If your child has had a run of ear infections, or if you have been told they have got “glue ear” you are probably concerned. Do they need antibiotics? Will they need an operation? Is this something which I should worry about.
The good news is that ear infections and fluid in the middle ear are extremely common in children and that we now have very clear, well researched guidelines in how to manage them.
This brief article explains what the evidence actually says, in plain language so you can feel more confident about what to do and provide you with questions to ask your doctor and/or treating specialist.
What is an Ear Infection (Acute Otitis Media)?
An ear infection known medically as “acute otitis media” or “AOM” happens when germs go from the back of the nose up the eustachian tube into the middle ear. This commonly occurs during or after a cold and tends to come on quickly. Children with this condition generally have:
- Ear pain.
- High temperature.
- Irritability or trouble sleeping.
- Sometimes discharge of fluid from the affected ear.
Does My Child Need Antibiotics Immediately?
This is a common question and the evidence based answer is “not always”. This statements is backed by research not guesswork. For many years antibiotics were prescribed for almost every ear infection. Large studies have actually shown what happens to children given antibiotics and compared them with children who were treated symptomatically.
A well established American paediatric guideline on ear infections (2013 updated since) recommends:
- Antibiotics for all children under the age of two.
- Antibiotics if a child is unwell with the ear infection or has a complication of an ear infection.
- Antibiotics associate with high temperature and other “systemic symptoms”.
- Perforation of the eardrum with discharge.
- Other Health Conditions that Put Your Child at a Risk of Complications
If your General Practitioner,or Paediatrician suggests treating your child symptomatically for the first 24 – 48 hours to see if they improve just with pain relief alone, that is actually an evidence based approach. This is meant to be a shared decision between you and your doctor, not something decided for you. So feel comfortable questioning a doctor regarding the need for antibiotic treatment of acute otitis media if recommended.
What If the Infections Keep Coming Back?
Occasional ear infections in children are common, especially in the pre-school years. If your child is getting frequent infections over a few months, it is worthwhile seeing an Ear, Nose and Throat Surgeon. Recurrent infections are treated differently from a single infection. Repeated prescription of antibiotics time and again is usually not advised.
What is Glue Ear?
Glue ear, which means fluid in the middle ear that last FOR MORE THAN THREE MONTHS, is different from infection. This is thick, almost gelatinous fluid that sits behind the eardrum. It is not painful, which is why it is commonly missed. The most common clue is hearing loss. This may mean that your child sits closer to the television set or seems to ignore you. School performance may deteriorate. Younger children may fail to progress with speech development. Fluid in the middle ear after a cold or an ear infection is common and in 90% of cases will resolve without any specific treatment within three months. Similarly, short periods of hearing loss do not have any long term impact on children. The current guidelines recommend:
- No treatment for fluid in the middle ear if it has been present for less than three months.
- If fluid has been present for more than three months your child should undergo formal hearing test and be reviewed by an Ear, Nose and Throat Surgeon.
When Would My Child Need Grommets?
“Grommets” (also called tympanostomy tubes) are tiny tubes that may be placed in the eardrum under general anaesthetic as a short day surgery procedure.
The allow air to enter the middle ear via the outside world and immediately improve hearing. They also minimise the risk of ear infections.
Based on the current guidelines, grommets are generally recommended when:
- Glue ear has lasted for more than three months AND A HEARING TEST SHOWS THAT IT IS SIGNIFICANTLY AFFECTING YOUR CHILD’S HEARING.
- Your child continues to get frequent ear infections (four or more in six months) and there is still fluid sitting in one or other ear when your child is examined.
- If your child has a complication of an ear infection.
Grommets are not recommended for:
- Fluid in the middle ear that has only been present for a few weeks (it is highly likely to clear up on its own).
- Ear infections occurring less frequently than four in six months or seven in one year.
Sometimes removal of the adenoids is advised with grommet insertion. Generally this recommendation is made only if children have coexisting nasal symptoms, or they continue to suffer glue ear or recurring ear infections and have already had grommets inserted once.
Why Are Doctors Cautious About Rushing to Surgery?
Grommet surgery used to be done very often in children, so frequently that health authorities raised concerns that it was overdone. The most recent guidelines were specifically designed to help doctors differentiate between children who would get better on their own, thus avoiding grommets and children who generally needed surgery. Most doctors now follow this guidance and as a consequence surgery is far less frequently employed than it was. In other words: If your child’s doctor recommends watchful waiting rather than operating, your child is not being overlooked. It is an evidence based approach working as expected. If surgery is recommended, please ensure that your child meets the criteria demonstrated by research.
When Should I See an ENT Specialist?
We suggest that your child see an ENT specialist if your child has had:
- Several ear infections over the past few months.
- Fluid in the middle ear or suggestion of hearing loss for three months or more.
- Changes in speech or language or school performance.
- You are simply unsure whether to keep waiting or seek a further opinion.
We Are Here to Help at Sydney Adult and Children’s ENT Surgery Centre
We assess every child individually using the same evidence based guidelines outlined above. You can feel confident that any recommendation, whether it is continued monitoring or surgery, is based on what is genuinely best for your child.
Worried About Your Child’s Ears?
Contact our Clinic to arrange a consultation. We are happy to talk it through with you.
This article is general information only and is not a substitute for advice from your own doctor. Every child is different so please discuss your child’s specific situation with your treating specialist.
