MIDDLE EAR INFECTIONS

MIDDLE EAR INFECTIONS A Guide to Treatment and Prevention

A Common Problem Middle ear infections are due to a buildup of fluid in the middle ear. This is a common problem in younger children, whose ears are not fully developed. Fluid and infection can cause pain and even affect hearing. Treatment can help your child both feel and hear better. The healthcare provider will guide you through the management of this common problem of childhood. What Are Middle Ear Infections? Tissue lining the middle ear normally produces fluid. Problems can cause the fluid to be trapped in the middle ear. In some cases, the trapped fluid becomes infected. The problem is commonly called a middle ear infection, but the ear isn t always infected. The medical name for this problem is otitis media. What Are the Symptoms? There may be no symptoms. Or your child may: Have a fever. Be irritable or fussy. Pull on the ear or complain of ear pain. Have problems with hearing. Lose his or her appetite, or have vomiting or diarrhea. What Are the Risk Factors? Certain things make a child more likely to have middle ear infections. These are called risk factors. These include: Young age. Family history of ear infections. Being in daycare or school with other kids. Not being breastfed. Not having immunizations. Using a pacifier. Being exposed to tobacco smoke or air pollution. Having nasal allergies. Having Down syndrome palate. or a cleft 2

Treatment Can Help Your child s healthcare provider will confirm your child s ear problem. Then, you and the healthcare provider can discuss options for treatment. Steps can be taken to help ease symptoms. Preventive measures can help make fluid less likely to build up in the future. For middle ear problems that won t go away or keep coming back, surgery may be recommended. At any point, your child may be referred to an ear, nose, and throat (ENT) doctor (also called an otolaryngologist) for testing or care. Be Informed About Options Work with your child s healthcare provider to explore treatment options. The healthcare provider can explain each option s benefits and risks. Talk over any concerns you have. Be sure to ask any questions you have and get answers you understand. By being informed, you can help ensure that your child gets the best treatment for his or her ear problem. 3

Understanding the Middle Ear The middle ear is an air-filled space located behind the eardrum. The eustachian tube is a narrow tube that connects the middle ear to the back of the throat. It helps control air pressure in the middle ear. It also drains excess fluid. In children, the tube is more likely to become blocked, allowing fluid to build up in the ear. This can lead to infections. It can also affect hearing. Eustachian tube Back of throat Eustachian tube The eustachian tube connects the middle ear to the nose and throat. In children, this tube is narrower and drains less easily than in adults. The middle ear is a chamber behind the eardrum. It is important for hearing. The eardrum separates the outer ear from the middle ear. The ear canal carries sound to the eardrum. Causes of Fluid Buildup Things such as colds, the flu, allergies, or tobacco smoke can irritate the eustachian tube. An irritated tube will swell and become blocked. This means that air can t get through the tube and fluid can t drain properly. This is often what leads to fluid buildup in the middle ear. 4

When Fluid Builds Up What is called a middle ear infection can be one of two types of middle ear problems: otitis media with effusion (OME) and acute otitis media (AOM). With OME, fluid is trapped behind the eardrum. With AOM, fluid is trapped and becomes infected. Your healthcare provider can tell you which type your child has. OME Otitis media with effusion occurs when middle ear fluid becomes trapped behind the eardrum. This fluid may become thick and sticky and take a long time to clear up. OME is rarely painful. AOM With acute otitis media, fluid trapped in the middle ear becomes infected. The infected fluid presses on the eardrum, often causing pain. A Burst Eardrum Pressure from infected fluid can cause the eardrum to burst. This is nature s way of letting the fluid drain and relieving pressure. A burst eardrum doesn t usually affect hearing. It often heals on its own. If the eardrum bursts, you will likely see bloody drainage from the ear. Call your child s healthcare provider for instructions. Fluid in middle ear Infected fluid in middle ear Swollen eustachian tube Swollen eustachian tube Fluid Can Affect Hearing Hearing is vital for a child s speech and language development. Fluid behind the eardrum can cause hearing loss for a short time. Hearing goes back to normal when the fluid drains, but repeated or ongoing infections can begin to affect speech and language. This is one reason why repeated ear infections are a cause for concern. Bulging eardrum 5

