EAR DISORDERS

WHY DO SOME CHILDREN GET MUCOUS IN THE MIDDLE EAR?

The middle ear is normally an air containing cavity and is ventilated (gets its air) through a tube known as the Eustachian tube, which opens at the back of the nose (at the level of the palate and in the area of the adenoids). The tubes can get blocked as a result of infection, allergy, adenoid enlargement or some reasons that are not clear. Absorption of the air in the middle ear then occurs and a negative pressure develops. Next the goblet or mucous secreting cells, which are present in small numbers to provide slight moisture, start to increase in quantity and size. They secrete more and more mucous until the middle ear cavity is filled with mucous.

What happens then?

• A hearing loss can occur – often not too bad , but enough to hamper schooling. The child can  understand you when you speak directly to him but when occupied he tends to ignore you. (Naughty? NO. Absorbed? NO. He just cannot hear you properly!)

• Recurrent infections  can then develop in the middle ear with earache and occasional discharge.

• Sometimes the child is just irritable. It is unpleasant to have a blocked feeling in one's ears!

What can happen in the long term?

If left alone a certain percentage of these children will improve spontaneously and the normal avenues of ventilation will reopen. Often no damage is done and the condition clears,with the hearing returning to normal. This should ideally happen within 4 to 6 weeks.

When it does not clear,recurring infections can cause scarring or damage to the eardrum. In the past,one saw such patients with the condition called the condition chronic adhesive otitis (with deafness).

How is this condition treated?

One first attempts to clear the natural ventilation system.If there is infection,antibiotics are used often with and decongestants to reduce swelling and open up the Eustachian tubes.Nasal steroid sprays might also be prescribed. If this fails, then we need to provide artificial ventilation which is done by inserting grommets.

What are Grommets?

Grommets are tiny plastic or metal tubes with a fine hole down the middle.They are inserted through a small hole made in the eardrum using a microscope and special instruments.Their purpose is to ventilate the middle ear.

The grommets remain in the ear from between 3 and 18 months (depending on the type of grommet) and then migrate out of the eardrum and are carried out of the ear canal with the wax.Sometimes a grommet becomes blocked and needs to be replaced.

One of the reasons that you need to see me every 3-4 months is to monitor the grommet-to see if it has extruded and that the eardrum is back to normal.

Do grommets need to be repeatedly inserted?

About 75% of children who have grommets, require no further attention after the grommet comes out.A minority require further grommet insertion if the factors that led to the disorder are still present and the disease reoccurs.There are a very small percentage of people that require permanent grommets.

Swimming and Grommets.

I would advise to to discuss this with me.In most cases, the child with grommets can swim as the small hole does not readily allow water to pass through.This does not apply to soapy water which very often can and will pass through the grommet causing middle ear irritation. So, take care with shampoo and don't let the child lie in a bath with the ears submerged.If you are anxious about swimming, a silicone earplug can be used during extensive water related activities.

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HEARING LOSS IN CHILDREN

Approximately 1 of every 1,000 children is born with a profound hearing loss and many other children are born with less severe degrees of hearing impairment. Others develop hearing impairment during childhood. Such hearing losses interfere with the development of speech and language skills and can have a negative effect on social, emotional, cognitive and academic development. Moreover delayed identification and management of severe to profound hearing impairment may impede the child's ability to adapt to life in a hearing world.

The first 3 years of life are regarded as the crucial period for speech and language development. Currently, although there are several methods for identifiying hearing loss within the first year of life, the average age of identification remains close to 3 years. Lesser degrees of hearing loss may go undetected for longer.

Resent research has shown that children with normal cognitive skills identified before 6 months of age of develop language skills normally. Hearing screening can be done at any age, even as early as just after birth. Children should routinely have their hearing tested before they start school. Lesser degrees of hearing loss or hearing loss in one ear may be determined this way. Such deficits, although not obvious, may negatively affect speech and language development.

If you suspect your child is not hearing normally, even if your child's doctor is not concerned, have your child's hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist.

The early identification of a hearing loss has significant positive benefits in terms of facilitating speech and language development.

RISK FACTORS AND SIGNS OF HEARING LOSS 

Pregnacy
- A History of German Measles, certain viral infections (Cytomegalovirus)
- Alcohol and drug consumption

The New Born (Birth to 28 days)
- Low APGAR score
- Low birth weight (less than 1.5kg)
- Time spent in the Neonatal Intensive Care Unit - especially where ventilation was required
- Bacterial Meningitis.
- Neonatal Jaundice - which requires medication or a transfusion.
- Cranial abnormalities (an unusual appearance of the face or ears).
- A history of ototoxic antibiotics given intravenously
- Family members with a permanent hearing loss.

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The Infant (29 days to Age 3 years)
- Parent /caregiver concerned about speech/language or developmental delay.
- Recurrent middle ear infections.
- Bacterial Meningitis.
- History of ototoxic antibiotics given intravenously
- Presence of neurological problems and/or head injury.

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HOW WOULD I RECOGNISE A POSSIBLE HEARING LOSS?

New Born (Birth to 28 days)
- Your child does not move, startle, cry or react to unexpected sound

The Infant (28 days to 6 months)
- Your child does not imitate sound freely

The Infant (6 to 12 months)
- Your child does not turn his/her head in the direction of the sound
- Your child id not babbling, or his babbling has stopped
- Your child does not point to fimiliar objects or people when asked to
- Your child does not understand simple phrases such as "Wave bye-bye" or "Clap your hands"   without the use of visual cues

The Infant (13 months to 2 years)
- Your child does not turn his/her head in the direction of a soft voice or when called by name
- Your child is not using sounds or speech like other children of the same age
- Your child is not taking note of environmental sounds
- Your child is not imitating sounds or words of familiar objects in their direct environment
- Your child does not listen to the television at a normal volume
- Your child frequently uses "uhh" or requests repetition

WHAT SHOULD I DO IF I SUSPECT THAT A HEARING LOSS EXISTS?

If you have noted one or more of these indicators it would be advisable to have your child's hearing tested. This can be done at any age.

If you did not note any of these indicators, but are still concerned, impress upon your doctor your desire to be referred to an audiologist, and if indicated a speech therapist. Such referrals are recognised by the Health Professionals Council and the costs are usually covered by your Medical Aid.

A delay in the diagnosis of a child's hearing problem has been found to affect speech and language development, which has implications for academic potential.

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