Childrens Ear Infections

(Glue Ear)

What are Childrens Ear Infections ?

A middle ear infection is an infection that fills the middle ear with fluid and pus. The childrens ear infection often causes pain and fever. The middle ear pressure can build up so much that the ear drum bursts and the pus and blood from the middle ear leaks out of the ear canal. The bursting of the ear drum often settles the pain and fever.

Middle ear infections are common with 80% of children suffering at least one infection in their childhood. The peak age for infections is between 2 to 4 with the incidence declining after the age of 7 as the Eustachian tube matures and the adenoid tissue shrinks.

What is Glue Ear?

Glue ear is a form of chronic middle ear infection that fills with thick glue like fluid.

Children with this problem may have had ear infections in the past or alternatively present with hearing loss.

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Normal ear

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Acute ear infection

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Glue ear

How do I know if my child has a middle ear infection?

Most typically children with ear infections will have fevers, pain in their ears and hearing loss. Other signs include uncontrollable crying, difficulty sleeping, irritability, ear rubbing/ pulling and restlessness in the infant or toddler age group. Children with glue ear often have no pain and present simply with hearing loss.

What is the treatment for middle ear infections?

Most middle ear infections can be initially managed with pain relief (panadol and nurofen) and observation. More than half the infections will start to settle down in within two days and any further treatment can be avoided. If your childs ear infection has been progressing for more than 2 days your general practitioner may prescribe antibiotics to settle the infection.

Other measures that may help include avoiding daycare or preschool, avoiding smoking around your child, trying low allergen milk (such as A2), avoiding bottle feeding your child whilst they are lying flat and keeping your childs nose clear with saline irrigation.

When is surgery required for middle ear infections?

Surgery is generally advised for your child most commonly to correct the hearing loss, prevent further ear infections and rarely to treat serious complications of ear infections.

Hearing Loss
When your child has had proven hearing loss for more than 3 months in two ears, or more than 6 months in one ear then treatment is recommended. If the medical and conservative treatments do not resolve the hearing loss, then surgery is usually recommended to clear the fluid in the middle ear and restore hearing back to normal.

Prevent Ear Infections
If your child is getting frequent ear infections then rarely long term damage can occur to their hearing (or adjacent anatomical structures) such as the brain or the facial nerve (which is the nerve that moves the face and makes your child smile and frown). Surgery to place grommet (middle ear ventilation) tubes, decreases the severity, frequency and intensity of the ear infections. The grommet tubes also allow the doctor to prescribe antibiotic ear drops to treat the ear infection.

After grommet surgery the infections settle down, but often do not completely go away until your child reaches the age of 7 to 10, when their Eustachian tube matures and allows more air into the middle ear.

Treat Serious Complications of Ear Infections
As you now know, ear infections are very common. Occasionally the infection can spread to the adjacent anatomical structures such as the facial nerve, brain, main vein that drains the brain; or become more complicated and form a collection of pus behind the ear or in the neck. These are serious complications and the treatment involves surgery to clear the pus and usually a grommet to clear the infection from the middle ear.

What surgery is involved with ear infections?

The most common surgery is the placement of grommet tubes. Grommets are plastic tubes that are surgically placed into the ear drum to allow pus to drain from the middle ear, and also to allow air to flow back into the middle ear.

Depending on the shape of the grommet they can stay in for as short as a few weeks up to a few years. As the child grows the skin of the ear drum grows underneath the tube and painlessly lifts the tube out of the ear drum and in time the tubes fall out in the wax.

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Short term tube

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Medium term tube

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Long term tube

Watch the surgery video

Short term grommets

Long term grommets

Shared decision grid for parents and caregivers regarding surgical options of Otitis Media with Effusion
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Credit: Clinical Practice guidelines Feb 2016 Otolaryngology Head and Neck Surgery.

How hearing works

Video by Associate Professor Nirmal Patel.