Otitis in Children

The middle ear is an air-filled space located behind the eardrum. It contains the ear’s three ossicles—the hammer, anvil and stirrup—which amplify the sound vibrations transmitted to the inner ear. Air reaches the middle ear cavity through a small tube called a Eustachian tube, which connects it to the throat. This tube opens when you yawn or swallow. Factors such as infection in the upper respiratory tract (a cold) or mucosal hypertrophy can prevent the Eustachian tube from opening; this causes a lack of air to the middle ear, which produces a suction effect on the eardrum. As a result, the middle ear fills with liquid. Young children are susceptible to ear infections because their immune systems are not yet fully developed, their Eustachian tubes are small and horizontal, and their adenoids are often swollen due to colds and infections. Toward the age of seven, the Eustachian tube becomes more vertical in position, reducing the risk of infection.

The most common symptoms of otitis media include severe ear pain, fever and congestion. These symptoms are frequently accompanied by a loss of appetite, irritability and hearing loss. An affected child will ask you to repeat more frequently and will tend to turn up the volume on the TV. Fortunately, this loss of hearing is usually temporary; acute symptoms typically heal in seven to fourteen days. However, otitis can be chronic, meaning the liquid remains in the middle ear for several months. A child in this situation may not feel any pain, as the symptoms become insidious. In such cases, the child’s hearing behaviour must be closely monitored to establish whether or not the otitis is chronic.

If a child has considerable nasal secretions (a cold), the use of a nasal pump with saline solution is recommended. The child should also avoid sniffing, be sure to blow his or her nose properly and drink lots of liquids. Another suggestion is to have the child blow up balloons to force open the Eustachian tubes, thereby allowing the pressure to equalize in the middle ear. Applying a lukewarm compress to the ear also helps soothe discomfort.

Ear infections are, without a doubt, most prevalent from October to April. During this period of the year, the use of a humidifier in your child’s bedroom is recommended in order to keep humidity levels at approximately 40%. It’s best to avoid smoking in the house or in the child’s presence. It is also recommended to avoid giving an infant a bottle in a horizontal position; the infant’s head should be propped up. Breastfeeding allows for the optimal position. Prolonged use of a pacifier is to be avoided, because the suction effect pushes liquid from the throat toward the middle ear and can increase the risk of infection.

For persistent ear infections, it is best to consult an audiologist to assess the auditory manifestations of the infection, and an ear-nose and throat specialist (ENT) for appropriate treatment, which may take the form of antibiotics or tympanostomy tubes. While otitis is generally without long-term consequences, the possible complications from repeated episodes are central auditory processing disorders, which are often the root cause of learning difficulties. Sometimes, a perforation of the tympanic membrane persists and has to be surgically closed. In very rare cases, inadequately treated chronic otitis can lead to the formation of a cholesteatoma or tympanosclerosis.