Tis the season for ear infections

Ear tubes are a common treatment in children

Winter is unfortunately not only the time for enjoying beautiful snowflakes, sledding, ice fishing, hot chocolate and fireplaces. It is also the most common time of year for our little ones to be plagued with episodes of ear infections. So why are ear infections so common in winter?

During the winter months the cold air will essentially preserve the common bacteria and viruses by suspending and freezing them as droplets in the air. Walking through that air, we then inhale it and moisturize it, bringing activation to the bacteria and viruses that subsequently cause us to get infections.  

In particular, sinus infections are common with the inhaling of bacteria causing inflammation of the nasal and sinus linings. This inflammation leads to drainage that impacts the eustachian tube. The eustachian tube is the main pathway for the middle ear.

Anatomy of the ear

Let us better explain the anatomy of the ear. You have an outer ear, which consists of the auricle and ear canal; a middle ear, which starts behind the eardrum and consists of the space surrounding the ossicles (bones of hearing) and a few muscles and ligaments; and an inner ear that consists of the organ of hearing (the cochlea) and the organ of balance (the semicircular canals).

What is a middle ear infection?

This is an infection that involves the eardrum and middle ear space. The tympanic membrane or eardrum becomes inflamed and there is middle ear fluid that accumulates. This fluid causes pressure on the eardrum as it accumulates, which adds to the pain and increases the risk that the eardrum might spontaneously rupture. If it does rupture, the pain significantly decreases and hearing is improved.

Symptoms of a middle ear space infection

This infection in a child leads to pulling on the ears, complaint of ear pain, irritability especially when laying down, decreased hearing, fevers, balance issues, ear drainage and decrease desire to eat.

Treatment of a middle ear infection

A middle ear infection with acute injection or inflammation of the eardrum is treated with waiting if there are no complications such as speech delay or balance issues, or with medications or surgical intervention. Acute infections are generally managed medically until the child has had three or more ear infections in six months, four or five ear infections in a year, or one ear infection that is persisting for three months or longer.

Photo courtesy of Wikipedia Commons

Children with chronic middle ear effusions are sometimes in error left untreated, as the impact of the middle ear fluid is not recognized. This can not only impact speech and language and overall developmental skills and learning, but also damages the eardrum and potentially the ossicles. Generally, if fluid is present in both ears for three months or longer or in one ear for six months, ventilation tube placement should be considered.

How does the fluid get in the middle ear space?

It’s not from the shower or water from swimming. The water in the middle ear space comes from different types of cells or tissue in the middle ear space that become inflamed when there is an infection. This inflammation leads to fluid essentially coming out of the cells or tissue and accumulating in the middle ear space.

How long do tubes last?

Ventilation tubes generally stay in place six to 18 months before usually removing themselves. As the eardrum grows, which it is always doing, it rotates the tubes out of the eardrum, generally sealing itself in the process. There is a very small chance of any hole persisting from where the tube was placed.

Can my child swim with tubes in place?

Swimming with tubes in place is fine to do unless it is in non-chlorinated water such as swimming in the lake, when precautions should be taken to decrease how much of the contaminated water gets into the middle ear space through the tubes. For my patients I recommend use of antibiotic drops after submersion in non-chlorinated water to help rinse out any possible contamination.

Some patients may need to not only use drops after swimming but also use earplugs to further decrease water getting into the middle ear space. Contaminated water staying in the middle ear space increases the risk for an ear infection.  

Is drainage from the ears okay?

Drainage from the ears after tube placement is a sign of an ear infection and should be treated with antibiotic drops. Depending on other symptoms, an oral antibiotic may also be needed. Drainage from the ears is not normal and calls for an evaluation.

Why do kids get more infections than adults?

Kids get more ear infections than adults for a number of reasons, but the two main reasons are: (1) they get more sinus infections and therefore more drainage to the back of the nose and swelling of the eustachian tube, and (2) their eustachian tube is shorter and more horizontal, so it is less effective as a ventilation tube in the middle ear space.

If my kids get tubes, will they always need tubes?

No. The medication schedule is one set of tubes, and repeat tubes are not needed in the future. Repeat tubes are only needed if there is recurrent infections after tube extrusion.

Will tubes cause scarring of my child’s eardrum and hearing loss?

While making an incision in the eardrum can cause some scarring, most scarring is caused by untreated ear infection with the fluid staying next to the eardrum and to the bones of hearing, causing irritation. This prolonged presence can cause further complications, dissolving the little bones of hearing, infection of the mastoid, or even inflammation of the brain.

How is surgery performed for tube placement?

For adults, ear tubes can be placed in the office; however, for most children this is done under a brief anesthetic where they are breathing on their own but are not aware of the discomfort of the tube placement. There is immediate improvement in hearing and decrease in pressure. They are able to return to normal activities 24 hours after this surgery.

How often should I get my child’s hearing tested?

Children should have their ears checked in the newborn period at birth and yearly with their physical exams or sooner if there is concern for decreased hearing or speech. With tubes in place, the hearing is often checked prior to the tubes if there is not a baseline hearing test available, and always after tube placement at their follow-up visit. Once the tubes have been removed is also a good time to get a follow-up hearing test.

Who should I call to assess my child’s speech?

Generally, if you have any concerns regarding your child’s speech or language development, they should be seen by their primary care provider and or the ENT specialists for ear and hearing evaluation.  Evaluation by the school audiologist or speech therapist is also helpful.

Remember, ear infections affect your child’s development adversely in many ways that with treatment can often be reversed.

Dr. Inell Rosario was born and raised on Andros, an island in the Bahamas. She graduated from Macalester College in 1987 with a Bachelor of Arts and went on to attend medical school at the University of Minnesota. She is board-certified in otolaryngology, head and neck surgery, and sleep medicine. She is the president of Andros ENT & Sleep Center. When she isn’t working at the clinic, Dr. Rosario likes to exercise, play basketball, and do mission work. She is married and has two children.