Otitis media is an infection of the middle ear space, deep to the ear drum. It can be bacterial (with pus) or a fluid build up in the middle ear (serous fluid) that fails to drain. Typically, the infection occurs most commonly in infants from 6months to 3 yrs old. Children in day care centers are more prone to these infections. Commonly the infection is in both ears and usually painful due to the bacteria, swelling and stretching of the ear drum, which may even rupture with noted drainage. Fever is not always present but can reach up to 104 degrees. Sleeping is difficult (for both patient and parents). The infection may resolve on its own in a few days, or antibiotics may help speed up the resolution. When the infection fails to resolve on multiple courses of antibiotics or there are multiple episodes, then the infection is termed “chronic” or “recurrent”. Once this occurs, the fluid in the middle ear space can inhibit or reduce the vibration of the ear drum, leading to reversible conductive type of hearing loss, that may affect speech and language skill development or cause some balance problems.
Chronic or Recurrent Ear Infections
Ear infections are said to be recurrent if there are more than 4-5/yr or chronic if there is persistent fluid or infection for 90 days without any resolution. If this occurs, then “tubes” may be a consideration to drain the fluid and allow the middle ear to ventilate, allowing the ear drum to vibrate normally. There are many theories of why ear infections become “chronic”, such as poor eustachian tube function, resistant bacteria, thickening of secretions or poor/ineffective antibiotics. An audiogram and tympanogram can help with the diagnosis.
What to expect if your child needs tubes:
The tubes are almost microscopic and are inserted with the aid of a high powered microscope, typically in an outpatient setting with a short light anesthetic. A very tiny incision is made on the ear drum and the pus or fluid is gently suctioned away using the microscope. Then a small grommet type of tube is then placed in the tiny incision. Usually, antibiotic drops are placed in the ear and may be necessary for a few days more. There is typically very little pain. Ibuprofen or Tylenol is adequate for any discomfort. Drainage is rare, and if persists for a few days, the ear should be examined. Typically, the tubes stay in for about 9 months (depending on the type of tube) and they usually extrude on their own. Rarely, they may stay in for too long i.e. years, and then they may need to be removed or they may fall out too soon i.e. within weeks or months, and may need to be replaced. Water protection is generally recommended if going swimming.