By John Gavin, MD
Otitis media is a condition in which the middle ear becomes inflamed, typically because of an infection. It is a problem seen much more often in children than adults and is one of the most common reasons that infants and children are seen by their pediatrician.
Acute otitis media is an infection within the middle ear typically associated with a rapid onset of ear pain and in many cases fever. The infections are frequently bacterial and may require antibiotic therapy. Otitis media with effusion occurs when the middle ear is filled with fluid but the signs of acute infection are not present. The fluid in the middle ear space can be thin and watery, thick and mucoid, or purulent (pus). Otitis media with effusion that persists for an extended period of time is called chronic otitis media with effusion. In patients who develop a chronic effusion, we worry that the fluid in the middle ear may produce a hearing loss. In young children this hearing loss can negatively impact speech and language development.
The middle ear space is the part of the ear that is most likely to become infected. It is the space behind the ear drum and includes the inner surface of the ear drum and the small bones of hearing (the malleus, the incus and the stapes). Ordinarily, the middle ear is air filled, but with otitis media it fills with fluid.
The only outlet for fluid in the middle ear is the Eustachian tube. It allows the ear to drain into the back of the nose (nasopharynx). Eustachian tube dysfunction may be seen in patients suffering from recurring episodes of acute otitis media or persistent middle ear effusion.
Recurring episodes of otitis media are seen more frequently in children in group daycare settings and those exposed to cigarette smoke at home. Recurring infections are more common in boys than in girls and children with a sibling who had recurring ear infections are more likely to develop recurring infections themselves. Breast feeding decreases the risk of recurrent otitis media.
Episodes of acute otitis media are usually treated with antibiotics. While most ear infections clear without an complications, in rare instances ear infections can lead to hearing loss, perforation of the ear drum, infection of the bone behind the ear (mastoiditis), and weakness of the facial nerve. Infections can spread intracranially and cause meningitis, encephalitis, or brain abscess.
When children have multiple episodes of otitis media in a short period of time or have a persistent effusion that produces a hearing loss and does not improve with medical therapy, surgical intervention is an option. Patients in these two categories often benefit from the placement of ear (pressure equalizing) tubes. These tubes allow fluid to drain from the middle ear and by equalizing the middle ear pressure they make middle ear infection less likely.
The placement of ear tubes is done using a microscope and can be completed in a matter of minutes. Children typically tolerate the procedure very well and post operative discomfort is usually minimal. There are many different types of ear tubes designed to last different lengths of time. The selection of the appropriate ear tube depends on the severity of the patient’s problem. Following tube placement, children suffering from recurring infections should require fewer antibiotics and children with persistent effusion and hearing loss should have improvement, and in most cases normalization, of their hearing.
While ear tubes have a very high success rate, like any surgical procedure there are potential downsides. Some patients will experience ear infections with ear tubes and these infections produce drainage from the ear (otorrhea). When the tubes extrude from the ear drum, a small percentage of patients may be left with a small hole or perforation of the ear drum requiring an additional procedure to repair the hole.
Each patient is different and all treatment options should be reviewed closely with your child’s doctor before deciding how to proceed.