Cold and flu season often signals a peak in incidence of ear infections in children. I see children in our clinic frequently for this condition. In many cases these infections are viral and they resolve on their own or resolve with a short course of antibiotics. Children with ear infections that recur frequently, or persist on a more chronic basis are often referred to our clinic for consideration of temporary ear tube placement which can decrease frequency and severity of the infections.
I am often asked by parents if there are other means of reducing the risk of these infections and if there are things that predispose their children to this problem so I wanted to take some time to outline risk factors for recurrent and chronic middle ear infections in children to help educate parents.
Here is the list of things that affect the risk of ear infections in children:
It is important to realize that each child, their medical condition and the influences on that medical condition be it an ear infection or otherwise are unique and statements above can not be generalized to every situation. Please consult with an ENT specialist near you for a personalized evaluation and treatment plan.
Sepehr Oliaei, MD
Anyone who has ever had a bout of chronic sinusitis or a child with numerous middle ear infections requiring round after round of antibiotics knows the toll that amoxicillin and other oral antibiotics can take on the body.
There has been a growing trend in the recent years away from aggressive use of pharmaceutical drugs and towards treatments with lower side effect profile. This has been a natural reaction to known (and unknown) short-term and long-term side effects of many medications. The problem with alternative treatments, however, is that they are not always as effective as the first choice. Physicians have grappled with this issue for years.
But what if you could use your first choice antibiotic or other medication, — perhaps even at a higher concentration — and deliver it directly to the tissue that is affected (for example the middle ear or the sinuses) without that drug reaching the rest of the body at all?
That is what is being addressed today with new innovations in topical drug delivery.
The idea of topical antibiotic delivery is certainly not new. Placing ear tubes in children with recurrent ear infections is recommended by the American Academy of Pediatrics, and it has been in practice for decades. Ear tubes are a very easy way to deliver a high concentration of antibiotic ear drops to the space behind the ear drum where the infection resides, resulting in a highly effective treatment without any of the associated reactions of oral antibiotics.
Variations on this idea are now in use, or being developed, for treating chronic infectious and allergic disorders of the nose and sinuses. Saline (salt water) rinses are a traditional natural remedy for hygiene and maintenance of the sinuses and has been highly effective using various forms of delivery that are readily available at retail stores and pharmacies, such as Neti pots, squeeze bottles, and so on. Modern advances in anti-inflammatory and antimicrobial treatments have allowed us to take compounded topical drugs, add these to saline rinse bottles and deliver them directly into the sinuses with minimal to no absorption in the rest of the body. This provides an effective treatment with fewer side effects!
Are the days of brightly colored elixirs and tablets for treatment of various ailments over? Not quite, but at least we now have some alternatives. For more information, ask your physicians about the availability of topical alternatives to anti-inflammatory, antibiotic and even non-steroidal pain medications.
For those of you suffering from chronic eustachian tube dysfunction who have been waiting for medical breakthroughs to help with treatment of their condition, there may be hope on the horizon. FDA in the past year has approved new devices to help dilate the Eustachian tube. Endoscopic balloon dilation of the Eustachian tubes uses same technology as balloon sinus surgery to dilate narrow passages of Eustachian tubes which connect the middle ear space to the back of the nose (nasopharynx) to help support hearing mechanisms of the ears via pressure equalization. Potential causes of this condition include mucosal inflammation around the tubes due to factors such as nasal allergies and acid reflux. In the past, this condition was medically treated via nasal sprays or via placement of artificial ventilating tubes (ear tubes) on the ear drum. Medical treatment is often unsuccessful, and ear tube placement often has to be repeated several times as tubes tend to have limited lifespan.
Newly FDA approved devices are inserted through the nostril without any external incisions. Under endoscopic visualization, the deflated balloon in inserted into the eustachian tube opening and then inflated for a few seconds to achieve the dilation. Initial trials have been promising. In one study, over 50% of patients that received dilation showed normal ear function compared to 14% receiving traditional therapy.
However, long term studies are still ongoing and it is not yet clear how frequently, if at all the dilation would need to be repeated. Selection of appropriate patients is also important, as is consideration of the complications of the surgery (carotid arteries course very close to the Eustachian tubes). Tube placement in the ears is still a simple in office procedure with minimal risks but at the very least, this balloon dilation is offering hope for a potential long term solution.
Have you had frustrating experiences with chronic eustachian tube dysfunction? Any personal experiences with balloon dilation? Please share them in the comments section below. (note: comments are visible to public)