children s health issues
Chronic Middle Ear Infection in Children
Treatment
Antibiotic ear drops Sometimes antibiotics taken by mouth Sometimes myringotomy Surgical removal of any cholesteatoma Doctors first clean any debris from the ear. At home, parents apply ear drops containing an antibiotic and possibly a corticosteroid. Children who have a severe infection are given antibiotics by mouth. If infection lasts or comes back despite the use of antibiotics, doctors may, after a period of time, do a myringotomy with insertion of ventilating (tympanostomy) tubes. If the eardrum is damaged, surgery to repair the eardrum (tympanoplasty) may be done. A cholesteatoma is removed surgically. During a myringotomy, doctors make a small opening in the eardrum to allow fluid to drain from the middle ear. Then they place a tiny, hollow plastic or metal tube (tympanostomy tube, or ventilating tube) in the eardrum through the opening. These tubes balance the pressure in the environment with that in the middle ear. Doctors recommend ventilating tubes for some children who have had recurring ear infections (acute otitis media) or recurring or persistent collections of fluid in their middle ears (chronic serous otitis media). Placement of ventilating tubes is a common surgical procedure that is done in a hospital or doctor’s office. General anesthesia or sedation is usually required. After the procedure, children usually go home within a few hours. Antibiotic ear drops are sometimes given after the procedure for about a week. The tubes usually come out on their own after about 6 to 12 months, but some types stay in longer. Tubes that do not come out on their own are removed by the doctor, sometimes under general anesthesia or sedation. If the opening does not close on its own, it may need to be closed surgically. Children with ventilating tubes may wash their hair and go swimming, but some doctors recommend children do not submerge their head in deep water without using earplugs. Drainage of fluid from the ears indicates an infection, and the doctor should be notified. When sound waves reach the ear, they are gathered by the funnel-shaped outer ear and channeled into the middle ear. At the opening to the middle ear, sound waves hit the tympanic membrane, or eardrum. The resultant vibrations then travel through the middle ear and the fluid-filled inner ear where they are converted to signals that are sent to the brain. Occasionally, the middle ear can become clogged and infected. Children are especially susceptible to this condition because they have shorter, more narrow eustachian tubes, the tube which allows the middle ear to drain. As fluid and pressure build within the ear, the child may experience pain and hearing impairment. When the infections become long-lasting or recur repeatedly it may be necessary for the child to have a tympanostomy. In this procedure, a small incision is made in the tympanic membrane and the built-up fluid is drained out. A small tube is then inserted into the incision to allow continuous drainage over a period of a few months. Eventually, the incision begins to heal and the tubes fall out naturally as the hole in the eardrum closes. There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery. 