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12.12.2013
Just as with all other aspects of human biology, there is a broad range of Eustachian tube function in children- some children get lots of ear infections, some get none. Allergies are common in children, but there is not much evidence to suggest that they are a cause of either ear infections or middle ear fluid.
Ear infections are not contagious, but are often associated with upper respiratory tract infections (such as colds).
Acute otitis media (middle ear infection) means that the space behind the eardrum - the middle ear - is full of infected fluid (pus). Any time the ear is filled with fluid (infected or clean), there will be a temporary hearing loss.
The poor ventilation of the middle ear by the immature Eustachian tube can cause fluid to accumulate behind the eardrum, as described above. Ear wax (cerumen) is a normal bodily secretion, which protects the ear canal skin from infections like swimmer's ear. Ear wax rarely causes hearing loss by itself, especially if it has not been packed in with a cotton tipped applicator. In the past, one approach to recurrent ear infections was prophylactic (preventative) antibiotics.
For children who have more than 5 or 6 ear infections in a year, many ENT doctors recommend placement of ear tubes (see below) to reduce the need for antibiotics, and prevent the temporary hearing loss and ear pain that goes along with infections. For children who have persistent middle ear fluid for more than a few months, most ENT doctors will recommend ear tubes (see below). It is important to remember that the tube does not "fix" the underlying problem (immature Eustachian tube function and poor ear ventilation).
Adenoidectomy adds a small amount of time and risk to the surgery, and like all operations, should not be done unless there is a good reason. In this case, though, the ventilation tube serves to drain the infected fluid out of the ear. The most common problem after tube placement is persistent drainage of liquid from the ear. In rare cases, the hole in the eardrum will not close as expected after the tube comes out (persistent perforation). I see my patients with tubes around 3 weeks after surgery, and then every three months until the tubes fall out and the ears are fully healed and healthy. If a child has a draining ear for more than 3-4 days, I ask that he or she be brought into the office for an examination. Once the tube is out and the hole in the eardrum has closed, the child is once again dependant on his or her own natural ear ventilation to prevent ear infections and the accumulation of fluid. About 10-15% of children will need a second set of tubes, and a smaller number will need a third set. Children who have ear tubes in place and who swim more than a foot or so under water should wear ear plugs. Deep diving (more than 3-4 feet underwater) should not be done even with ear plugs while pressure equalizing tubes are in place.
Definition A superficial fungal infection of the ear; usually located in the external auditory canal, it can also be found in the middle ear or in a mastoidectomy or fenestration cavity. Most-likely, a child with an Atretic ear will have just as many or just as few ear infections than a child with a non-Atretic “in tact” ear will. As an adult or a child, if you appear to be experiencing pain and pressure in your ear, visit with your ENT. It is possible that if your child or as an adult often become congested, that you may need to have your tonsils and adenoids removed. It is possible that also, due to fluid in the ear, you may be experiencing some pressure and pain feelings in your ear. Sometimes, your child or as an adult, you may be experiencing pain in your ear, but you have no leakage or pressure.


