OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Dr. Michelle Facer

Ear Infections, Hearing Loss
& Children

By Michelle Facer, DO
Northern Pines Ear, Nose & Throat, Eau Claire

If your child doesn’t pay attention to directions, seems slow to respond to spoken requests, or has difficulty speaking, he may have a hearing loss due to an ear infection. In fact, ear infections are very common among young children. They are the second most common illness next to the common cold and almost all children will experience at least one infection before the age of three. Otitis media or inflammation of the middle ear is the most common cause of hearing loss in children.

There are a couple of definitions of otitis media. These include acute otitis media and otitis media with effusion. Acute otitis media (AOM) commonly occurs after having a cold. In children, the eustachian tube is shorter and more horizontally oriented and allows bacteria and viruses to find their way more easily into the middle ear. The middle ear becomes acutely infected with the rapid development of pain and fever. Younger children may demonstrate irritability, fussiness, or difficulty sleeping or feeding. There is a pus-like fluid present behind the eardrum in the middle ear. The presence of this pus behind the eardrum leads to temporary hearing loss. The average hearing loss in ears with fluid is 24 decibels or the equivalent of wearing ear plugs. Hearing loss can lead to difficulties with language development and learning. The standard therapy for acute otitis media is antibiotics. More than 30 million prescriptions are written each year for ear infections, accounting for 25 percent of all antibiotics prescribed in the United States. Antibiotics help to prevent the possible serious complications of untreated otitis media. Other medications that may be prescribed include decongestants, antihistamines, or analgesic ear drops. Some children are prone to recurrent ear infections. Otitis media is more common in children between 6 months and 3 years of age. By age 3, more than two-thirds of children have had one or more episodes of otitis media, and one third have had more than three episodes. Recurrent episodes of AOM (more than 3 episodes in 6 months or more than 4 episodes in 12 months) is an indication for surgery.

Otitis media with effusion (OME) is defined as the presence of middle ear fluid for 6 weeks or longer from the initial acute otitis media. With OME there is watery or mucous-like fluid in the middle ear, which can cause mild to moderate hearing loss for weeks or even months. There are no signs or symptoms of active ear infection, but there may be significant hearing loss or balance disturbances. Children attending day care are more likely to have OME than children who are not in day care. Tonsil and adenoid problems can also cause ear problems. Allergies can also be an underlying factor contributing to OME. More than 75% of OME will resolve spontaneously within 3 months time. Physicians will occasionally prescribe antibiotics to attempt to resolve the fluid. Control of risk factors such as pacifier use, day care exposure, tobacco smoke exposure, and allergies are advocated. A hearing test is suggested when fluid has been present for 3 months or longer. If hearing loss is present in both ears and is significant (greater than 30 decibels), surgery is recommended. Surgery is also recommended if the child develops recurrent episodes of acute otitis media.

What happens if surgery (myringotomy and tubes) needs to be performed? The child’s primary care physician will refer the family to an Otolaryngologist -- an Ear, Nose and Throat specialist. A complete exam and hearing evaluation will be completed and all options will be discussed with the family. If the decision is made to proceed with surgery, the procedure is described in detail to the family. Myringotomy involves a small surgical incision in the eardrum to promote drainage of fluid and relief of pain. A small tube is placed in the incision to prevent fluid re-accumulation and to thus improve hearing. Tubes usually decrease the frequency and severity of infections, but will not eliminate infections completely. The tubes tend to remain in place for 6 months to several years. Most tubes fall out on their own. If the child has underlying tonsil and adenoid problems, this issue may also be addressed at the time of myringotomy and tube insertion.

So, remember that acute otitis media is generally not serious if treated promptly and properly. Options include both medical and surgical management depending on the frequency of infections, the amount of hearing loss, and the wishes of the patient and family. Finally, if there is any concern that your child has a hearing loss, be sure to discuss this with your physician and to pursue the recommended testing and follow-up.

Symptoms of ear infections:

Infants and toddlers:

  • pulling or scratching at the ear
  • hearing problems
  • crying, irritability
  • fever
  • vomiting
  • ear drainage
  • fever

Young children, adolescents, and adults

  • earache
  • feeling of fullness or pressure
  • hearing problems
  • dizziness, loss of balance
  • nausea, vomiting
  • ear drainage

For more information, call Dr. Facer, Otolaryngology at Northern Pines Ear, Nose & Throat » 715.830.9990 www.northernpinesent.com