Middle Ear Infections in Children

A common condition that Dr. Rejowski sees in children is a middle ear infection, or otitis media.  This occurs when the middle ear becomes inflamed, typically due to a bacterial or a viral infection.

Otitis media is more common in children. Most children will have at least one ear infection by their third birthday, and 30 percent of children will have had three or more episodes by three years of age.

In general, there are three main types of middle ear infections:

  • Acute otitis media (AOM): This is the most common ear infection. The middle ear becomes infected and swollen, and fluid gets trapped behind the eardrum.
  • Otitis media with effusion (OME): This condition typically follows an episode of AOM that has resolved, and is characterized by residual fluid behind the eardrum.
  • Chronic otitis media with effusion (COME): Fluid that remains in the middle ear for a long time or returns repeatedly, even though there is no infection, will often become mucoid or thickened. This condition can impair hearing.

Symptoms

Middle ear infections can be extremely painful for some while others may have little or no discomfort. Because many ear infections happen before children are able to communicate that their ears hurt, significant symptoms may include:

  • Tugging at the ear(s)
  • Fussiness and irritability
  • Decreased appetite
  • Not wanting to lie flat
  • Trouble sleeping
  • Fever (especially in infants and younger children)
  • Discharge from the ear
  • Balance problems
  • Trouble hearing

A child displaying signs of a middle ear infection should see a doctor. Untreated infections can lead to complications such as a hole or perforation in the eardrum, chronic hearing loss and mastoiditis (infection or inflammation of the mastoid bone). Though rare, life-threatening complications can arise including meningitis or brain abscess.

Causes

Children are far more likely than adults to get middle ear infections because the Eustachian tubes (a tube that runs from the middle ear to the back of the pharynx) are smaller and more level in children than in adults. This allows infection to pass more easily to the middle ear during a respiratory illness.

Risk factors for the development of otitis media include:

  • Sinusitis
  • Viral infections
  • Attending daycare
  • Sleeping with a bottle
  • Allergies
  • Congenital anomalies such as a cleft palate

Treatment

Children with symptoms of middle ear infections should see a board certified ENT specialist like Dr. Rejowski.  He will recommend therapy and follow up with patients to ensure the ear infection resolves completely and there is no remaining fluid in the middle ear.

Typical treatments include:

  • Over-the-counter pain relievers such as acetaminophen or ibuprofen
  • Oral antibiotics directed against the bacteria most likely to be the source of the infection. This is usually taken for 7 to 10 days.  If ear infections recur but completely clear between episodes, Dr. Rejowski may prescribe low dosage antibiotics for four to six weeks as a preventative measure.
  • Intramuscular or intravenous antibiotics may be necessary in cases of severe infection
  • Anesthetic ear drops for pain
  • Surgical treatment. In cases where the fluid will not clear, the infection recurs, or antibiotics fail to work, surgical therapy may be indicated. For recurrent infections, it is important for children to be evaluated by an ear, nose, and throat specialist.

Dr. Rejowski may recommend the following surgical solutions:

  • Tympanostomy or myringotomy with tube insertion (commonly referred to as tubes).  A board-certified ENT specialist such as Dr. Rejowski will place tubes into the eardrum to drain the fluid trapped there. The tubes are small titanium or silastic tubes that allow movement of air into the middle ear. The tubes will usually fall out of the tympanic membrane within one to two years as the eardrum grows.  Dr. Rejowski places the tubes through the ear canal during a five- to ten-minute procedure in which a child is under a general anesthetic. Children typically are able to resume normal activity upon leaving the hospital on the same day as the surgery.
  • Adenoidectomy: This procedure involves removing the adenoid (a tonsil-like tissue located behind the nose) to prevent the spread of infection through the Eustachian tube. An adenoidectomy is typically recommended if a child needs a second set of tympanostomy tubes or if the middle ear infection is closely linked to nasal stuffiness or other sinus symptoms. This outpatient surgery is done through the mouth and lasts about 20 minutes.
  • Mastoidectomy: In rare cases of severe infection, Dr. Rejowski may recommend a mastoidectomy. This procedure is done under general anesthesia. The mastoid bone behind the ear is opened and the infection is drained utilizing an operating microscope and surgical drill. An overnight hospital stay is usually required for children.

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