It is possible that from time to time a Microtia ear that does not have an ear canal (Atresia) may leak or ooze. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. This ulceration, if combined with infection, results in necrosis of the underlying periosteum with exposure, infection (osteitis) and ultimately sequestration of the underlying tympanic bone. The bacteria or virus that starts an ear infection gains access to the middle ear through the Eustachion Tube – which those with Atresia have. It is best to consult with your ENT to see if this would be the best solution to helping you breath better and become less congested. Consult with your ENT to see what may be the underlying issue causing the pressure and to also see what could be done to alleviate it. One may ask, how is this possible if there is no canal present where anything fluid can leak from? Through this site and linkages to other sites, we provide general information for educational purposes only. With an ear infection, the pain we associate with the acute otitis media is caused by the eardrum bulging outward with the pressure from the infection and pus in the middle ear. Both a tonsillectomy and an adenoidectomy are routine procedures and can be completed easily within 20 to 30 minutes. A Microtia ear may hurt when sleeping or lying on it and may even tend to get a little colder at times during colder temperature. The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.
Since there is no eardrum, children with Atresia may not feel pain with an infection (sometimes there is a mild ache but nowhere near the usual pain with AOM). This makes sense because the ear is not fully developed like the other non-Microtic ear (if unilateral Microtia Atresia) and isn’t flat. A fever of unknown origin or dizziness or meningitis can all be sudden signs of an ongoing infection and should be considered by a physician treating a child with Atresia who exhibits one of these symptoms. This may have to be done often, but it will relieve the pressure build up in your ear from the fluid. Only a CAT Scan can rule out a cholesteatoma because an ENT has to be able to see deep in side of the ear to see hat may be causing the problem. Also, a Microtia ear doesn’t nearly have the vascular supply that a fully developed ear has having more blood flow within it keeping it warmer.
Note the fluffy white diagnostic island which consists of the fungal hyphae of Aspergillus species. The entire ulcerated area may be covered with a smooth yellowish layer of inspissated serum like exudate which can on first glance resemble cerumen or even normal deep canal skin. In some patients, fresh granulations and an accumulation of white keratin debris may be found covering the base of the ulcer. Cholasteatomas are excess growths of skin that can become a tumor (benign or non cancerous)growing from the inside of the ear to the middle ear. This still takes judgement as both soft tissue, cholesteatoma, and fluid all look the same on CT scan.
Consult with your ENT to verify if you do have an ear infection and ask how it can be treated. If a child has a scan showing air in the middle ear space at one point (proving the ET is open) and then a repeat scan with no air with a clinical picture consistent with an ear infection, it is very likely that is what is going on. They can destroy hearing with symptoms of pus or an unpleasant smelling substance, oozing fluid or recurring discharge coming from the ear. If a patient has a scan showing no air, the provider is unsure whether this is the way it has always been since birth or whether there was an air containing middle ear space that now has fluid or infection contained in it. It appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin.
Histologi- cally, it is usually either (1) an epidermoid cyst, common on the face and neck, or (2) a pilar (trichilemmal) cyst, com- mon in the scalp.


They are classified as central perforations, which do not extend to the margin of the drum, and marginal perforations, which do involve the margin. The more common central perforation is illustrated here.
A reddened ring of granulation tissue surrounds the perforation, indicating chronic infection.
It is typical of tympanosclerosis: a deposition of hyaline material within the layers of the tympanic membrane that sometimes follows a severe episode of otitis media. It does not usually impair hearing and is seldom clinically significant. Other abnormalities in this eardrum include a healed perforation (the large oval area in the upper posterior drum) and signs of a retracted drum. A retracted drum is pulled medially, away from the examiner’s eye, and the malleolar folds are tightened into sharp outlines.
The eustachian tube cannot equalize the air pressure in the middle ear with that of the outside air.
Air is partly or completely absorbed from the middle ear into the bloodstream, and serous fluid accumulates there instead.
Symptoms include fullness and popping sensations in the ear, mild conduction hearing loss, and perhaps some pain. Amber fluid behind the eardrum is characteristic, as in this patient with otitic barotrauma.
A fluid level, a line between air above and amber fluid below, can be seen on either side of the short process.
Redness is most obvious near the umbo, but dilated vessels can be seen in all segments of the drum. Spontaneous rupture (perforation) of the drum may follow, with discharge of purulent material into the ear canal. Hearing loss is of the conductive type. Symptoms include earache, blood-tinged discharge from the ear, and hearing loss of the conductive type. In this right ear, at least two large vesicles (bullae) are discernible on the drum.
The inner ear or cochlear nerve is less able to transmit impulses regardless of how the vibrations reach the cochlea. It may be due to nutritional deficiency or, more commonly, to overclosure of the mouth, as in people with no teeth or with ill-fitting dentures. The lip loses its normal redness and may become scaly, somewhat thickened, and slightly everted. It may appear as a scaly plaque, as an ulcer with or without a crust, or as a nodular lesion, illustrated here. This, together with fever and enlarged cervical nodes, increases the probability of group A streptococcal infection or infectious mononucleosis. The throat is dull red, and a gray exudate (pseudomembrane) is present on the uvula, pharynx, and tongue.
Petechiae in the buccal mucosa, as shown, are often caused by accidentally biting the cheek. The extensive example shown on this buccal mucosa resulted from frequent chewing of tobacco, a local irritant.
The gingival margins are reddened and swollen, and the interdental papillae are blunted, swollen, and red. Then the destructive (necrotizing) process spreads along the gum margins, where a grayish pseudomembrane develops. Note here the erosion of the enamel from the lingual surfaces of the upper incisors, exposing the yellow- brown dentin. The upper central incisors of the permanent (not the deciduous) teeth are most often affected.



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