Common ear problems in children
Three most common preventable Ear problems in Children
A common refrain in my practice is ‘ Doctor, my son used to be good at studies. Since a few months, he has slipped behind. Can you prescribe some vitamins for him?’ When I check his IQ, memory etc, they would be normal. But when I check his ears, the real reason manifests itself – hearing impairment! Such children are not deaf; but have impaired hearing and they could not hear the teacher clearly and slip behind in their studies. A redeeming feature is that a majority of such children can be cured of this malady. If only we know about them, we can actually prevent them. The single stumbling block is our lack of awareness. There are quite a few similar diseases in the ENT territory. In this article, I expect to describe three such problems.
2. Sudden ear pain in children
3. Collection of fluid in the middle ear (OME, Serous Otitis Media)
Picking the ear is certainly very pleasurable! Various appliances are readily available to afford this tactile pleasure. Several times, earnest efforts at cleaning the ears can land us in trouble. All of us know this, but very few resist the temptation. Not many of us realise that the ears have a refined self-cleansing mechanism and need no assistance from us to stay clean. The thin wax blanket actually aids in moving the moulting scales from the inside of the ear to the outside. Well meant efforts at cleaning the ear canal only results in disrupting this blanket and leads to heaping. Should there be any itching, a few drops of a thin oil will help. Ordinary cocanut oil is as good as any. But beware, if there is any discharge (pus), oil may lead to superinfection with fungus.
The omnipresent ‘ear buds’ need mention here. By any reckoning, the commercially available buds are not the right size for putting inside the ear; they are too big and because of their tight fit, further impact the debris deeper-thus creating a problem which was not there originally. It is always safer to consult an ENT surgeon if the debris is quite large. Sometimes an enthusiastic effort at clearing the ear of wax can lead to a perforation of the drum. Once this occurs, it is quite difficult to treat.
When an unfortunate child gets ear discharge, it is very difficult to clean and keep the ear dry. I have devised a simple technique. A thin cotton wick – exactly what our housewives prepare for the traditional ‘kuthuvilakku’, but rendered a lot more stiff by further rolling up – should be inserted inside the ear canal and kept there. Depending on the amount of discharge, this wick should be replaced several times a day. Pulling the ear lobe a little backwards may help the insertion of the wick, by opening up the canal. This simple technique is very effective and also practical. Over the ears, I have found that children accept this very well. Also there is no danger of a perforating the drum.
2. Sudden ear pain in children:
It is very distressing to see a baby, crying in pain, in the middle of the night. A common scenario is that the child, who had been happily seeing cartoons and had gone to bed, suddenly wakes up in the middle of the night, with excruciating ear pain. Crocin had not helped much. There is some vomiting also. What other medicine to give? The father had gone on a business trip; the driver had gone home; the family doctor could not be reached; a terrible situation indeed! Is it a serious disease requiring surgery? The concerned grandmother tenders a diagnosis of abdominal colic and suggests ‘vasambu’. (Vasambu is a herbal corm, which is flamed to a char, mixed with castor oil and smeared over the umbilicus). In her infinite wisdom, it had certainly been helpful in quitening a crying child. However, in a full third of such crying children, the cause will have to be looked for in the ear. In fact, the child might have been pulling at its ears, craving your attention to that part. But ignorant as we are, we tend to overlook the obvious. In addition, there might have been a spot of cold in the previous few days. A look at the inside of the ear will reveal a bulging and angry red drum head. This condition is called Acute Otitis Media, usually abbreviated to AOM. This condition is one of the few emergencies in Paediatric ENT. The immediate need is to reduce the pain by an effective pain relieving syrup, like paracetamol or ibuprofen. Even a steroid may be indicated to reduce the inflammation. Some times, the inflammatory fluid may accumulate inside the ear, deep to the drum. If the pain persists the next morning or if there is bulging of the drumhead, this fluid may have to be let out by incising the drum head. This procedure is called tympanocentesis. This procedure helps the ear to heal faster. Negligence at this stage, may inexorably lead to a frank infection, thinning of the drum and perforation. Once a perforation sets in, it will continue to discharge, every time the child gets a cold. If only we had known earlier, we could have prevented such a nuisance!
3. Collection of fluid in the middle ear (OME, Serous Otitis Media) :
This is the next stage of AOM. The presence of fluid in the middle ear space impedes the movement of the drum and the bony chain within, leading to a hearing impairment. Inadequate treatment may lead to drying up of the middle fluid into a glue. If the collection persists for more than a few weeks, such a glue may either resolve completely without any problem or may lead to plastering of the drum onto the inside of the ear with resulting in a permanent hearing loss. A tympanocentesis at the stage of AOM could have prevented this. However, all is not lost. Still the ENT surgeon can insert a ventilation tube, called a grommet, into the ear at this stage. Such a tube equalizes the pressure on either side of the drum and restores the mobility of the drum, thus improving the hearing. After its purpose is served, the grommet may either extrude by itself or may have to be taken out after a few months. Occasionally it may have to be reinserted a few times. At this time, if the adenoids show signs of infection and enlargement, they also may need surgical removal. However, proper treatment at the initial stage could have prevented all this misery. If only we had known!
