American Medical Association Family Medical Guide - American Medical Association [194]
• Breastfeed your child. Breastfeeding provides some immunity against ear infections because breast milk contains infection-fighting antibodies from the mother.
• Keep your child upright when bottle-feeding. If a child drinks from a bottle while lying down, the liquid can pool in the back of his or her throat, blocking the eustachian tubes.
• Do not smoke around your child. Secondhand smoke can increase the risk of inflammation and infections in the respiratory tract in young children.
• Choose a small day care center. If possible, find a day care setting with no more than six children. Larger numbers of children increase the risk of spreading germs that cause upper respiratory infections, which can lead to ear infections.
Myringotomy
For children who have frequent ear infections or who have persistent fluid in their ears, doctors sometimes recommend a surgical procedure called myringotomy to drain the fluid. In this procedure, tiny tubes may be placed in the eardrum to ventilate the middle ear. The procedure restores hearing, relieves pain, and helps prevent fluid from reaccumulating and causing more ear infections.
Chronic Otitis Media With Effusion
When fluid from an acute middle ear infection remains in the middle ear longer than 6 weeks, doctors call the condition chronic otitis media with effusion (also called chronic middle ear fluid). Chronic otitis media with effusion can also develop without infection—from an anatomical cause such as a cleft palate (see page 403), Down syndrome (see page 955), or a too-narrow eustachian tube. In some cases, the fluid becomes very sticky (which doctors call glue ear). The buildup of fluid can cause mild hearing loss and may delay a child’s language development.
Symptoms
Chronic middle ear fluid often does not cause any symptoms. However, sounds may seem muffled or faint, as if heard under water. Some children may have difficulty distinguishing certain sounds in noisy situations.
If untreated, chronic middle ear fluid can result in poor development of language skills in very young children. Less often, the disorder can cause an abnormal growth of the skin of the eardrum (cholesteatoma; see page 1024). Chronic middle ear fluid can also cause the tiny bones of the middle ear (ossicles) to become scarred and bond to the middle ear. If your child is developing language skills slowly or does not respond when you speak to him or her, or if he or she is having trouble paying attention at school, it could be due to partial hearing loss from chronic middle ear fluid.
Diagnosis
Because chronic middle ear fluid usually has no obvious symptoms, doctors often diagnose the disorder while examining a child for another reason or during a well-child visit. However, if you suspect that your child has hearing loss after he or she has had an ear infection, see your doctor. The doctor will take a detailed health history and examine the affected ear with a lighted viewing instrument called an otoscope. He or she may also use a device called a pneumatic otoscope, which blows a puff of air into the ear to check for stiffness of the eardrum.
The doctor may refer you to an otolaryngologist (a doctor who specializes in disorders of the ear, nose, and throat), who may perform special tests such as an impedance test (see page 1016), which can help determine whether your child has fluid in his or her ear. The doctor may refer you to an audiologist (a health care professional who specializes in hearing evaluation and treatment), who will perform hearing tests (see page 1016) to determine if your child has any hearing loss.
Treatment
To treat chronic middle ear fluid that has resulted from a bacterial infection, a doctor may prescribe antibiotics, especially if he or she suspects an underlying sinus infection. Most doctors prefer to wait to see if the fluid clears up on its own, which can take up to 3 months when it affects both ears, and up to 6 months when it affects only one ear. In some cases, a doctor may recommend a procedure called myringotomy (see previous page), to drain