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VCU Department of Otolaryngology, Virginia Commonwealth University VCU Department of Otolaryngology VCU Medical Center VCU

VCU Department of Otolaryngology

Pediatric Otolaryngology - Ears

The most common health problem in children concerns their ears. Ear infections can occur frequently and may start as early as two months of age. Every parent who has experienced ear infections can report the symptoms: pulling at one or both ears, fever, crankiness, and not eating or sleeping right. Within a day of the symptoms the child is on oral antibiotics. After multiple courses of antibiotics, the child is referred to an otolaryngologist for ear tubes. Ear tubes allow drainage of the middle ear fluid and permit the use of antibiotic eardrops to fight infection directly in the middle ear. This direct use of the antibiotic eardrops helps to prevent antibiotic resistance.

The child's head development, the location of the eustachian tube opening high in the back of the throat and rapid growth of adenoid tissue contribute to ear infections. The eustachian tube function is to drain fluid from the middle ear and deposit it high in the back of the throat. The child's head development makes this tube be in a flat line position until about age three or four when the eustachian tube makes a downward slant from the middle ear to it's opening high in the back of the throat. Enlarged adenoid tissue may block the drainage opening of the eustachian tube and cause an ear infection, even if the tube slants downward.

Hearing loss and speech delays are common in children who need ear tubes. The middle ear fills with fluid and this muffles the sound coming through the eardrum. It is like trying to hear with cotton in the ear. The child cannot hear certain sounds clearly; for example, "lub dub" sounds like "ub". If the child cannot hear the sound correctly, his speech will sound like the sound that he does hear. Others around him will report that he talks but only his parents understand what he says. If this speech pattern continues, he will be at a loss in speaking with other adults such as teachers. Multiple ear infections can lead to more serious middle ear problems and possible permanent hearing loss. Inserting ear tubes (myringotomy tubes) can also prevent rupture of the eardrum.

The otolaryngologist inserts ear tubes in the operating room in less than 20 minutes. The child is put to sleep using a mask to give the anesthetic sleep medication. The eardrum is opened with a special tool, the fluid behind the eardrum is suctioned away, and the ear tube is placed in position. An ear tube looks like a miniature tire rim or grommet. The hole in the middle allows fluid and air to escape from the middle ear. The hole also allows antibiotic eardrops to flow into the middle ear to fight ear infections.

Since fluid does not collect in the middle ear space, the child should not have as many ear infections. The tube usually falls out after one year. By then, the child has grown and has less need for ear tubes. Occasionally, a second set of ear tubes has to be inserted because the child continues to have ear infections. At the same time the adenoids will usually also be removed to allow better drainage from the eustachian tube.



Virginia Commonwealth University Medical Center
School of Medicine
Department of Otolaryngology
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