Published in Panorama
When ear infections cause deafness and speech problems
According to European studies, at least two thirds of children get otitis media or middle ear infection, once in their life time. 46% of children get otitis media two to three times; 16% get it more than 5 times. It is one of the most common ear infections affecting children, the peak incidence occurring between the age of 6-18 months, followed by a decline and again an upswing during the initial school going years followed by a lowering of incidence, says Dr.J.Antony Chalissery, ENT Specialist, Indian Specialist Medical Centre, Dubai.
How Does Otitis Media Happen? The inflammation usually begins with infection due to sore throat, cold or upper respiratory problems, explains Dr.Chalissery. Otitis media usually happens when viruses or bacteria get inside the ear and cause an infection. The Eustachian tube which connects the ear to the back of the throat gets blocked and as a result there is a fluid collection in the middle ear. The Eustachian tube being shorter, narrower, relatively incompetent and more horizontal in children, they are more prone to the problem. Especially when children are fed lying in a horizontal position, the chances of the milk regurgitating into the nasal passage and Eustachean tube is much more. The fluid build up behind the eardrum causes pain, swelling and redness of the ear. The infection may also spread through the pre-existing perforation of the eardrum, says Dr.Chalissery.
Alternatively, says Dr.Chalissery, the adenoids located in the throat, near the eustachian tubes, can become infected and swollen. They can also block the openings of the eustachian tubes, trapping air and fluid.
What are the symptoms of otitis media? Particularly in children as young as 6 months, how does one suspect otitis media? “Such children will be cross, irritable, bang head on the sides of the cot. Some other children may become quiet and refuse food, have altered behavioural patterns, have restless sleep. Alternatively, they may tug at one or both ears, have fever, fluid discharge from the ear, hearing difficulty and loss of balance.
What are the risk factors contributing to otitis media? Dr.Chalissery lists a number of factors which could predispose children to the malady. “Immunologically incompetent children, those in whom the immunity is low, poor children, those in under developed countries with hostile environment have extra ordinary incidence of severe episodes of Acute Otitis media because they are more prone to all kinds of infection. Children in day care centres have 25% higher chances of infection than children cared for in their homes. Incidence of infection reaches the peak during winter months. Male children have a higher incidence of disease than females. Children who were breast fed for 12 months or more have significantly lower risk of ear disease. The presence of tobacco smoke increases the chances of recurrent middle ear infection.”
What are the complications that can occur due to otitis media? Dr.Chalissery explains, “In the case of chronic otitis media with perforation of both the sides of the tympanic membrane or the eardrum, children are likely to develop hearing defects and problem in language development in the form of some speech impairment. Usually in unilateral otitis media and perforation, this will not happen because the other ear is perfectly alright. But in bilateral, large central perforations, with hearing less than 30-40%, these children do get language problems.”
In a certain dangerous form of the problem, the infection can spread to the brain and meninges leading to severe complications, cautions Dr.Chalissery.
How is Otitis media diagnosed? An otoscopy is done to look for fluid in the middle ear and the observe the appearance of the eardrum. Also, a tympanogram is used to see how well the eustachian tube is working and how well the eardrum can move, says Dr.Chalissery.
Once diagnosis is made, what is the course of treatment? “Most of the time,” says Dr.Chalissery, “Otitis media may clear up with proper medication and home treatment. Simple analgesics like paracetamol, local and systemic decongestants may be sufficient in mild cases. Treatment with antibiotics is still a highly debated issue since many medical personnel feel that a number of antibiotics are ototoxic. The same reasoning is put forward against using ear drops for the purpose. But personally, I would say that the risk of ototoxicity is less than the risk of chronic sepsis in causing strong sensory neural deafness.”
What then is the role of surgery in treating otitis media? Dr.Chalissery explains, “When fluids from an ear infection stay in the ear for several months and may cause hearing loss and speech problems, when there is perforation of the eardrum, in such cases it is better to go in for surgery for repair of the ear drum, at least on the one side. Surgery is usually advised after the age of 14 or 15 because by this time the incidence of the infection comes down and the child becomes healthier.”
What is the kind of surgery that is undertaken? “For children prone to recurrent infection, there are two types of surgery,” explains Dr.Chalissery. “The most common surgical treatment involves having small grommets or tubes placed inside the ear, by a procedure called a myringotomy. “This is undertaken to prevent the rupture of the ear drum. The ear drum is microscopically incised and a grommet, a tube to drain fluid is introduced. So with this opening the middle ear pressure is equalized with the atmospheric pressure. This will prevent the rupture of the ear drum. The tube works to relieve pressure in the clogged ear so that the child can hear again. Fluid cannot accumulate in the ear if the tube is venting it with fresh air. After a few months, the tubes will fall out on their own. In rare cases, a child may need to have a myringotomy more than once. The problem with this procedure is that we are incising the ear drum. So the children cannot go for swimming since water will get inside and infection will be more.”
“The other procedure is adenoidectomy – the removal of the adenoids. Since the Adenoids perform the function of aiding immunity, there is controversy over its removal”, adds Dr.Chalissery.
Is it possible to prevent otitis media? Prevention lies in taking care of the risk factors, says Dr.Chalissery.
At least the risk of contracting infection may be lowered, according to the specialist. Preventive measures include:
1. Breast feeding of infants since it is shown to lower the risk of infection.
2. Children under the age of 2 years should not lie flat when being fed with the bottle.
3. Smoking should be avoided when children are around.
4. Children in daycare centres tend to have more cold and risk risk of ear infection. It is better to keep a child at home when he is sick.
5. General hygiene should be adhered to.