Is it really an ear infection?
Ear infections are one of the leading illnesses in young children. We take a closer look at this common condition.

Ear infection is one of the most common reasons for antibiotics to be prescribed for children, with 75 percent of children having had at least one ear infection before their third birthday. What’s more, it’s caused by the same germs that give way to upper respiratory tract infection.

Children are all ears

The middle ear comprises an eardrum, a hollow space (the tympanic cavity) and three minute bones known as ossicles that are joined to each other and span the space to the inner ear. At the bottom end of the tympanic cavity, there’s a small tube (called the Eustachian tube) that ensures that any fluid that builds up in the space drains to the throat.

Ear infection is caused when this tube doesn’t work and fluid starts building up in the tympanic cavity. The fluid may or may not be infected. A child’s Eustachian tube is shorter and more horizontal than that of an adult, and for this reason kids are more prone to ear infections.

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An upper respiratory tract infection, sinusitis, reflux or allergies can all cause the Eustachian tube to become blocked and fluid and pressure to build up in the ear. That is what causes the pain and discomfort. If the pressure is not relieved, the ear drum can burst and then the fluid ends up in the canal of the outer ear.

Normally a burst eardrum heals all by itself, but if it blocks up repeatedly a permanent little hole can remain that can cause loss of hearing. For this reason, it’s important to get your child checked out by a doctor if you suspect he has an ear infection.

Symptoms of infection

Ear infections usually go hand-in-hand with an upper respiratory tract infection and symptoms such as fever, mucus (a snotty nose), lack of appetite and listlessness are common. If your child also complains of earache, pulls at or rubs his ears, or if there’s blood or fluid coming out of his ears, he probably has acute ear infection.

It’s also possible to have an ear infection without fever or pain. This is called a chronic ear infection (otitis media) with effusion and is known as glue ear in the popular parlance.

This happens when a thick fluid gets stuck in the middle ear and can’t drain. Often the only symptoms are slight to average loss of hearing and impaired listening abilities. Simply put, otitis media is an invisible ear infection that can cause lots of damage.

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Antibiotics or grommets?

Ear infections are usually treated with antibiotics that your doctor will prescribe. Sometimes middle ear infection doesn’t react to antibiotics.

This can be because of a resistant germ or because the concentrate of antibiotic that reaches the middle ear is not strong enough to kill the bacteria. If your child has three or more bouts within a three-month period, grommets may need to be considered.

Grommets are small tubes, made of metal or silicone, that are placed in the eardrum to take over the function of the Eustachian tube. The procedure is a relatively minor surgical one that requires anaesthesia.

A small incision is made in the eardrum, after which the fluid is sucked out and the tube inserted into the eardrum. The child is discharged with antibiotic eardrops to sort out any remaining infection and prevent fluid from blocking the grommet.

A couple of weeks after the operation the doctor should examine the child again to make sure that the infection is gone and the ears are dry. The tubes usually fall out all by themselves six to eight months later, but the child should see the specialist every three or six months until then.

Before the tubes are inserted, though,the cause of the ear infection should first be determined, says Dr Nisius du Plessis, an ear, nose and throat specialist at the Pretoria East Hospital. Typical culprits are enlarged adenoids and allergies.

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Consequences of repetitive ear infections

More and more preschoolers are battling with language and speech problems due to repetitive ear infections, says Chrisna Oosthuizen, an audiologist at the Carel du Toit Centre for children with hearing disabilities in Bellville, Cape Town.

Because the fluid in the middle ear causes slight to average loss of hearing, these children often have unclear speech: they don’t hear the s-, f- and t-sounds, and so they don’t say them.

They also often don’t hear short words in a sentence and then don’t say them either. This leads to a limitation in their language development. “Hearing is one of the senses, but listening is a skill,” says Chrisna.

A child that can’t hear well for periods of time doesn’t develop good listening skills and it can undermine later achievements at school. This erratic loss of hearing can lead to a problem with the processing of sounds, which gives way to the child struggling with attention, concentration (especially in a setup where there’s background noise, such as in a classroom), reading and spelling.

According to Susan Strauss, president of the South African Association of Audiologists, it is of uppermost importance to ensure that a child who’s had an ear infection can hear normally again, even if the infection has been cleared up.

An audiologist is specially trained to evaluate children’s hearing and can perform a quick, painless test to determine if there’s fluid in the middle ear. No doctor’s reference is necessary for a visit to an audiologist.

An audiologist can also help parents and teachers to make adjustments in a child’s learning environment to help him to hear and listen better.

How to prevent an ear infection in your child

  • Ensure that your child’s vaccination schedule is up to date. The haemophilus influenzae type B and pneumococcal vaccines can help limit ear infections. 
  • Research shows that children who are breastfed for at least six months are less likely to get ear infections.
  • Keep little ones away from cigarette smoke. There’s a clear connection between the number of upper respiratory tract infections and exposure to smoke. 
  • Daycares where there are fewer children per minder can reduce the risk of ear inflammation.
  • Control allergies that can cause the Eustachian tube to swell and get blocked. 
  • Always position your baby at a 25 to 45° angle when he’s drinking a bottle – he should not be lying flat on his back. Because bottled milk dams up a lot easier in a baby’s mouth, some of the milk can flow through the Eustachian tube and into the middle ear cavity and cause infection.

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