So long to sore ears What you need to know about ear in­fec­tions and grommets

Mid­dle ear in­fec­tion usu­ally makes your child feel re­ally aw­ful. Is it pre­ventable, and what’s the best route to go with treat­ment? asks Lib­bie Jou­bert

Your Baby & Toddler - - Contents -

THE CAUSES

The mid­dle ear con­sists of an eardrum, an air-filled space and three tiny lit­tle in­ter­linked bones that span the space from the outer to the in­ner ear. At the bot­tom of the mid­dle ear there’s the Eus­tachian tube, which en­sures fluid that builds up in the space drains to the throat. Ear in­fec­tion hap­pens when this tube doesn’t work so well and fluid builds up in the mid­dle ear. This fluid can be­come in­fected. The Eus­tachian tube is shorter and more hor­i­zon­tal in chil­dren, and for this rea­son they’re more prone than adults to ear in­fec­tions.

An up­per res­pi­ra­tory tract in­fec­tion, si­nusi­tis, re­flux or al­ler­gies can all cause the Eus­tachian tube to be­come blocked and fluid and pres­sure to build up in the ear. This is what causes the pain and dis­com­fort. If the pres­sure is not re­lieved, the eardrum bursts and the fluid ends up in the ex­ter­nal ear canal. A burst eardrum usu­ally heals it­self, but if it hap­pens re­peat­edly it can leave a per­ma­nent per­fo­ra­tion that can cause hear­ing loss.

RE­PEATED EAR IN­FEC­TIONS CAN DAM­AGE THE EARDRUM TO SUCH AN EX­TENT THAT IT LEADS TO HEAR­ING LOSS

IF YOUR CHILD HAS THREE OR MORE EAR IN­FEC­TIONS IN A THREE-MONTH PE­RIOD, YOU CAN CON­SIDER GROMMETS

SYMP­TOMS OF EAR IN­FEC­TION

Ear and up­per res­pi­ra­tory tract in­fec­tions of­ten go hand in hand, and symp­toms such as fever, mu­cus pro­duc­tion, loss of ap­petite and list­less­ness are com­mon. If a child also com­plains of ear­ache, of­ten pulls at or rubs his ears, or if there’s blood or fluid com­ing out of his ears, he prob­a­bly has an acute ear in­fec­tion.

It’s also pos­si­ble to have an in­fec­tion with­out the ear be­ing in­flamed, run­ning a fever or ex­pe­ri­enc­ing pain. This is called chronic ear in­fec­tion with dis­charge and is known col­lo­qui­ally as glue ear. It hap­pens when a glue-like fluid builds up in the mid­dle ear and can­not drain. Of­ten the only symp­toms are slight to av­er­age hear­ing loss and sub­se­quent weak lis­ten­ing abil­i­ties. In truth it’s an in­vis­i­ble ear in­fec­tion, and can do lots of dam­age. The ear os­si­cles can’t move like they should if they’re con­stantly cov­ered in thick fluid, and it re­sults in your child not be­ing able to hear prop­erly. The os­si­cles can also suf­fer per­ma­nent dam­age from the ex­po­sure to acid in the fluid.

MEDS OR GROMMETS?

An­tibi­otics are usu­ally given, but if your child has three or more ear in­fec­tions over a three-month pe­riod, ven­ti­la­tion tubes or grommets should be con­sid­ered.

These are small sil­i­con tubes in­serted into the eardrum to take over the func­tion of the Eus­tachian tube.

Be­fore they’re in­serted, the source of the in­fec­tion should be found first. Typ­i­cally, en­larged ade­noids and al­ler­gies are the cul­prits.

Some­times mid­dle ear in­fec­tion does not re­act to an­tibi­otics. This can be the re­sult of a re­sis­tant bug or be­cause the con­cen­tra­tion of an­tibi­otics reach­ing the mid­dle ear is not enough to kill the bac­te­ria.

PRE­VENT EAR IN­FEC­TION •

En­sure that your child’s vac­ci­na­tions are up to date. The haemophilus in­fluen­zae type b (Hib) and pneu­mo­coc­cal vac­cines help to curb ear in­fec­tion. • Re­search shows that chil­dren who are breast­fed for at least six months are less sus­cep­ti­ble to ear in­fec­tions. •

Keep the lit­tle ones away from smoke. There’s a link be­tween up­per res­pi­ra­tory tract in­fec­tion and smoke ex­po­sure. • Choos­ing a day­care cen­tre where there are fewer chil­dren per carer can re­duce the risk of ear in­fec­tion. • Con­trol al­ler­gies that can cause the Eus­tachian tube to swell up so much that it closes up. • En­sure that your baby al­ways lies at a 25 to 45 ˚ an­gle when he takes his bot­tle. It’s eas­ier for for­mula to dam up in a baby’s mouth, and some of the milk can flow through the Eus­tachian tube into the mid­dle ear and cause in­fec­tion. YB

EAR CANAL EARDRUM A TINY TUBE IS IN­SERTED INTO THE IN­CI­SION OF THE EARDRUM. EUS­TACHIAN TUBE

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