Diagnosing Fluid and Infection If a middle ear infection is suspected, the healthcare provider will examine your child. Tests may also be done to look more closely at the middle ear and check for hearing loss. Treatment is based on the exam and any tests, as well as your child s health history. Health History The healthcare provider will ask questions about your child s health and medical history. These include: Does your child have nasal allergies or other types of allergy? Is your child in daycare or often around a lot of children? Is this your child s first ear infection? If not, how many ear infections has your child had? When was the last one? What treatments has your child had for ear infections? Have you noticed any hearing or speech problems in your child? Exam and Tests During the exam, the healthcare provider examines your child s ears. The nose and throat may also be looked at. To check for fluid, a test called pneumatic otoscopy may be performed. This uses a special device (otoscope) to look into the ear canal. A puff of air is sent into the canal to see if the eardrum moves. A stiff eardrum can be a sign of fluid buildup. If other tests are needed, your child s healthcare provider can tell you more. 6

Checking Hearing If ear infections keep coming back, hearing tests may be recommended. For these tests, you will likely be referred to an audiologist. This is a healthcare professional who specializes in hearing and hearing testing. Tests That May Be Done The type of test or tests done will depend on the age of your child, as well as the kind of ear problem he or she has. Some of the tests may include: Audiometry, to test your child s response to sound. This can be done in various ways, using play or visual reinforcement. Otoacoustic emissions (OAE), to test the function of the inner ear. Auditory brainstem response (ABR), also called brainstem auditory evoked response (BAER), to record how well sound signals travel along the hearing nerve to the brain. 7

Medical Care Can Help The best care for your child will depend on many factors. These include your child s age and the type of fluid buildup your child has. In many cases, the ear clears up on its own without treatment. In others, medications are needed to treat infection or pain. Either way, keep follow-up visits with the healthcare provider so that your child s condition can be followed. Watchful Waiting Many ear problems go away on their own without medication. Also, antibiotics won t work if there is no infection or if an infection is caused by a virus. It is healthiest if antibiotics are used only if they are needed. So the healthcare provider may prescribe a period of watchful waiting. During this time, your child s ears are monitored for changes. Hearing tests may also be done. This period can last for a few days to several months. In many cases, the ear problem will clear up during this time. If it doesn t, your healthcare provider can discuss next steps with you. Using Antibiotics If your child is younger than 2 years, has a high fever, or has an infection caused by bacteria, antibiotics may be prescribed. These will treat the infection, though they won t clear the fluid from the ear. Give your child the entire prescription as directed, even if he or she feels better. If the medication is stopped too soon, the infection can return and be harder to treat. If Your Child Has Pain If your child has pain, you can help him or her feel better. Try these tips: Give over-the-counter pain medications such as acetaminophen and ibuprofen. Do not give aspirin. Ask the healthcare provider whether to use numbing eardrops. It may soothe your child if you apply a warm (not hot) compress to the ear. It may also be comforting to cuddle and rock your child. If your child s pain isn t controlled by medication or if he or she cannot be comforted, call the healthcare provider. 8

Preventing New Infections Ear infections are a common part of childhood. However, you can help make them less likely. This page outlines steps you can take. These are useful no matter what treatment your healthcare provider recommends. What You Can Do You can help protect your child from future ear infections. Take the steps listed below. Have your child wash his or her hands regularly. Wash your own hands often as well. Make sure your child has had his or her immunizations and has them on time. If possible, breastfeed rather than bottlefeed your child. As much as possible, keep your child away from tobacco smoke. Do not allow anyone to smoke in the home. Limit your child s exposure to other children or adults who are sick with colds or the flu. Avoid giving a pacifier to a child older than 6 months. Have your child sit up when drinking from a bottle or spillproof ( sippy ) cup. If your child has nasal allergies, have them treated. Also help your child avoid allergy triggers, such as house dust, mold, and pets. Talk to your child s healthcare provider to learn more. 9

If Your Child Needs Surgery In some cases, medical care is not enough to control the problems. Ear tube surgery is then recommended. Ear tubes help restore hearing and help reduce future fluid buildup and infections. The surgery is quick and usually done without an overnight stay. If your child can benefit from surgery, you will work closely with an ENT doctor (otolaryngologist). He or she will tell you more about the procedure and what to expect. Reassuring Your Child Ask the healthcare provider how best to reassure your child before surgery. Your child will pick up if you are stressed or fearful, so try to remain calm and cheerful. Explain to your child that you will go to a special building and meet many new people. Assure your child that you will be close by the whole time. Some children find it helpful and fun to act out an exam or surgery with stuffed animals or dolls. Getting Ready for Surgery You will be given instructions for how to get your child ready for the surgery. Be sure to do the following: Tell the doctor about any medications (prescribed or over-the-counter), vitamins, or herbal supplements your child takes, including antibiotics. Ask if any need to be stopped before surgery. Keep any pre-admission visits that are scheduled. You may be asked to fill out and sign forms ahead of time. Call the doctor if your child has a fever, cold, or rash within 48 hours before surgery. The surgery may need to be postponed. Have your child stop eating and drinking at the time instructed. An empty stomach helps keep your child safe during surgery. 10

