INFECTIONS

Infection of the middle ear (otitis media) is a common problem, particularly for children younger than 3 years of age. Two out of three children will have at least one ear infection in the first 3 years of life. About half of these children will have 3 or more episodes. The symptoms include fever, earache and occasional drainage from the ear. Other less dramatic symptoms, but of equal concern, are persistent fussiness or temporary hearing impairment.

About 80% of middle ear infections respond to antibiotics or sometimes even resolve without treatment. However, for many children, medicines are not completely effective.

WHY INFECTIONS RECUR

There are two main reasons why infections recur. The most common reason is that the bacteria responsible for these infections may not be sensitive to certain antibiotics. For this reason, your pediatrician (or family physician) has likely used several different antibiotics to treat your child's infections.

The second reason some young children suffer from recurring infections is that the middle ear space is not well ventilated. T his is usually due to poor function of the eustachian tube (the tube that connects the middle ear to the back of the nasal cavity near the adenoids).

TYMPANOTOMY TUBES

Children with persistent infections that do not respond to medications will benefit from drainage tubes, called tympanotomy tubes, inserted into the eardrum to ventilate the middle ear.

Benefits include immediate restoration of hearing and marked decrease in infection rates for most children. Tympanotomy tubes do require protection while bathing and swimming so that water does not get through the tubes.

Tympanotomy tubes are placed during a surgical procedure that is performed under general anesthesia in the operating room. The procedure takes about 15-30 minutes, and the child goes home the same day after the effects of anesthesia have worn off.

Utilizing a microscope to visualize the eardrum, the surgeon makes an incision through the eardrum. Any fluid in the middle ear is suctioned out. A small plastic tube is inserted into the drum. The tube is approximately the size of the top of a ballpoint pen and sits like a button in the eardrum. The tube is hollow and permits air to enter and fluids to drain out.

Tympanotomy tubes are not permanent and generally fall out after 12-28 months. This usually happens after the infection has cleared up and the child's eustachian tube begins working more efficiently. A bout 10% of children may require tube reinsertion.

The eardrums usually heal completely, but in about 1% of children a small hole remains in the eardrum after the tube falls out which may require repair. This rarely happens and the benefits of tube placement far outweighs the risks.

PREOPERATIVE TESTS

Physical examination by the pediatrician or otolaryngologist. Complete blood count may be performed the morning of the surgery.

HOSPITAL STAY

The operation is usually performed as a one-day admission which means there is NO overnight stay. Persistent nausea and vomiting after surgery or bleeding if tonsils or adenoids were removed could necessitate overnight observation.

DIETARY INSTRUCTIONS

A light dinner the night before surgery and absolutely nothing to eat or drink after 2:00 a.m. the morning of surgery.

After surgery, there may be some post-anesthetic nausea. Wait for this to wear off before giving any liquids. A light diet is recommended for the rest of the day and then resume a normal diet.

ANESTHESIA

Children are usually anesthetized with gas delivered through a mask. Adults may be given intravenous medications. The anesthesiologist will often discuss the choices with the parent and child and then decide which is most appropriate for the individual. The patient is usually in the operating room for 15-30 minutes. After the surgery, he is immediately taken to the recovery room where he stays for 30 minutes to an hour. The anesthesiologist decides how long he will stay in the recovery room based on how rapidly he awakens from the anesthetic.

POSTOPERATIVE PAIN

Myringotomy alone is not usually associated with pain. Adenoidectomy may give rise to a sore throat or ear pain. If pain does occur, Tylenol is recommended instead of aspirin. It is available without prescription and the dosage is as follows:

• Tylenol Elixir - dosage every 4 hours as needed
  1-3 years of age - 1/2 teaspoon
  3-6 years of age - 1 teaspoon
  Over 6 years of age - 2 teaspoons
  Adult - 3 teaspoons

  Tylenol Tablets - dosage every 4 hours as needed

  6-12 years of age -1 tablet

  Adult - 1-2 tablets

If pain is severe or prolonged, you should call the office.

POSTOPERATIVE FEVER

For fever up to 101° orally or 102° rectally, force fluids. Many times this is a sign of dehydration. For fever over 101° orally or 102° rectally, please call the office.

POSTOPERATIVE INSTRUCTIONS

Occasionally some bleeding or drainage from the ears may occur within the first 2-3 days. Simply keep the cotton in the ear, changing it whenever necessary, until the bleeding stops. If it persists for more than 48 hours, you should call the office. Some mucous drainage is not unusual in the first 48 hours after surgery. If it lasts longer than 48 yours or it becomes thick, heavy or odorous, please call the office for appropriate treatment.

INFECTION

THE ears should be kept ABSOLUTELY DRY. DO NOT ALLOW ANY WATER TO ENTER THE EAR CANALS. If this should happen, a middle ear infection could occur. The main sign of infection is drainage or pus, mucus or blood from the ear. If drainage does occur, this is usually a sign of infection requiring medical treatment.

EAR PROTECTION DEVICES

We will furnish your child with fitted ear plugs. These should be used whenever there is a chance of water getting in the ear. There are other means of sealing the ear canal, some of which are listed below in increasing order of effectiveness:

1. A piece of cotton, dipped in Vaseline, and placed in the outer ear canal, serves as an efficient temporary plug for use while washing in the hair, etc.
2. Commercially available pre-formed soft rubber ear plugs (this is the type you will receive).
3. Custom-made ear molds, cast to conform to the individual's ear contours (most expensive type).