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Prakash Chandran (Host): Ear infections are common among kids and often painful. Ear infections actually happen when viruses or bacteria get into the middle ear, the space behind the ear drum, causing a feeling of pressure and discomfort. I’m Prakash Chandran and in this episode of Northfield Hospital & Clinics podcast series Kids ENT, we’ll talk about ear infections in children. Here with us to discuss is Dr. Gerard O’Halloran, an Ear, Nose and Throat doctor at Northfield Hospital. Dr. O’Halloran, thanks so much for educating us today.

Gerard O’Halloran, MD (Guest): Thank you for having me Prakash.

Host: Of course. So I want to get started by asking what actually causes an infection?

Dr. O’Halloran: Well the most common type of ear infection is called otitis media and that’s an infection in the space behind the eardrum where the little chain of bones most of us learn about in high school are, the hammer, anvil, stirrup. That room or space is normally filled with air that gets there coming through the – air comes through the nose and up a little tube called the Eustachian tube to ventilate that space. If not enough air gets passed the nose and up the Eustachian tube, then the air that’s there gets absorbed and it develops a vacuum or a negative pressure that will actually pull fluid in from the surrounding tissues and when you have fluid just sitting there, it is sort of like water in a stagnant pond where the algae grow, bacteria can easily grow in that fluid and cause an ear infection.

The most common cause that we can identify in and children that get this are usually quite young, although it can go on into adults is large adenoids that block the Eustachian tube. The other causes are well in children, babies everything is very small so, the Eustachian tube is small and it’s easy to get blocked when they have a cold and the other know causes are second hand smoke exposure and just being around other kids where you catch a lot of colds.

Host: So, why are children specifically, so susceptible to ear infections. I feel like I always hear my friends with children of their kids kind of contracting these ear infections and it just seems to happen all the time. Can you explain that a little bit?

Dr. O’Halloran: Well, a lot of it is just because we are around other kids a lot and get colds. Colds will congest the nose, make the adenoids swell and block the Eustachian tube as I just described. And so then it’s very easy for them to develop an ear infection after that. Most parents have to have their kids in day care, or they are in school around other kids. The only known prevention that seems to be helpful is avoiding any smoke exposure at home.

Host: Okay, that’s helpful. So, when these tubes are blocked, as you’re mentioning, what is the right course of action to fix that, to open that tube up and to clear the ear infection?

Dr. O’Halloran: Well, when people come to see me as an Ear, Nose and Throat surgeon, they are coming to decide that their child needs ear ventilation tubes or not. But that’s not the first step obviously. The first thing when the child has an ear infection is, they are going to go see their primary doctor, their pediatrician or their family doctor or their healthcare provider and most ear infections are treated with antibiotics. Sometimes, if it’s not a terrible looking infection and it appears probably viral; they will do careful watching and waiting and seeing if it clears on its own because that does occur sometimes. When children have lots of trouble, that’s when they come to see me to decide do we need to do something more.

And the criteria for like deciding to do something more like ear tubes, which is a surgery, so it’s a big deal would be the child is having lots of ear infections or the antibiotics are no longer working for ear infections or they are starting to develop complications from antibiotics. Chronic diaper rash, diarrhea from the antibiotics or if their hearing is affected. So, when I see parents, we discuss all of those things. What kinds of troubles are they having? We also evaluate the hearing usually to see because some children will have the fluid behind the eardrum won’t clear up and it will impact the hearing, but the guidelines for ear infections seem to make a lot of sense.

We will consider putting ear tubes in for children who have had three or more infections in the last six months or having complications from the treatments or no longer responding to treatment and then we’ll also do it if the hearing is affected for an extended period of time. And that’s always a bit of a judgement call. Children that get one ear infection, it will take up to two to three months for the fluid to go away even normally. So, we probably wouldn’t jump to do tubes after two or three months, but if the fluid was still there after six months and their hearing is affected; then we think about doing tubes because the chance of the fluid clearing is pretty low.

Now, the exceptions to that, would be kids that are having troubles with say school, learning, speech and language development or special needs children where we really want to optimize everything including their hearing for them. That’s when we would consider – all of those situations it would be reasonable to consider doing ear tubes.

The way ear tubes work is, they are called ventilation tubes. So, we talked before about how air comes through the nose up the Eustachian tube into the middle ear space, well ear tubes are placed in the eardrum. The child goes to sleep for roughly three or four minutes, a small nick is made in the eardrum, if any fluid it present, it is vacuumed out and the tubes look like a little spool with a hole in the middle and they sit in the eardrum and they just basically keep that small hole in the eardrum open to let air come in from the outside because it’s not coming in from the inside through the Eustachian tube.

