Ear Infections in Ear Infections in ChildrenChildren

Matt Stumpe, M.D.Matt Stumpe, M.D.Mid Kansas Ear, Nose, & ThroatMid Kansas Ear, Nose, & Throat

Personal InterestPersonal Interest

Ear AnatomyEar Anatomy

External EarExternal Ear–– AuricleAuricle–– CanalCanal

Middle EarMiddle Ear–– Ear DrumEar Drum–– OssiclesOssicles

Inner EarInner Ear

InfectionsInfections

Can involve any of the 3Can involve any of the 3–– External earExternal ear

Swimmers Ear or Otitis externaSwimmers Ear or Otitis externa

–– Middle earMiddle earOtitis media (most common child infection)Otitis media (most common child infection)

–– Inner EarInner EarLabyrinthitisLabyrinthitis

Normal Ear ExamNormal Ear Exam

Middle ear InfectionsMiddle ear Infections

Otitis mediaOtitis media–– Most common ear infection in young Most common ear infection in young

childrenchildren–– Likelihood much higher in first 3 years of Likelihood much higher in first 3 years of

lifelife

Childhood differencesChildhood differences

Eustachian TubeEustachian Tube–– ChildhoodChildhood

1717--18mm in length18mm in lengthHorizontalHorizontal

–– AdultAdult3131--38mm in length38mm in length45 degree angle45 degree angle

Childhood DifferencesChildhood Differences

Immune NaïveImmune NaïveEnvironmental exposureEnvironmental exposure–– Exploration through touch and tasteExploration through touch and taste

Shared GermsShared Germs

Confounding FactorsConfounding Factors

Factors associated with increaseFactors associated with increase–– Pacifier usePacifier use–– Daycare attendance Daycare attendance –– Environmental tobacco smokeEnvironmental tobacco smoke

Factors associated with decreaseFactors associated with decrease–– Breast FeedingBreast Feeding

Eustachian Tube Eustachian Tube InflammationInflammation

AnatomyAnatomyViral infectionViral infectionAllergyAllergy

Ear DrumEar Drum

Air is needed Air is needed behind ear drum behind ear drum Negative pressure, Negative pressure, fluid can build up in fluid can build up in earearHearing can be Hearing can be effectedeffected

Ear FluidEar Fluid

Ear effectsEar effects

Ear InfectionEar Infection

“Scarred Ear Drum”: “Scarred Ear Drum”: TympanosclerosisTympanosclerosis

Tympanosclerosis Normal

Middle Ear Infection Middle Ear Infection SymptomsSymptoms

PainPainFeverFeverDecreased hearingDecreased hearing

Medical treatmentMedical treatment

AntibioticsAntibioticsDecongestantsDecongestantsNasal irrigationNasal irrigationNasal SteroidNasal Steroid

Surgical Management: Surgical Management: Ear TubesEar Tubes

One of the most common surgeries for One of the most common surgeries for ChildrenChildrenProvide alternative route for pressure Provide alternative route for pressure changes and fluidchanges and fluidAllow Child to outgrow anatomic Allow Child to outgrow anatomic issuesissues

Ear Tube limitationsEar Tube limitations

Average tube stays 9Average tube stays 9--12 months12 months–– Can extrude earlyCan extrude early–– Can retain tubeCan retain tube

Usually tubes come out on ownUsually tubes come out on own

Ear drum perforationEar drum perforation

Ear TubesEar Tubes

Ear TubeEar Tube

Ear Drum PerforationEar Drum Perforation

Most heal Most heal spontaneouslyspontaneouslyLocation and size Location and size dictate effect on dictate effect on hearinghearing

Ear Drum PerforationsEar Drum Perforations

Surgery for Ear Drum Surgery for Ear Drum PerforationPerforation

4 month Post OP picture

AdenoidsAdenoids

Enlarged AdenoidsEnlarged Adenoids–– Impair Eustachian Impair Eustachian

tube functiontube function–– Harbor infective Harbor infective

agentsagents

AdenoidectomyAdenoidectomy

AdenoidectomyAdenoidectomy

Proven to decrease incidence of Otitis Proven to decrease incidence of Otitis MediaMediaTheorized to improve eustachian tube Theorized to improve eustachian tube functionfunctionTheorized to decrease pathogens near Theorized to decrease pathogens near middle earmiddle ear

Middle Ear Infection Middle Ear Infection ComplicationsComplications

MastoiditisMastoiditisFacial ParalysisFacial ParalysisMeningitisMeningitisBrain AbscessBrain Abscess

Swimmers EarSwimmers Ear

Otitis ExternaOtitis Externa

Swimmers earSwimmers earEar Canal slightly acidicEar Canal slightly acidic–– Moisture leads to change in pHMoisture leads to change in pH

SymptomsSymptoms–– Itching, Pain, Drainage, Decreased Itching, Pain, Drainage, Decreased

hearinghearing

Outer Ear Infection Outer Ear Infection CausesCauses

Water Trapped in Water Trapped in EarEarQQ--Tip trauma Tip trauma Wax ImpactionWax Impaction

Swelling of CanalSwelling of Canal

Trapping of Trapping of –– MoistureMoisture–– InfectionInfection

Inability to deliver Inability to deliver dropsdrops

Outer ear InfectionOuter ear Infection

SeveritySeverity

TreatmentTreatment

AntibioticsAntibioticsDebridementDebridementEar DropsEar DropsEar WickEar Wick

Almost ThereAlmost There

Inner Ear InfectionsInner Ear Infections

LabyrinthitisLabyrinthitisSterile Environment Sterile Environment –– No connection to outside worldNo connection to outside world

Inflammatory mediatedInflammatory mediatedSymptomsSymptoms–– Hearing loss, Ringing, VertigoHearing loss, Ringing, Vertigo

Labyrinthitis CausesLabyrinthitis Causes

AutoAuto--ImmuneImmuneViralViralBacterialBacterialTumorTumor

TreatmentTreatment

SteroidsSteroids–– SystemicSystemic–– TranstympanicTranstympanic

AntibioticsAntibioticsAntiviralsAntiviralsImagingImaging

ConclusionConclusion

Children many factors increase Children many factors increase incidence of ear infectionincidence of ear infectionMultiple modalities of treatment Multiple modalities of treatment dependent on correct diagnosisdependent on correct diagnosisQuestions?Questions?

Contact InformationContact Information

Matt Stumpe, M.D.Matt Stumpe, M.D.MidMid--Kansas Ear, Nose & Throat Kansas Ear, Nose & Throat AssociatesAssociatesTelephone: 316Telephone: 316--684684--28382838Toll Free Telephone: 800Toll Free Telephone: 800--794794--4ENT4ENT