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Otitis media is an ear infection. It is the most common bacterial infection during childhood and the most common reason that a pediatrician would write a prescription for an antibiotic. Ear infections that keep returning and do not respond to antibiotics may need to be treated with ear tubes. Ear tube placement for ear infections that have failed medical therapy is the most common outpatient surgical procedure in the United States.
Ear infections can occur in the outer ear, the ear canal, the middle ear and the inner ear. By far, the most common ear infections in children are infections of the middle ear, the area behind the eardrum.
There are three types of otitis media:
Ear infections can occur if the eustachian tubes do not work properly. Eustachian tubes connect the middle ear to the back of the nose. They help to drain fluid from the middle ear. Eustachian tubes in infants and young children do not work as well as they do in adults. This is because the tubes are smaller and more level, which makes it harder for fluid to drain from the ear.
Viral upper respiratory infections (common colds) can prevent the eustachian tubes from working properly because they cause fluid to build up in the ear. The fluid in the middle ear then gets infected by the bacteria that live in the tissues in our nasopharynx, the area in the back of the nose near the opening of the eustachian tubes.
Ear infections are very common in young children ages 6 months to 5 years, but they can affect an individual at any age. Children with Down syndrome and cleft palate are at higher risk for ear infections.
Otitis media (middle ear infections) are diagnosed by a thorough examination and history. On examination, the area behind the eardrum will be full of pus or fluid. When air pressure is applied to the eardrum, it won’t move due to fluid buildup. Occasionally a hearing test will be given to your child to see if the fluid in the middle ear has caused any hearing loss.
There are two types of hearing tests:
These tests are given by an audiologist. The tests are tailored to each child based on their clinical condition as well as their age and development. There should be no or minimal discomfort during these tests.
Your child’s ear infection may clear up on its own without any treatment. Middle ear infections may be treated with antibiotics. Antibiotics are reserved for children who have an acute infection with symptoms. Over the past two decades, there has been an increase in drug-resistant strains of bacteria that cause ear infections. This contributes to the failure of medical therapy. If the fluid will not go away, ear tube surgery may be needed.
To manage pain at home, you may give acetaminophen (Tylenol®) or ibuprofen (Motrin®) to your child. Follow the manufacturer’s recommended dosages. Call your doctor if you have any questions.
Ear tube surgery is a 10-minute outpatient procedure under general anesthesia to place ear tubes. Anesthesia is the use of medicines called anesthetics to make your child unable to feel pain during an operation or procedure. The surgeon will make a small incision in the eardrum and clean fluid out of the middle ear. The surgeon will then place a small, hollow tube in the incision. The tube is usually made from surgical-grade plastic or metal.
The purpose of the ear tube is to equalize pressure between the middle ear and the environment. The ear tubes allow extra fluid from the infection to drain out, which reduces inflammation and allows the ear to heal. This procedure can help reduce ear infections and resolve symptoms, including hearing loss.
Your surgeon may recommend that your child have an adenoidectomy at the same time as ear tube surgery. An adenoidectomy is surgery to remove the adenoid. The adenoid is lymphoid tissue located behind the nose. It helps fight off infection by trapping bacteria that enter through the mouth. In some cases, bacteria can get trapped in the adenoids and lead to chronic infections. An adenoidectomy may be recommended if your child needs a second set of tubes or has significant nasal obstruction (blockage) from enlarged adenoids.
Ear tubes generally stay in place for six to 12 months. The ear tubes will then fall out on their own. The most common complication of the procedure is ear drainage, which generally responds to antibiotic ear drops. Rarely, a small hole may remain on the eardrum (in about 1% of children) after the tube falls out.
Your surgeon will see your child again three to four weeks after surgery to make sure the tubes are working well and to do a hearing test. Your child will then be followed every nine to 12 months after that until the tubes have fallen out. There is a 30% chance that your child will need more than one set of tubes.
The Ear, Nose and Throat doctors and audiologists at Children’s Colorado have additional training in caring for children. We are at the top of our field in treating children with ear, nose and throat disorders, including ear infections.
Certified Pediatric Nurse Practitioner