Page 57

Pindara Private Hospital Magazine - Issue Seven

CHILDREN'S HEALTH TREATING RECURRENT EAR INFECTIONS i n c h i l d r e n Ear infections in children are distressingly common. Watching a child in severe pain is incredibly difficult to take but the fact is 90 per cent of children will have at least one ear infection and more than three in four will have repeated infections. When we talk about ear infections in children, we’re almost exclusively dealing with middle ear infections. The middle ear lies behind the eardrum, too deep for us to see with the naked eye. Middle ear infections (otitis media) are all too frequent, and are one of the most common reasons children are seen by GPs. The main reason these infection are so common in children is that their eustachian tube (the draining duct that drains from the middle ear into the nose) is very short, flat and narrow. It allows for the backward flow of bacteria back into the middle ear and also means that it can block very easily with simple colds. Children’s adenoids (the lymph tissue at the back of the nose) also can cause it to block. Factors such as prematurity, day-care, the use of a pacifier, smokers in the house and bottle feeding are all known to increase the risk for ear infections. The good news is that they almost always improve as your child gets older. The diagnosis of ear infections can sometimes be difficult, particularly in small children. Sometimes the only sign will be a high temperature. Occasionally, very young children will pull at their ears as a sign of discomfort but this can be unreliable. The most sensible method is to have your child properly evaluated by your GP. The organisms that cause the infections can be both bacterial and viral. The good news is that the most common bacteria, streptococcus pneumoniae, is covered in the Australian vaccination schedule. By having your child’s vaccinations up to date, you are significantly reducing the risk of your child having otitis media. What can we do when it happens? Pain relief is obviously the first step. Paracetamol and/ or ibuprofen are excellent at both reducing pain and your child's temperature. It is always then sensible to see your local doctor so that an informed choice can be made as to whether antibiotics are required. Antibiotics remain controversial and there is increasing evidence that they are not as effective as we traditionally thought. A large review of all the medical literature (Cochrane review) showed they are particularly effective if the infection is in both ears, the ear drum has perforated (ruptured) or your child is under two. If your child isn’t systemically unwell or meet the above criteria, your GP may discuss withholding antibiotics to see if the infection resolves on its own. While it is frustrating when antibiotics seem to be ineffective, unfortunately complementary medicine has not been shown to be helpful. In particular, osteopathy, chiropractics and massage have not been shown to be any more effective than placebo. If your child is having frequent recurrent infections - specifically more than six infections a year - then there are options other than antibiotics or watchful waiting. Tympanostomy tubes, or grommets, are small barrels that sit within the ear drum and replace the eustachian tube. By allowing the air back into the middle ear, the infection rate reduces dramatically. They need to be placed by an ENT surgeon and require a very short anaesthetic. It’s a very safe procedure and is one of the most common operations in Australia. Grommets are not a cure-all, though, and can cause problems in themselves such as holes in the ear drum and discharge. You should have a conversation with your ENT surgeon about the pros and cons of this option. Sometimes they will recommend removal of the adenoids as an adjunct to the grommets. Other options are to reduce any identifiable risk factors such as exposure to passive smoke and day-care. What are the risks of recurrent middle ear infections? Good question! Thankfully the risks are relatively low. There’s a small risk of hearing loss but this is usually due to either a persistent perforation of the eardrum, or fluid behind the eardrum (effusion). A perforation can be repaired with a small operation to graft the eardrum (myringoplasty) and effusions are drained with the use of grommets. Both of these procedures restore the hearing back to normal levels in the majority of cases. If you’re ever concerned about your child’s hearing, particularly if there’s any delay in their speech or language development, they should have a hearing test. Hearing tests are available at any age but do need to be modified for young children. There are rare but very serious complications of otitis media worth mentioning, such as meningitis, abscesses, sepsis and bone infections (mastoiditis). Thankfully they are almost never seen but if you are ever concerned that your child may be developing any of these then seek urgent advice. It can seem as though your child may never outgrow their run of ear infections, but with good guidance from both your GP and specialists the impact can be reduced and complications avoided. Dr Matt Cronin, ENT Surgeon pindaramagazine.com.au Pindara Magazine 55


Pindara Private Hospital Magazine - Issue Seven
To see the actual publication please follow the link above