Helping Little Ears Overcome Repeated Infections

Ear infections and early childhood go hand in hand, as most parents of young children are well aware.

In fact, ear infections rank at the top of many lists of most-sought pediatric services:  

• Ear infections are the most common reason that children visit their doctor. (Five out of six children have at least one ear infection before their third birthday.)
• Ear infections are the leading cause for antibiotic prescriptions in children.
• Procedures to place ear tubes to address persistent ear problems are the number one childhood surgery performed under anesthesia. 

Why Are Little Ears So Infection Prone?

Children ages 3 months to 3 years are most susceptible to ear infections. The anatomy of a young child’s ear, combined with an underdeveloped immune system, creates a perfect environment to capture fluids in the ear, leading to fluid retention and infections.

While their immune systems are developing, young children are prone to upper respiratory infections. When inflammation occurs in the eustachian tubes due to bacterial or viral infections, fluid can become trapped in the middle ear, leading to infection.

Fluid within the inner ear typically drains into the throat through the eustachian tubes. In young children, eustachian tubes are shorter and have less slope to promote drainage than those of older children and adults, encouraging fluid buildup.

Recurrent Ear Infections

Approximately 25 percent of young children get frequent ear infections. These recurrent events are of concern primarily because they are associated with temporary hearing reduction at a pivotal time in a child’s development. Reduced hearing among infants and toddlers can lead to speech, language and learning delays.

Children who experience repeated ear infections are often referred to a pediatric otolaryngologist, also known as an ear, nose and throat (ENT) specialist. Typically, pediatricians refer children who have three or more ear infections in six months, or four or more infections in a year, for ENT evaluation.

A pediatric ENT can assess the causes of a child’s repeated infections and offer guidance on prevention as well as treatments that can end the cycle of ear infections. 

Strategies to Avoid Repeat Infections

Pediatricians and ENTs can also help families learn how to prevent ear infections. Strategies include:

• Keeping children away from secondhand smoke, which can cause ear infections
• Ensuring children receive all recommended immunizations, including an annual flu shot
• Washing hands frequently and having children do the same
• Breastfeeding for the first 6 to 12 months to provide antibodies to reduce risk of infection
• Feeding babies in an upright position (at least 30 degrees) to prevent fluid from traveling to the middle ear. Avoid propping bottles in cribs.
• Identifying and controlling environmental allergens that contribute to fluid buildup
• Placing ear tubes surgically or in an outpatient setting to reduce fluid retention in the ears

Ear Tube Placement Can be the Answer

Use of ear tubes (tympanostomy tubes) is an effective, safe and common treatment for young children with chronic, recurring infections and persistent fluid accumulation in the ears. Approximately 1 in 15 (roughly 7 percent) of U.S. children have tubes placed in their ears by age 3.

Tympanostomy tubes, which are made of metal, plastic or silicone, work by providing ventilation to the middle ear, enabling fluids to drain and preventing future buildup.

Once placed, the tubes provide immediate relief of pain and pressure and reduce the number of infections and the need for oral antibiotics. They provide valuable relief while a child’s eustachian tubes mature and usually fall out on their own within six to 18 months.

Ear tubes are typically placed by a pediatric ENT in brief surgical procedure called a myringotomy with tube placement. The procedure is performed in a hospital while the child is under a short-acting general anesthesia, needed to ensure the child remains still and comfortable during the procedure. Patients breathe the anesthetic gas via a mask for about 15 minutes. Often no intravenous line is needed, or the line can be placed after the child is asleep.

New Outpatient Tube Option for Eligible Children

Recently, some pediatric ENTs have begun offering new ear tube placement methods that can be performed without general anesthesia in an outpatient medical office. Nicklaus Children’s Hospital’s Division of Otolaryngology offers the Tula Tympanostomy System, developed by Smith & Nephew. The division offers this method to children over age 5 who have the capability to hold still for the procedure.

The Tula system first delivers a local anesthetic within the patient’s ear, followed by placement of the tube. The entire procedure is performed in less than an hour within a medical office. Parents are encouraged to discuss available treatment options with their ENT to determine the best approach for their child.

To request an appointment with an ENT at Nicklaus Children’s Hospital, please call 786-624-3687.