Dr. Bob: My 18-month-old son is having a lot of ear infections. At times, it seems like he is having one continuous ear infection. I have heard about the benefit of ear tubes to prevent ear infections, but I worry about poking a hole in the eardrum. What is your advice?
Answer: Early in my career, especially in the winter months, I spent the good part of everyday seeing children with ear infection after ear infection. Later in my career, I noticed fewer ear infections (possibly because of newer vaccines), but ear infections are still very prevalent in children. Let’s address why children get so many ear infections and then answer your question.
- Children are exposed to so many viruses from home and especially daycare. These winter viruses tend to affect the upper respiratory tract (upper respiratory infections or URIs) and lead to swelling and excess mucous production in the nose and throat.
- Please remember that this mucous production is a normal response from the body’s immune system and is not in itself a hazard.
- The Eustachian (pronounced U-station) tube that leads from the back of the nasal passages to the middle ear is shorter and easily clogged in children. This tube is what opens when you “pop” open your ears.
- Because the Eustachian tube tends to get clogged in children, fluid can be retained in the middle ear instead of normal draining out of the middle.
- This trapped fluid in the middle ear can get infected with the “normal” bacteria that are in the upper respiratory tract. When this infected fluid builds up pressure and pushes on the eardrum, pain ensues and is often accompanied by fever. We now have what is called Otitis Media – “oto” – ear; “itis” – inflammation/infection; “media” – middle. (Otitis externa is an outer ear infection and is also known as swimmer’s ear.)
- After examination by the physician with an otoscope, the diagnosis can be made and treated as necessary with antibiotics. But two things must be noted here – 1) it is often difficult to see the eardrum well because of wax or a screaming/squirming child. Sometimes we only see a portion of the eardrum and make an educated guess as to the overall status of the eardrum; 2) not every eardrum with visible middle ear fluid demonstrates infection. I suspect that many “ear infections” years ago were overtreated. Demonstrable middle ear fluid without signs of infection is often just watched now to see if a serious infection will develop. This latter step seems like it is denying treatment, but we now know that over treatment with antibiotics is a hazard for children and for society at large. Drug-resistant antibiotics have developed, and doctors now are much more cautious with prescribing antibiotics.
Now your question –
- Your child is probably just getting separate URIs that seem to be one continuous URI. Then middle ear fluid is retained and often this fluid is getting infected. When this fluid is retained for a significant amount of time, it can affect the hearing. Sometimes this fluid is best drained by placing a tube in the eardrum by an ENT physician. While this therapy might seem drastic, this tube usually extrudes itself into the ear canal over time and the small hole in the eardrum heals on its own. Complications are rare but can occur, so a discussion with your pediatrician and ENT doctor is certainly warranted. Each child is different so I cannot tell you specifically what I would do, but persistent ear infections and diminished hearing are obviously a concern.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.