Children and Family Hearing Associates, Peoria, IL
HOW COMMON IS OTITIS MEDIA?
It ranks as second behind the common cold as the most common problem among children. It is estimated that 90% of babies have had at least 1 episode by 1 year of age, with 35% of babies having repeated episodes. Its peak is between 6 months to 3 years of age with another peak between 4 to 6 years of age when children are enrolled in some type of school situation.
WHAT IS OTITIS MEDIA?
- Otitis Media is an inflammation of the middle ear with a liquid or fluid behind the eardrum. It is commonly referred to as an ear infection.
HOW DOES OTITIS MEDIA DEVELOP?
- The most common way is from blockage of the Eustachian tube. The Eustachian tube is a narrow passageway that runs from behind the eardrum to the back part of the nose and the top part of the throat. It is responsible for equalizing air pressure and drains moisture from the area behind the eardrum down the throat. When the pressure behind the eardrum is not equal to that in the environment, the Eustachian tube should automatically open, causing the ears to pop so that the pressure is equalized. When the Eustachian tube becomes blocked, pressure builds up behind the eardrum. The air filled space behind the eardrum is replaced with fluid which may be thin and watery or as thick as glue.
WHAT ARE THE SIGNS OF OTITIS MEDIA?
- Often, there are no signs and otitis media is not identified for weeks or months after it develops. In some instances, it develops quickly. It is sometimes diagnosed when a baby or child is seen for a check-up or for a cold. Many children with otitis media do not run fevers and do not seem sick, while others have fevers and complain of ear pain. Some signs of otitis media include pulling on the ears, complaints of popping or ringing ears, irritability, difficulty sleeping at night or restlessness during sleep and difficulty maintaining balance, especially when babies are learning to walk. Other signs of otitis media include appearing to ignore what is said, needing messages and directions repeated, difficulty understanding what is said when the speaker's face cannot be seen, inattentiveness which is especially noticed at school and a decrease in clarity of the child's speech, especially for a child who is between 1 to 3 years of age.
WHY IS OTITIS MEDIA SO COMMON AMONG BABIES AND CHILDREN?
- The reason for the greater incidence among babies and younger children is due to the shape of and position of the Eustachian tube. The Eustachian tube is shorter, straighter and proportionately wider in young children than in older ones. As a result, it is much easier for the tube to become blocked.
ARE THERE SOME CHILDREN WHO ARE MORE AT RISK FOR OTITIS MEDIA THAN OTHERS?
- Yes, children who are born with Down syndrome, cleft palates or other craniofacial anomalies are more likely to experience frequent episodes of otitis media due to structural factors which make them more at risk for developing it. Other children who are at risk are those with allergies, asthma or enlarged tonsils and adenoids. These children are likely to have poor functioning Eustachian tubes which lead to episodes of otitis media. Children who have a family history of ear infections are also likely to experience frequent episodes of otitis media since they inherit the tendency for developing it.
WHEN IS OTITIS MEDIA MOST LIKELY TO OCCUR?
- It is most prevalent during the late fall, winter and early spring when colds and flu occur.
WHAT SHOULD I DO IF I SUSPECT MY BABY OR CHILD HAS OTITIA MEDIA?
- Consult with your child's physician immediately so he or she can look in your child's ears and determine if a problem is present. While otitis media is not the life-threatening condition it once was, it can lead to complications and permanent hearing loss if it goes untreated for an extended period of time.
IF OTITIS MEDIA IS PRESENT, WHAT TYPE OF TREATMENTS ARE AVAILABLE?
- Medical treatment of otitis media should be monitored by your child's physician. It is important for you to carefully follow your physician's recommendations. The most common treatment is the use of antibiotics which are sometimes used in conjunction with decongestants and antihistamines. When medication is recommended, you may notice that your child may seem better a few days after it is taken. However, it is important for your child to finish taking the prescribed amount of medication. If medicine is discontinued too early, the fluid may remain behind the eardrum and an infection may remain or redevelop.
WILL MEDICATION ALWAYS BE EFFECTIVE IN TREATING OTITIS MEDIA?