Host: It’s just so cool to hear about this. This is the first time I’m hearing about these ear tubes and normally, you always hear about the antibiotics and I’m sure parents listening to this, they just hope that it works, but like you said, when it gets past that multi-month mark, and they’re looking for something to relieve their children from the stress and this pain; it’s good to know that this option is available. What is the success rate like? When tubes do become an option, what do you normally see in children afterwards?

Dr. O’Halloran: So, tubes are a good operation in general. I like to tell parents sort of the pros and cons. Because nothing is perfect. Tubes in general, are pretty good. For example, before ear tubes were invented in the 60s, Ear, Nose and Throat doctors like myself, spent about half their time rebuilding ears because the infections couldn’t be treated.

The pros of tubes are sort of the same as the reasons we put them in. They generally, but not always, will decrease the number of infections dramatically. Having one or two infections after ear tubes go in is relatively common. To have much more than that, is rare, maybe one or two percent. So, I do roughly 100-150 sets of children a year that get ear tubes, I only have one or two that will continue to have a lot of trouble and even then, those kids are better because the fluid can drain out and we can treat them with antibiotic drops rather than oral antibiotics.

The nuisance things with tubes are, do they ever get plugged? Yes. Unfortunately, yes. Less frequently than when I would expect to be honest, but I always have a couple kids a year that get plugged. We can often unplug them with drops. But sometimes we have to go replace the tube. The tubes also almost always restore the hearing to normal. About a half percent of kids that get tubes have another cause of hearing loss too, so congenital hearing loss or sensorineural hearing loss and tubes won’t fix that, but in general, if fluid is the issue, the tubes fix that immediately.

And then in the very big picture, as I mentioned, they tend to head off permanent damage. The downside of tubes in my opinion, there are mainly three. One is it’s expensive. If you walk into a hospital, you write a big check and most of us are high deductibles now, so you’ll probably hit that. Second issue is your child has to have a general anesthetic. The general anesthesia is brief. It’s not a full – you don’t have to have an IV or a breathing tube. They just use a mask anesthetic and at Northfield here, we let the parents be there when the kid falls asleep and then the parents go out and the tubes go in and they are done in four minutes and the parents go home about an hour later.

The anesthesia risk is likely statistically lower than the risk of another ear infection. More children have significant issues from meningitis from ear infections than they do from a four minute anesthetic. So, I tend not to worry as much about the anesthesia and tubes as I would with other procedures. The real risk to me, if it was my own child, is that when we do ear tubes, we made a small hole in the eardrum and if we do 100 kids, one or two of them the tubes normally fall out on their own; but one or two of them when it falls out will leave a hole behind in the eardrum. Not that’s 100% fixable, but it’s a big hassle. So, that’s why we don’t do tubes for the first ear infection. That’s why we follow guidelines and say yeah, we want to see three or four, they have to be really bad before we take even a small risk of leaving a kid with a hole in the eardrum, even though we know it can be fixed, it’s still a hassle.

Host: Yeah, and it sounds like you have, or you follow a pretty good set of guidelines that will dictate whether it is necessary. Just a quick question about recovery time after they go and get the tubes in, how long does it normally take them to recover afterwards?

Dr. O’Halloran: Most children go home roughly an hour after the surgery. They are often mad coming out of the anesthesia. Tubes don’t really hurt though. We do adults in the office with local anesthetic and they feel just fine and walk out two minutes later. So, really, it’s mainly - the recovery is getting over the brief general anesthetic and most kids once you see them are perfectly fine and they are certainly okay by noon and we just tell parents to take it easy that day and patients often get on airplanes the next day and of course with ear tubes in, you’re bullet proof for flying. You’ll never have any ear trouble.

Host: Wow. Well I really appreciate you educating us Dr. O’Halloran on ear infections and all the different treatment options that are available including these ear tubes. Is there anything else that you wanted to share with our audience before we wrap up?

Dr. O’Halloran: The one brief thing I would share that I think is really helpful and I found it helpful with my children is – I mentioned flying and how ear tubes prevent any of the pressure changes because they are venting into the outside. If a child doesn’t have ear tubes, but typically has trouble with flying, there is a product called Ear Planes E-A-R P-L-A-N-E-S that can be purchased and I have no relationship with them, but you can purchase them on Amazon for children and if they wear them as the plane is coming down, you will often avoid the screaming child during airplane descent.

Host: Well, that is pro tip. I’m actually expecting my first in July and I was wondering how I was going to handle that on the plane. So, it’s good to know that.

Dr. O’Halloran: Oh, congratulations. Bottle feeding helps too, but the Ear Planes are magic.

Host: Okay. That’s really good to know. Well thank you so much again. I really appreciate your time. For more information, please visit www.northfieldhospital.org. My guest today has been Dr. Gerard O’Halloran. I’m Prakash Chandran. Thank you so much for listening.