OTITIS MEDIA & GROMMET INSERTION
Otitis media is the most common reason why children see their doctor.
Over 1/3 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’,- i.e. the part of the ear on the inside of the eardrum.
It can occur in one, or both, ears.
It occurs 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.
This may impair the child’s learning capacity.
It may also delay speech development.
On rare occasions, the infection can spread to nearby structures in the head, especially the mastoid bone.
It can potentially lead to meningitis.
MIDDLE EAR FUNCTION
The middle ear is an air-filled space.
It is separated from the ear canal by a membrane (eardrum).
It contains 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.
WHAT CAUSES OTITIS MEDIA?
If the Eustachian tube is blocked,e.g. when you have a cold, then the air in the middle ear is not regularly replenished.
The air pressure drops within the middle ear, and fluid exudes into the middle ear space.
The fluid may become infected by nasal bacteria (or viruses) that ascend the Eustachian tube to reach the middle ear.
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 years.
TYPES OF OTITIS MEDIA
Acute Otitis Media
This results from a build-up of infected pus and mucus behind the eardrum.
Symptoms include 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.
This is defined as the accumulation of fluid in the middle ear. This will cause a degree of hearing loss (without earache).
The hearing loss may not be obvious in very young children.
However they may show ” indirect” signs of hearing loss, eg turning up the volume on the TV, speaking loudly etc.
Glue ear may occur after acute (painful) ear infections, but may also develop ‘silently’ with no signs of discomfort.
The child suffers hearing loss for as long as the condition persists.
During an examination, I will use an instrument called an otoscope to assess the condition of the ears.
I will examine for redness and fluid behind the eardrum and see if the eardrum moves in response to air pressure.
An Audiogram test for hearing may be requested.
A tympanogram measures the ear pressure in the middle ear.
In the case of acute otitis media due to bacteria, an antibiotic will be prescribed.
The antibiotic may help the earache to go away very rapidly, i.e. within 24 hours.
However, the infection and fluid may take several weeks of treatment to clear.
Medication to relive pain and reduce fever will also be used.
In the case of glue ear a conservative ‘wait and see’ approach may be adopted for up to 3 months.
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:
2.Glue Ear: In the absence of painful ear infections, glue ear may be observed for up to 3 months before grommets are considered
Adenoidectomy or sinus irrigations may be recommended .
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.
Grommets do not readily admit water.
However, 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.