- While antibiotics are usually effective in treating otitis media, sometimes the bacteria in the fluid behind the eardrum are resistant to one or more antibiotics prescribed and other antibiotics are tried. With some children, the fluid goes away with medication but returns shortly after medication is discontinued and this process tends to repeat itself. In these instances, use of a daily low dose of antibiotics is often recommended. In addition, when otitis media does not clear up after 2 months, hearing should be professionally evaluated by an audiologist. An audiologist is a specialist who has received extensive training in identification and measurement of hearing loss.
HOW DOES AN AUDIOLOGIST EVALUATE HEARING IN A BABY OR YOUNG CHILD?
- Testing a baby or young child's hearing should preferably be completed by an audiologist familiar with working with this population. An audiologist evaluates a baby's hearing in a variety of ways. One way is through otoacoustic emission testing (OAE). This test involves inserting a tip in the baby's ear canal and obtaining responses from the hearing nerve for different tones for each ear. In addition, testing can also be completed by carefully observing the loudness levels it takes for a baby to respond to a variety of sounds, which may include speech, music and different pitch sounds. The sounds are presented through speakers in a sound-treated room. By observing the loudness that it takes for a baby to react at a particular age, a determination can be made if a hearing loss is present. A newborn baby requires more volume to respond but as the baby grows older, the amount of volume for responses to be seen usually decreases.
DOES OTITIS MEDIA USUALLY CREATE A HEARING LOSS?
- Yes, in most instances, there is some amount of hearing loss. The most common amount of hearing loss caused by otitis media is around 25 to 30 dB, which is in the range of a mild hearing loss. Hearing may change considerably during the course of treatment and between episodes.
WHAT IF MEDICATION IS NOT EFFECTIVE IN TREATING OTITIS MEDIA?
- Approximately 35% of the time, otitis media is not caused by a bacterial infection and the use of antibiotics is not effective in treating the problem. In some instances, fluid remains despite antibiotics. When fluid remains after several months, surgical insertion of tympanostomy tubes in the eardrums is often recommended. The tubes allow air to pass through the eardrum and permits fluid to drain more naturally. The tubes are designed to fall out on their own in 6 months to a year after they are inserted.
WHEN ARE TUBES NECESSARY?
- There is no universal agreement among physicians regarding when tubes are necessary. Discuss the issue with your child's physician who is familiar with your child. Factors which are usually considered include the number of episodes of otitis media, the length of time it is present and the amount of hearing loss that it creates.
DOES OTITIS MEDIA INTERFERE WITH SPEECH/LANGUAGE DEVELOPMENT?
It is the hearing loss which results from otitis media that can interfere with a child's speech/language development. The greater the amount of hearing loss present and the longer the hearing loss is present, the greater the chances that the child's speech and language development may be delayed. When hearing remains depressed at least half of the time in a 6 month period, the child is at risk for delays in speech acquisition. As hearing fluctuates and changes, the child has difficulty hearing many speech sounds particularly consonants and word endings. The child may not hear short words and may miss many language opportunities to learn word meanings and how words can be put together to make sentences. In a young child learning language, even a mild hearing loss may interfere with speech and language development because the child does not possess enough knowledge about language to compensate for the hearing loss. A child with repeated episodes of otitis media is likely to be delayed in speech and language development by 6 months or greater.
WHAT SHOULD I DO IF I THINK OTITIS MEDIA HAS INTERFERED WITH MY CHILD'S SPEECH?
- Have your child's hearing professionally evaluated by a pediatric audiologist to determine whether a hearing loss is present which may be interfering with your child's speech and language development. Consult with your child's physician who may refer you to a facility that provides speech and language evaluations for children. For children 3 years of age and older, schools as well as private practice speech/language pathologists can provide testing and therapy when necessary for your child.
DOES OTITIS MEDIA INTERFERE WITH LEARNING IN A SCHOOL-AGED CHILD?
- The hearing loss that often accompanies otitis media may interfere with a child's learning by preventing the child from hearing the entire message. The child may miss many opportunities to learn academic concepts and may have trouble with paying attention, may have a short attention span and may have trouble following directions as a result of not being able to hear the teacher well. The farther the child is from the teacher, the less the child will be able to hear. The child may particularly have trouble with reading, spelling and language since these subjects require good hearing.
WHAT SHOULD I DO IF I THINK MY CHILD HAS A HEARING LOSS?
- Consult with Children and Family Hearing Associates at (309) 686-7250 to schedule an audiological evaluation for your child.