimes, the eustachian tube may malfunction. For example, when a child has a cold or an allergy affecting the nasal passages, the eustachian tube may become blocked by congestion in its lining or by mucus within the tube. This blockage will allow fluid to build up within the normally air-filled middle ear. Bacteria or viruses that have entered the middle ear through the eustachian tube can also get trapped in this way. These germs can breed in the trapped fluid, eventually leading to an ear infection. “In early childhood, about 75 percent of all children have at least one ear infection before the age of 2,” says Randall Uyeno, M.D., with Pediatric Associates in Factoria. “Middle ear infection, the most common type, is usually a complication of congestion.”
If a child has cold symptoms followed by extreme fussiness, there is a good chance that he or she has a middle ear infection. There are a number of factors that contribute to children developing ear infections:
Their eustachian tubes are shorter and more horizontal than those of adults, which allow bacteria and viruses to find their way into the middle ear more easily. Their tubes are also narrower and less stiff, which makes them more prone to blockage.
The adenoids, which are gland-like structures located in the back of the upper throat near the eustachian tubes, are large in children and can interfere with the opening of the eustachian tubes.
Children’s immune systems aren’t fully developed until the age of 7. Therefore, they have more trouble fighting infections.
Ear infections also occur more commonly in children whose families have a history of ear infections, and more often in the winter season when upper-respiratory tract infections or colds are most frequent. “The pain from an ear infection can be managed with oral medications such as acetaminophen (Tylenol) or ibuprofen (Motrin), and ear drops,” says Dr. Uyeno. If the ear infection lasts longer than several months, it may be a chronic condition. In this case, hearing may be affected, so it is wise to have your child’s hearing screened by an audiologist.
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“If oral antibiotics fail, after some time patients should be referred to an ear, nose and throat specialist,” says Dr. Uyeno. In some cases, an ear, nose and throat specialist will suggest surgically inserting tubes (called tympanostomy tubes) in the tympanic membrane. This allows fluid to drain from the middle ear and helps equalize the pressure in the ear because the eustachian tube is unable to do so. “Anything that causes congestion can play a factor in ear infections,” says Dr. Uyeno. “If there is a strong food allergy to milk protein, for example, eliminating dairy products can be a great help. However, usually diet is not the major factor.” A few food products that children have reactions to are cow milk products, soybeans (and soy formula), eggs and wheat. Children with an earache or a sense of fullness in the ear, especially when combined with fever, should be evaluated by their doctor if they aren’t improving. According to Dr. Uyeno, the pros of inserting tubes are decreased usage of oral antibiotics, instant pain
relief and improvement in hearing. However, the cons are that each tube insertion causes a bit of scarring of the eardrum. If multiple sets are required, scarring risk increases. “A child will need to have tubes until their body matures to the point where they can handle colds without getting an ear infection,” says Dr. Uyeno. “This is usually months to years.” To help limit ear infection inflammations it is important for parents to try to decrease factors that lead to congestion. Sometimes this means limiting exposure to infection by changing a child care situation or identifying and eliminating a source for allergies.
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