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Ear infections left untreated can develop serious consequences
http://www.reviewjournal.com/lvrj_home/2003/Oct-06-Mon-2003/living/22277944.html

By JOHN PRZYBYS
Las Vegas Review-Journal
10/6/03

Middle ear infections -- otitis media, as doctors are apt to refer to it -- are a common, but painful, part of childhood for both kid and parent.

Painful for a child in that, well, it hurts. And, painful for the parent in that, well, the child hurts.

But as common as they are, middle ear infections shouldn't be treated lightly. Left untreated, they can have some serious consequences for a child's hearing and development.

First, though, a quick word about a few terms.

"An earache doesn't automatically equal acute otitis media, an acute inflammation of the middle ear," said Dr. Andrew Eisen, assistant professor of pediatrics at the University of Nevada School of Medicine.

Swimmer's ear, an infection of the ear canal -- which extends from the external ear to the eardrum -- can cause an earache, he said, as can a foreign body that scratches or inflames the outer ear canal.

In fact, said Las Vegas ear, nose and throat specialist Dr. Walter Schroeder, tonsillitis, teething, orthodontia or even referred pain from a sore throat can cause an earache in a child.

But, Schroeder said, otitis media -- infection in the middle ear, between the eardrum and the inner ear -- is a likely culprit when a child ranging in age from late infancy to toddlerhood complains of an earache.

Part of the reason kids are so susceptible to middle ear infections comes down to anatomy, Eisen said.

"The way things are supposed to function is that you vent your middle ear through the eustachian tubes, which connect the middle ear to the back of the throat," Eisen said.

The eustachian tubes help to equalize pressure in the middle ear. In fact, they're the mechanism by which yawning can unplug an airplane passenger's stuffed ears.

However, kids' eustachian tubes are shorter, thinner and situated more horizontally than those of adults, Eisen said, and whenever the function of a child's eustachian tubes is impaired, an infection can result.

Fluid becomes trapped in the middle ear, Eisen said. "That now makes a place that's warm and moist, and that's someplace that bacteria like to live. So, some bacteria can make their way up the eustachian tube from the back of the throat to the middle ear."

Bacteria grow in the fluid trapped in the middle ear, and a middle ear infection -- and, for the child, pain -- result.

The anatomical conditions that make kids particularly susceptible to middle ear infections change as a child ages, said Dr. Sina Nasri, a Las Vegas ear, nose and throat specialist.

Kids ages 4 to 6 are particularly susceptible to middle ear infections, Nasri said, and the incidence of otitis media tapers off when kids hit 7 or so.

However, middle ear infections are not always caused by bacteria. They also can be caused by viruses such as those that cause upper respiratory infections, Nasri said, or an infection that begins as a viral infection can turn into an bacterial one, too.

The distinction is important, because antibiotics -- typically the first line of treatment for a middle ear infection -- are ineffective on viral infections.

So, Eisen said "not every earache requires antibiotics."

If antibiotics are called for, about 80 percent of kids will see relief after a single seven- to 10-day course of treatment, Schroeder said.

But in cases of recurrent or prolonged infections, or cases in which fluid remains in the middle ear cavity, a doctor may recommend surgically placing a small tube in the eardrum.

The tubes aren't intended to drain the fluid from the middle ear. Rather, Schroeder said, the tube "allows air to get into the middle ear even if the eustachian tube is clogged."

That helps to prevent the middle ear from filling with fluid. And, Schroeder said, "the fluid is the culture medium (for infection) so without it there it's not as easy to get an ear infection.

"With the tube, the odds of an ear infection are not zero, but they're greatly reduced," Schroeder said.

"It's usually done with general anesthesia, and it's a very simple procedure," Nasri said. "It takes minutes to do."

Using a microscope, the surgeon goes through the outer ear canal and makes a tiny opening in the ear drum.

"We get all the fluid out and put a small tube in the ear drum," Nasri said. "And what it does it creates an opening between the middle ear cavity and the ear canal. As long as the tube is in and open, the middle ear cavity does not need to rely on the eustachian tube to equalize pressure."

The tubes typically stay in place for six to 18 months before falling out naturally, Nasri said, and "the majority of kids need only one set of tubes."

Precisely when the placement of tubes is merited depends upon "a variety of things," Eisen said. "It's not that there's some specific cutoff. It's a matter of not just the number of infections they have, but the frequency at which they have them."

However, Nasri said, "the guidelines are changing, and a lot of us believe we have to be a lot more aggressive now" in treating middle ear infections.

During the first two or three years of life, "the development of speech is very significant," Nasri said. "If kids don't hear well, they don't develop speech well."

So, the conductive hearing loss that results from a fluid-filled or infected middle ear can affect a child's language and speech skills, Nasri said.

In fact, Nasri said, brain mapping studies have indicated that if the portions of the brain that deal with speech and hearing don't receive proper stimulation in early childhood, lifelong problems can result.

Parents long have heard the rule of thumb that a child's tugging on his or her ear could be a sign of an ear infection.

"Unfortunately, what we've found is that the predictive value of that is pretty poor, really," Eisen said. "The most common reason kids pull on their ears is not ear pain, but it's because their ears stick out on the side of their head and it's something to grab on to."

Look, instead, for other signs -- crying or agitation -- that might be associated with the ear-tugging, Eisen said.

The child also might experience appetite changes, Schroeder said." That's very common. When you get pressure in the ears, you don't want to swallow."

Similarly, the child "won't sleep as well," Schroeder said.

But, Nasri said, "a lot of kids who have middle ear infections are asymptomatic. Sometimes parents notice a problem because kids just don't respond the way they should. In other words, their hearing is affected."

See a doctor, Nasri said, if the a child is "not responding to sounds, especially sounds that are not face-on."

The child "could have nothing wrong. They could be ignoring you or playing. But if it's a lack of response in general, if it's a suspicion the kid is not hearing well, that should be checked out."

Unfortunately, Eisen said, there's no real way to prevent middle ear infections.

"The biggest thing -- and this goes for the prevention of almost all infections in the household -- is good hygiene and hand-washing," he said. "If one kid in the family has a cold, you've got to be particularly attentive to hand-washing so that likelihood of spreading goes down."

But, Eisen said, "it's not going to prevent (ear infections) all the time. Kids are going to get these."

 

 
 

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