OTITIS MEDIA AND GROMMETS
Otitis media is the most common reason why children see their doctor. Over one third of all children have more than 3 ear infections in the first 3 years of life. Otitis media is also the most common cause of hearing loss in children.
WHAT IS OTITIS MEDIA?
Otitis media means ‘inflammation of the middle ear’. It can occur in one, or both, ears, most commonly in the winter and early spring months. Otitis media is most common in young children, but may affect adults occasionally.
IS IT SERIOUS?
Yes, it is serious because the hearing loss it creates may impair the child’s learning capacity and even delay speech development. It is also serious because on rare occasions, the infection can spread to nearby structures in the head, especially the mastoid bone. Otitis media is not serious if it is treated properly and effectively, and the hearing can almost always be restored to normal.
MIDDLE EAR FUNCTION
The middle ear is an air-filled space separated from the ear canal by a membrane (eardrum) and containing three little bones which conduct sound vibrations through to the inner ear. The healthy middle ear is ventilated via the Eustachian tube (from the back of the nose) whenever we yawn or swallow, so that middle ear air pressure is normally the same as the surrounding atmosphere.
WHAT CAUSES OTITIS MEDIA?
If the Eustachian tube is not functioning properly, the air in the middle ear is not regularly replenished. The air pressure drops within the middle ear, and fluid exudes into the resultant vacuum from the mucus membranes lining the space. The fluid may become infected by nasal bacteria (or viruses) that ascend the Eustachian tube to reach the middle ear.
Eustachian tube function may be immature in babies and may be compromised in older children by nasal congestion (from winter colds or nasal allergy). A large adenoid pad (tonsil-like tissue at the back of the nose) may physically block the Eustachian tubes. As children get bigger the Eustachian tubes work more efficiently and these factors become less critical. Otitis media is much less common in children over the age of six
TYPES OF OTITIS MEDIA
Acute Otitis Media results from a build-up of infected pus and mucus behind the eardrum. This results in earache (infants and toddlers often pull or scratch at the ear), crying, irritability, fever and vomiting. Sometimes the eardrum ruptures, and pus drains out of the ear.
Glue ear is defined as the accumulation and persistence of watery or mucoid fluid in the middle ear. Glue Ear may occur in the context of frequent acute (painful) ear infections, but may also develop ‘silently’ with no signs of discomfort. In either case, the child suffers hearing loss for as long as the condition persists. In longstanding, unrecognised glue ear the eardrum may become weakened and in-drawn, posing the risk of more significant middle ear damage.
During an examination, the doctor will use an instrument called an otoscope to assess the condition of the ears. The doctor will examine for redness and fluid behind the eardrum and see if the eardrum moves in response to air pressure. If the eardrum doesn’t move and/or is red, an ear infection is present.
Two other tests may be performed for more information. An Audiogram tests if hearing loss has occurred by presenting tones at various pitches. A tympanogram measures the ear pressure in the middle ear to see how well the eardrum can move. Screening hearing tests are invaluable in detecting painless glue ear in young children.
In the case of acute otitis media your doctor may prescribe one or more medications for your child. One may be an antibiotic, which fights infection. Although the antibiotic may help the earache to go away very rapidly, the underlying infection itself may need more time to clear up. This may take up to 3 weeks treatment with antibiotics. Always read the label on the prescription bottle and follow instructions carefully. The doctor may also recommend medication to relieve pain and reduce fever. Antihistamines can occasionally be useful if the child suffers from nasal allergies, and decongestants for severe colds.
In the case of glue ear a conservative ‘wait and see’ approach may be adopted for up to 3 months unless frequent, painful ear infections make the situation more urgent. During this time regular nose-blowing is encouraged and specific treatment may be directed at suspected nasal allergy. Ventilation tubes (grommets) may be recommended if the problem persists.
VENTILATION TUBES (GROMMETS)
A grommet is a small tube inserted into the eardrum under a short general anaesthetic (sometimes local anaesthetic in adults). The tube artificially ventilates the middle ear, by-passing the Eustachian tube which normally performs this function. Grommets are used to improve hearing, decrease ear infections and limit permanent middle ear damage from recurrent infections.
WHEN ARE GROMMETS CONSIDERED?
Grommets may be greatly beneficial in 2 situations:
- Recurrent Acute Ear Infections. Virtually all small children will suffer a few acute (painful) ear infections, usually effectively treated with Paracetamol and an antibiotic. When acute infections are frequent, grommets offer an attractive and effective alternative to repeated courses of antibiotic
- Glue Ear: In the absence of painful ear infections, glue ear may be observed for up to 3 months before grommets are considered. During this time treatment may be directed towards contributing nasal factors (Refer: “Glue Ear” information brochure). In evolving glue ear (characterised by negative middle ear air pressure) grommets may be recommended as a precaution, before air travel.
Adenoidectomy or sinus irrigations may be recommended to address nasal factors contributing to poor Eustachian tube function.
Grommets usually remain for 3- 6 months and extrude spontaneously. Surgical removal is only rarely required – usually after 2 years if no problem occur.
Water precautions have probably been overstated in the past. The fear is that bacteria laden water will provoke a middle ear infection and discharge. Grommets do not readily admit water, but earplugs are a reasonable precaution in older children who ‘live’ underwater (important in pools and spas, but less so in the sea). Babies and most toddlers will not tolerate earplugs, and are at low risk even with swimming lessons. Children should not swim if they have an actively discharging ear.
However, care should be taken with soapy water entering the ear, e.g. during baths, showers, washing hair
If you think that you or your child has persistent otitis media, and may require grommet insertion, please call 031 201 3118 for an appointment.
A complete history of the problem will be taken, and will be followed by a thorough examination of the ears, nose and throat. Further investigations, e.g. tympanomety, audiometry, may be requested.
The decision regarding grommet insertion will be made according to best ENT specialist practice guidelines.