Many kids get middle ear infections (
otitis media
, or OM), usually between the ages of 6 months and 2 years.
Some kids are particularly susceptible because of environmental
and lifestyle factors (like attendance at a group child-care,
secondhand tobacco smoke exposure, and taking a bottle to bed).
Although these infections are relatively easy to treat, a child who
has multiple ear infections that do not get better easily or has
evidence of hearing loss or speech delay may be a candidate for ear
tube surgery.
During this surgery, small tubes are placed in the eardrums to
ventilate the area behind the eardrum and keep the pressure
equalized to atmospheric pressure in the middle ear.
About Otitis Media
The middle ear is an air-filled cavity located behind the
eardrum. When sound enters the ear, it makes the eardrum vibrate,
which in turn makes tiny bones in the middle ear vibrate. This
transmits sound signals to the inner ear, where nerves relay the
signals to the brain.
A small passage leading from the middle ear to the back of the
nose - called the eustachian tube - equalizes the air pressure
between the middle ear and the outside world. (When your ears pop
while yawning or swallowing, the eustachian tubes are adjusting the
air pressure in the middle ears.)
Bacteria or viruses can enter the middle ear through the
eustachian tube and cause an infection - this often occurs when a
child has had a cold or other respiratory infection. When the
middle ear becomes infected, it may fill with fluid or pus,
particularly if the infection is bacterial. Pressure from this
buildup pushes on the eardrum and causes pain, and because the
eardrum cannot vibrate, the child may experience a temporary
decrease in hearing.
With treatment, a bacterial infection can be quickly cleared up.
In most kids the fluid will resolve over time and hearing will be
restored. Some research suggests that long periods of hearing loss
in young children can lead to delays in speech development and
learning.
Symptoms and Diagnosis
Symptoms of otitis media include:
- pulling or rubbing the ears because of ear pain
- fever
- fussiness or irritability
- fluid leaking from the ear
- changes in appetite or sleeping patterns
- trouble hearing
Call your doctor if you think your child has an ear infection.
He or she will perform a physical examination and look at your
child's eardrums. If the doctor suspects a bacterial infection
(often based on the presence of pus behind the eardrum), treatment
will begin immediately.
In some instances, the doctor will insert a needle through the
eardrum to remove a sample of the pus from the middle ear for a
laboratory culture. Called a tympanocentesis, this procedure can
help the doctor decide which antibiotic to use.
Treatment
Although ear tube surgery is a relatively common procedure,
surgery is not the first choice of treatment for otitis media.
Antibiotics are often used to treat bacterial ear infections but
many ear infections are viral and cannot be treated with
antibiotics. These infections need to get better on their own, and
only time can help them heal.
But if your child has frequent ear infections that don't
clear up easily or a hearing loss or speech delay, the doctor may
suggest surgery to drain fluid from the middle ear and insert a
ventilation tube.
Because most kids have had infections in both ears, surgery is
often done in both; this is called a bilateral myringotomy, or
BMT. A tiny tube, called a pressure equalization (PE) or
tympanostomy tube, is inserted into the eardrum to ventilate and
equalize pressure in the middle ear. This will help to prevent
future infections and the accumulation of fluid, and will help
normalize hearing.
The presence of the tiny hole in the eardrum from the tube
doesn't impair hearing (in fact, kids with a speech or language
delay from hearing loss often will see a normalization of
their hearing). Depending on the type used, the tube remains
in place for about 6 months to 18 months or more.
Tympanostomy Tube Surgery
If your child is old enough to understand what surgery is, talk
about what happens during ear tube surgery:
- Because your child will receive general anesthesia, the
surgery will be performed in a hospital so that an
anesthesiologist can monitor your child. The procedure takes
about 10 to 15 minutes.
- The surgeon will make a small hole in the eardrum and remove
fluid from the middle ear using suction. Because the surgeon can
reach the eardrum through the ear canal, there is no visible
incision or stitches.
- The surgeon will finish by inserting a small metal or plastic
tube into the hole in the eardrum.
Afterwards, your child will wake up in the recovery area. In
most cases, the total time spent in the hospital is a few hours.
Very young children or those with significant medical problems may
stay longer.
After Surgery
A tympanostomy tube helps prevent recurring ear infections by
allowing air into the middle ear. Other substances, including
water, may sometimes enter through the tube, but this is rarely a
problem. Your surgeon may or may not recommend earplugs for regular
bathing or swimming.
In most cases, surgery to remove a tympanostomy tube isn't
necessary. The tube usually falls out on its own, pushed out as the
eardrum heals. A tube generally stays in the ear anywhere from 6
months to 18 months, depending on the type of tube used. If the
tube remains in the eardrum beyond 2 to 3 years, however, it will
likely be removed surgically to prevent a perforation in the
eardrum or accumulation of debris around the tube.
Although effective in reducing chronic ear infections, ear tubes
are not always a permanent cure for otitis media. Up to 25% of kids
who need ear tubes before the age of 2 may need them again.
Reviewed by:
Robert C. O'Reilly, MD, and Thierry Morlet, PhD
Date reviewed: June 2006
Originally reviewed by:
Steven P. Cook, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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