Updated: Jun 1
Did you know that there are many kinds of ear infections requiring different treatments?
Which type of ear infection is your child experiencing? Those poor ears get blamed for a lot
of things in the infant and toddler age groups. Anything from fever, restlessness, poor sleep
and loss of balance have been blamed on ear infections when the ears may be just perfect.
Let’s get the terminology right first. The ear is divided into three parts:
- The outer ear: earlobe and ear canal
- The middle ear: the area behind the eardrum housing the three tiny hearing bones
- The inner ear: the cochlea nerve and vestibular balance system.
When someone says they have an inner ear infection, they usually mean the middle ear. A true inner ear infection affecting the cochlea is extremely rare. The treatment differs depending on which kind of ear infection your child is suffering from. Let's cover the two most common ear infections!
Outer ear infection (Otitis Externa)
Otherwise known as swimmer’s ears, this is an infection of the ear canal outside the drum.
It causes the skin to be inflamed and often there is some ear discharge and pain associated
with it. Interestingly, the ear canal is gently curved and narrow like a test tube to funnel
sound. Therefore it can trap water and debris. Once bacteria swims into the ear canal, they can cause a skin infection. To prevent this, avoid using cotton buds, reduce the number of
earphones or earplugs used, be careful around dirty water in the ear canal and leave earwax
alone as it is actually antibiotic and protective. We also recommend that you're aware of cartilage infections that may arise from earrings or ear studs.
If your child has an underlying skin condition such as eczema, they may be at higher risk of developing an outer ear infection. Regular skin care may be needed in some situations.
Outer ear infection treatment
An outer ear infection is painful and is associated with discharge. What’s the first line of
treatment? SWAB, MOP, DROPS. Take a swab at the GP to see what bacteria or fungus,
we’re dealing with. Mop the ear with tissue twirls or tissue spears. The use of a hairdryer on
a cold low setting may help. Sometimes a specialist can micro-suction the discharge. Then
start eardrops. Remember that the infection is outside the body, not in the middle or inner
ear. So oral antibiotics don’t end up in the right spot as well as topical ear drops can. I’d
recommend ear drops as first-line therapy for discharging wet ears. In severe cases, we
may add oral or intravenous antibiotics if the topical drops have not controlled the
infection. With eardrops, pain relief, cold or warm compresses and time, most outer ear
infections will dry up and settle. Grommets are not the answer here.
Middle ear infection (Otitis Media)
This is pus behind the drum. It has nothing to do with swimming at all. Unlike otitis externa,
otitis media occurs inside the body, behind the ear drum. The predisposing factors are
upper respiratory tract infection, childcare attendance, reflux disease and parental smoking.
Other uncommon predisposing factors include craniofacial syndromes such as trisomy 21,
cleft palate, and others. It often begins with a snotty nose or viral infection, then leads to
fluid buildup behind the drum often causing a sense of pressure, blocked ear and some mild degree of hearing loss. This is when your toddler may pull on one ear as the blocked
sensation and muffled hearing are annoying.
Middle ear infection treatment
If the child is unwell or has any other risk factors (congenital hearing loss, cochlear implantation, immunosuppressive disorder, etc.), then starting oral antibiotics early is
acceptable. It is also acceptable to wait a few days as the vast majority are virus-mediated
and many will resolve spontaneously without any antibiotics. In most middle ear infections,
the eardrum stays intact, so the ear canal is dry. No eardrops will permeate through the drum, so oral antibiotics are the way forward. In some situations, the pressure behind the drum gets so full that the eardrum may perforate and cause fluid leakage. Do not worry. The relief of pressure is so welcoming that kids actually feel better after that release. Do not
worry about the perforation. Most will close spontaneously. This is also a time when the ear
drops will be useful to get straight to where the problem is.
An otherwise healthy child is can have up to 4 ear infections per year. Beyond that, or if each
of these infections is severe, we would consider a definitive treatment in the form of middle ear ventilation tube insertion, otherwise known as grommets. Many are so concerned about eardrum perforations while ENT (ear, nose and throat) surgeons perforate the drums multiple times a week when we insert these grommets.
The two main reasons for grommet insertions are:
More than four middle ear infections a year
Persistent fluid behind the drum for over three months resulted in hearing loss (and possible language delay). A grommet (“ear tube”) is a plastic tube with a diameter of 1mm that sits through the drum. We needle the drum, suction the fluid, and place the grommet. Grommets stay in the ear and will typically spontaneously extrude after 1-2 years.
How do ear grommets work?
Remember, ear grommets do not reduce your risk of ear infections. Your child has the same risk of getting middle ear infections as anyone else if they continue to attend childcare and
catch childcare viruses. A plastic tube doesn’t magically reduce the infections. What they do
is prevent the trapping of pus behind the drum. The grommets allow pus to leak out so
that ear drops can be better delivered directly. This way, the hearing remains good, the pressure build-up is prevented, and ear drop antibiotics can be given. Oral antibiotics are not often necessary when a grommet is in the ear. Is the ear drum perforated when the
grommet is in? Of course. Will it repair itself once the grommet falls out? Certainly, for the
vast majority. What happens if the hole does not close? We will patch the hole. Fixing an eardrum perforation is a basic operation every ENT surgeon is trained to perform. Can my child swim with grommets in the ear? Absolutely, with good earplugs.
If you have any concerns about your child’s hearing and ear health, your local General
Practitioner, Paediatrician, Audiologist, or ENT Surgeon will be delighted to help you.
This article was written by Parents You've Got This ENT Expert Dr Levi - a Specialist Paediatric Ear, Nose & Throat, Head & Neck Surgeon. He treats general ENT conditions such as hearing loss, ear infections, allergic rhinitis, sinusitis, snoring and sleep apnoea. He also treats and researches some of the less common conditions, such as drooling, lumps & bumps, floppy larynx, airway stenosis and malignancies.
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