August 22, 2006

Prairie du Sac, Wis. - It isn't always easy to detect ear infections in children, according to Dr. Timothy Shaw, an ear, nose and throat (ENT) physician at Sauk Prairie Memorial Hospital and Dean Specialty Clinic. Shaw, who has cared for children for more than 30 years, urges parents to follow their intuition to determine if a doctor's visit makes sense for their children.

Ear infection symptoms and treatment
"If your child has irritability, sleeplessness, pulling at the ear - particularly in the setting of a severe cold, cough or running nose - they might have an ear infection," said Shaw. While many ear infections resolve on their own in a few days and don't mandate treatment with antibiotics, some linger, and in doing so, can affect hearing and lead to more serious infections such as meningitis or mastoiditis.

"Most earaches are due to negative pressure in the ear, not bacteria or infection," said Shaw. "Ear infections most often occur after onset of a cold." A common cold can cause the eustachian tubes, the tubes connecting the middle ear to the throat, to close - increasing pressure inside the ear, according to Shaw. To relieve the pressure, the body secretes fluid into the ear, which creates a breeding ground for bacteria.

Contrary to popular opinion, Shaw maintains treating the infection with antibiotics doesn't always work. Many bacteria are resistant to antibiotics and treatment isn't always effective. Typically, ear infections clear up on their own thanks to the body's immune response system. In the interim, parents can relieve earaches using appropriate doses of ibuprofen or acetaminophen, topical nasal decongestants and warm compresses to the ear, suggests Shaw. If in two days the pain hasn't subsided, a visit to the family doctor or pediatrician may be warranted - or sooner if parents desire.

When to visit an ENT
While most infections resolve on their own, some persist. Repetitive infections may require a conversation with your family physician to refer for a visit to an ENT. Shaw suggests children see an ENT if they suffer four or more ear infections in one year; are not hearing properly; have delayed speech; have been on chronic antibiotic therapy and continue to get ear infections (more than six times); or if an eardrum ruptures.

Typically ENTs work in concert with audiologists, who determine if a child is hearing normal, and if not, pinpoint where the hearing loss occurs inside the ear. "Sauk Prairie Memorial Hospital has audiologists on staff and we work right in the same clinic," said Shaw. "I usually see the patients first, obtain a hearing test by our audiologist, and then determine the right treatment."

Sandy Hoke is an audiologist at Sauk Prairie Memorial Hospital who works closely with Shaw. "We test hearing through the whole auditory system first, then we bypass the outer and middle ear to focus on the inner ear," she explained. "By comparing these measures, we can determine if there is something blocking the sound from getting to the inner ear. The hearing test, in combination with a tympanogram which measures eardrum mobility and pressure in the middle ear, helps to confirm the doctor's diagnosis of ear infection and fluid."

When tubes make sense
Sometimes, the best treatment for a child's repetitive infections is to place a tiny tube no smaller than the tip of a ballpoint pen into the eardrum. The "ventilation" tube can prevent ear infections in children and eliminate the fluid that collects behind the eardrum. Not only does fluid buildup create a breeding ground for bacteria, it can result in hearing loss, and in the case of small children, slowed speech development. "Children who are developmentally delayed should be treated aggressively," said Shaw. Developmentally delayed children, he maintains, can't afford to have their hearing impaired because it is more difficult for them to develop speech and language than a normal child. "In the case of a child with Downs Syndrome, good hearing can mean the difference between eventually living independently or not," said Shaw.

Tubes, which are inserted under general anesthesia, typically remain in place for six to 12 months. They are pushed out of the ear naturally as the tiny hole in the eardrum heals. For most children, this is enough time for the eustachian tubes to take on a less horizontal shape and better ventilate the inner ear.

Shaw, who sees patients at the Dean Specialty Clinic - Sauk Prairie and Dean West Clinic in Madison, performs surgeries at both Sauk Prairie Memorial Hospital in Prairie du Sac and Saint Marys Hospital Medical Center in Madison. "The benefit of Sauk Prairie Memorial Hospital is that the level of staff expertise is superb and patients who need surgery can get scheduled quickly," said Shaw.

If your child has suffered from frequent ear infections, hearing loss, delayed speech or ruptured ear drums, ask your family doctor or pediatrician to consider a referral to an ENT or contact Dean Specialty Clinic - Sauk Prairie at 608-643-7899.

Sauk Prairie Memorial Hospital's audiologist, Sandy Hoke, uses a test called a tympanogram to test Joey Pethan's ear drum mobility and pressure in the middle ear. Hoke, who works closely with Dr. Timothy Shaw, ENT physician at Sauk Prairie Memorial Hospital and Dean Specialty Clinic, performs this test as well as a hearing test for Shaw's patients who may have an ear infection.

Tips for Preventing Ear Infections

Dr. Timothy Shaw, an ear, nose and throat physician at Sauk Prairie Memorial Hospital and Dean Specialty Clinic, offers several tips for preventing ear infections, including getting children vaccinated against meningitis. "The immunization prevents many bacteria that also cause ear infections," said Shaw. Other suggestions include not having cats inside the home. "Cat dander is highly allergenic"

• proper diet and sleep
• use a decongestant with colds
• breast feed your infant - it provides increased immunity to ear infections
• don't smoke (parents)

Timothy Shaw, MD, FACS