The Day of Surgery When you arrive at the hospital or surgery center: You and your child will meet with an anesthesia specialist. You ll discuss anesthesia, medication that puts your child into a state like deep sleep. It keeps your child from feeling pain during surgery. The specialist can explain how anesthesia works and any risks or side effects. Your child s name and what procedure he or she is having will be asked more than once. This is for your child s safety. Your child may be given an IV (intravenous) line to provide medications and fluids during surgery. When your child goes in for surgery, you will be taken to a special area to wait until the surgery is over. Risks and Complications Ear tube surgery is considered very safe. But any surgery has risks and possible complications. These include: Bleeding Infection Hole in the eardrum that doesn t close Scarring or damage to the eardrum Tubes becoming blocked, falling out too soon, or moving out of place The need for another surgery 11

The Ear Tube Procedure During surgery, the ENT doctor makes a small hole in the eardrum and removes the fluid. Then he or she places a tiny tube in the eardrum. The tube creates a small channel between the eustachian tube and the middle ear. This allows air to pass through and helps keep fluid from building up. A slit is made in the eardrum Fluid is removed Actual tube size An ear tube is inserted Making a Slit Once your child is asleep, the ear canal is cleaned. The doctor uses a microscope and special surgical instruments to make a small slit in the eardrum. This is called myringotomy or tympanotomy. Removing Any Fluid Gentle suction is used to remove fluid from behind the eardrum. Putting in the Tube The doctor inserts a tiny tube (called a tympanostomy tube) into the slit in the eardrum. Tubes are made of plastic, ceramic, or metal and come in many shapes, sizes, and colors. The doctor will choose the best tube for your child. 12

After Surgery At the end of surgery, cotton may be placed in your child s ears. He or she may also be given medication to help relieve pain. Your child is then taken to a recovery area to wake up from the anesthesia. You may be able to see your child when he or she wakes up. Your child may be upset, scared, or irritable at first. This is a normal response to the effects of the anesthesia, not due to pain. Your child may also be more sensitive to noise for a few days. Going Home A healthcare provider will tell you when it s okay to take your child home. Once at home: Your child can go back to normal activities. He or she can likely return to school or daycare the next day. Be sure to give your child any prescribed medication on schedule and as directed. This may include antibiotic eardrops. You may notice drainage from your child s ears for a few days after surgery. This is normal. A small amount of dried blood in the ear canal is also normal. When to Call the ENT Doctor Call the doctor if your child has any of the following after surgery: Fever of 100.4 F (38 C) or higher Bloody ear drainage Pain unrelieved by pain medications Hearing loss Balance problems or dizziness 13

Living with Ear Tubes Once tubes are in place, your child s hearing may improve. For best results, follow up as instructed by the ENT doctor. The tubes help prevent fluid buildup in the middle ear, but keep in mind that fluid and infection can still happen. So don t stop taking the preventive steps listed on page 9. Follow-Up Visits Within a few weeks of surgery, you will meet with the ENT doctor or other healthcare provider. During the visit, your child s ears will be checked to ensure the tubes remain in place. Hearing may also be retested at this time. It s important to make and keep these follow-up visits. They allow the healthcare provider to make sure the tubes are working properly. Proper Ear Care These tips help you care for your child s ears while tubes are in place. Don t use cotton swabs to clean your child s ears. They can easily damage the eardrum. Water is unlikely to affect the tubes. However, the doctor may suggest keeping water out of the child s ears in certain situations. Tubes are deep inside the ear canal. They are unlikely to be pushed in or pulled out with fingers or earplugs. 14

Tubes Aren t Forever Most tubes stay in place for up to a year. Some last longer. Most tubes fall out on their own, and the holes heal. In rare cases, tubes need to be removed by the ENT doctor. Some children need a second set of tubes after the first set comes out. Your child s doctor can tell you more about what is needed. A Note About the Adenoids If your child needs another set of tubes, his or her adenoids may be removed during the second surgery. The adenoids are a mass of tissue in the back of the nose. They are prone to infection in some children. This may contribute to middle ear problems. Adenoids 15

Getting Past Ear Infections Middle ear infections can be tough on your child and on you. But treatment can help ease the painful symptoms. You can also take steps to reduce your child s risk for fluid buildup and infection. Rest assured that your child will eventually outgrow middle ear infections. Also available in Spanish TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit www.kramesurvey.com to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2015 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA. 11934 1412