Children, ear infections and ENT specialists

‘Tis the season for children to suffer from middle ear infections, says Lon Petchenik, M.D., Ear, Nose, and Throat/Otolaryngology, who serves on the medical staff of Northwest Community Healthcare and is a member of Suburban Ear, Nose, and Throat Associates.

But before asking your child’s healthcare provider for antibiotics, consider seeing an ear, nose and throat (ENT) specialist to better understand treatment options for recurring ear infections.

“Typically, ear infections are a complication of a respiratory illness,” says Dr. Petchenik. “Kids may have a common cold or flu and then days later, start to complain of hearing loss or ear pain or they may tell you that their ear hurts, or their ears are popping.”

Younger kids will be crabby, fussy, not eating well, or tugging at their ears, he added.

Middle ear infections

There are two categories of middle ear infections, requiring different treatments: Acute Otitis Media (AOM) and Otitis Media with Effusion – middle ear fluid (OME).

AOM is one of the most common types of bacterial illnesses in children.

“One-third of kids will have a middle ear infection by the age of three,” says Dr. Petchenik.

The middle ear is an air-containing cavity that is connected to the throat via the eustachian tube. When this tube becomes inflamed or doesn’t work properly, middle ear infections occur or fluid accumulates, according to Dr. Petchenik.

In kids, the incidence of middle ear infections goes down by age seven or eight as the eustachian tube and immune system matures. It is also less common in infants six months of age and younger.

Ear infections may be caused by viruses, bacteria or both. The American Academy of Pediatrics (AAP) explains that symptoms of ear infections may include: pain, loss of appetite, trouble sleeping, fever, ear drainage and trouble hearing. Another symptom may include more crying than usual, especially when lying down.

Middle ear infections often are treated with:

• Observation
• Oral antibiotics, when appropriate
• Eardrops (if tubes are present)
• Tympanostomy tubes

To minimize antibiotic side effects, AAP guidelines now give parents with children meeting select criteria the option to fight infections on their own for 48 to 72 hours, then start antibiotics if they do not improve. Children whose ear infections are not treated immediately with antibiotics are not likely to develop a serious illness.

When used appropriately, antibiotics can offer much symptomatic relief for children with bacterial middle ear infections, and reduce the chance of a complication of ear infections, such as eardrum perforation or infection of the mastoid bone behind the middle ear.  Antibiotic resistance should be considered in the selection of antibiotic prescribed.  For instance, a child is more likely to have an antibiotic resistant bacterial strain if they attend daycare or have been prescribed an antibiotic within the prior three months.  In these circumstances, a second line – or a ‘stronger’ antibiotic should be prescribed.

Tubes

“As a solution, one of the most common procedures we perform is surgically implanting pressure equalization or tympanostomy tubes,” says Dr. Petchenik.

More than 600,000 are performed annually in the United States.

“For children who are experiencing hearing loss, due to middle ear fluid (effusion), especially kids 12 months to 2½ years of age, this procedure can prevent delay and improve speech and language acquisition,” says Dr. Petchenik.

The three most common reasons for tube implantation are:

• Recurring infections (five or more a year)

• Middle ear fluid that persists for three months or more 

• Persistent middle ear fluid and recurring ear infections 

“This painless, highly successful, five to 10-minute outpatient surgical procedure is done under general anesthesia,” Dr. Petchenik says.

How it works

“A small incision is made in the ear drum, maintained by an implanted tube that acts as an artificial Eustachian tube, allowing the middle ear space to remain aerated,” says Dr. Petchenik.

This procedure automatically helps reduce the frequency of ear infections and hearing is immediately restored, often improving speech and language development.

“If an occasional infection develops once tubes are in place, topical drops then usually take care of the problem, often avoiding the need for oral antibiotics,” says Dr. Petchenik. “Kids with hearing loss from chronic middle ear fluid immediately hear better upon awakening from surgery,” he says. ”Many times, within a week or two after placing tubes, parents notice a dramatic improvement in their child’s articulation, pronunciation, and even vocabulary as hearing is critical for speech and language development.”

The majority of tubes placed are short-term tubes which last on average six to 12 months. Then there are long term tubes for kids that have other middle ear problems or have required multiple sets of tubes which last one to three years.

“Occasionally, tubes need to be placed more than one time, especially if a child is under the age of 12 months when the first procedure takes place,” says Dr. Petchenik.