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Author: admin, 17.04.2015
In early childhood, ear infections are the most common illness to strike under the age of two. The symptoms of an ear infection can include fevers, ear pain, stuffiness of the head, pressure behind the eye, and ear drainage. Young children can suffer from ear infections due to Eustachian tube dysfunction or swelling, which commonly squeeze and equalize pressure. Many factors are associated with a child’s likelihood to develop ear infections, including family history, their exposure rate to child care and other children, age, race, second hand smoke, season, and the feeding position of the baby.
In persons who have a very large amount of ear wax, putting drops into the ear may simply block up the ear and make it wet.
Large amounts of hard wax -- take out as much as can be easily removed with microscope, and have person use drops, return in a few days to a week for suction.
The Welch Allyn Ear Wash System simultaneously irrigates and suctions out water and wax in a single step.
With respect to using drops, the current literature is inconclusive and basically suggests that nearly anything works as well as anything else. Colace (a liquid stool softener), having the active ingrediant of docuate, when dropped in the ear, has also been studied for ear wax control.
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. Three out of four children have been afflicted with an ear infection before the age of three. Small children who can not communicate that their ears are bothering them will likely tug on their ear or continuously put their fingers or other objects in their ear in an attempt to rid themselves of discomfort. Ear infections can often begin with the common cold which allows fluid to build up in the ear and develops into an ear infection. Fluid is easily blocked and turns infections in children’s Eustachian tubes due to their small size. Children who are exposed to other children on a regular basis are likely to develop more colds and ear infections due to their immature immune system and their tendency to touch everything and everyone. Many ear infections clear on their own and require no treatment, although an over the counter pain reliever may be recommended to ease the child’s discomfort.
Placing a warm, moist cloth over the ear and keeping your child calm for a few days will help the infection clear up faster. Children do eventually outgrow their tendency to get multiple ear infections in short periods of time. Anthropologists have used cerumen type to tract human migratory patterns and epidemiologists have related cerumen type to breast cancer.
The reason is that wax is often embedded into the hair that grows onto the side of the ear canal. Because of this consideration, the optimal method of doing this is to have someone look into your ear first, and act depending on the situation.
In this situation one may attempt to soften the wax with oil and return in one week for another attempt. This is not to say that they are worthless -- just that salt water is equally effective (Roland et al, 2004). Otitis media, which is the medical term for a middle ear infection, is the most common type of ear infection that children of all ages tend to come down with. Older children and adults who spend ample time swimming in brackish water such as the Chesapeake and other bays and some lakes are prone to a bacterial ear infection known as swimmer’s ear.

Native Americans and Eskimos in cold climates tend to get more ear infections than Caucasians. Long term ear infections are possible if fluid remains in the ear long enough to damage the small bones or the eardrum.
Keeping the child comfortable and making sure they get some extra rest and quiet play time is effective in helping the child cope with their discomfort. When one takes the wax out using a cerumen instrument, hair often comes with it -- this can hurt.
While irrigation is a conventional and accepted method of ear wax removal, it has many disadvantages compared to removal under direct vision. The first two involve putting liquids into the ear, and should not be used by people with a hole in their ear drum (perforation). Ear infections are typically caused by a bacterium, although foreign objects in the ear canal can also attribute to an ear infection. The bacteria in the water stays lodged in the middle ear and develops into a common swimmer’s ear infection. Adenoids typically fight infection, but once they swell due to foreign objects or illness, their swelling causes middle ear infections. Looking into the patient’s ear with an otoscope can usually determine if an ear infection is present, as the eardrum will be red and irritated and sometimes swollen.
A ruptured eardrum is possible if the fluid causes enough pressure against the eardrum, which results in pus and blood oozing from the child’s ear. Antibiotics are not prescribed as often as they used to be to avoid over exposure to antibiotics at an early age. This particular problem can be avoided by softening up the wax first with some oil (we often recommend Debrox) -- or by irrigating it out (see below). For example, in the rare instances when there is a perforation under the wax, irrigation may force water and wax into the middle ear, causing a nidus for infection.
Docusate is ototoxic in guinea pigs (Nader et al, 2011), and for this reason, should be especially avoided when there is any chance of a perforation. Instruments which puff air or sound into the ear to determine eardrum movement are also commonly used, especially if fluid has been in the ear for any length of time. Usually the eardrum will repair itself unless repeated ruptures occur, in which case surgical repairs may be necessary.
Antibiotics may also be prescribed if the child has had numerous ear infections within a close period of time or if the ear infection presents with effusion. Some authors recommend placing 1 or 2 drops of Domeboro, Vosol or Cortisporin otic in the irrigated canal to prevent infection.

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