Ear infections

Most of the time, the fluid that accumulates behind the eardrum comes from nasal and throat secretions that travel up the eustachian tube. It can also happen that fluid from too much nasal irrigation can enter the eustachian tube.

The eustachian tube is a small, flexible canal, 2 mm to 4 mm in diameter, which shares the same mucous membrane as the nose and opens behind the soft palate, at the back of the nasopharynx.

In children, the eustachian tube is horizontal and very small, making drainage much more difficult.

During growth, the eustachian tube increases in diameter and takes on a downward-angled position, allowing better drainage.

This makes children under 3 much more susceptible to fluid entering the middle ear and ear infections.

This is why the frequency of ear infections usually decreases with age.

The following conditions can contribute to otitis media: eustachian tube dysfunction, enlarged adenoids (vegetations) and/or tonsils, environmental allergies, laryngopharyngeal reflux, smoking and/or vaping, nasopharyngeal tumours, nasopharyngeal radiotherapy, diabetes, autoimmune diseases and many others.

Acute otitis media causes a decrease in hearing in the ear, along with pain.

There may also be fever (some children and adults don't always get it) and disturbances of balance. The pain can be excruciating, preventing the child or adult from sleeping or eating.

Serous otitis presents with the same symptoms, except that there's no fever, and the pain and pressure are less severe.

It can be difficult to distinguish between viral and bacterial acute otitis media.

Clues pointing to bacterial otitis are: a fever lasting more than 72 hours, repeated ear infections, a purulent appearance of the fluid behind the eardrum, and an eardrum under pressure due to excess secretions.

Acute otitis media is first treated with painkillers such as acetaminophen or ibuprofen. When a bacterial infection is suspected, antibiotics are administered by mouth.

Finally, acute otitis media and serous otitis can be treated with tube insertion.

Acute otitis media can be complicated in many ways. There may be scarring of the eardrum, perforation of the eardrum, permanent neurological hearing loss, infection of the ear bone(mastoiditis), brain abscess, cervical abscess or even blood infection(septicemia).

These complications are more common in the very young, as well as in immunocompromised adults such as diabetics, organ transplant recipients and people with immune diseases.

In children, it is well documented that breastfeeding reduces the risk of ear infections by supporting the baby's immunity. It is also important to avoid breast-feeding in the supine position, or letting the child drink a bottle in bed, as this can contribute to the liquid entering the ear through the eustachian tube.

Whenever possible, avoid using a pacifier or straw with your child, as the negative suction pressure created by the pacifier can contribute to the backflow of secretions into the eustachian tube.

Nasal hygiene is very important to prevent ear infections. It's a good idea to clean your child's nose thoroughly with a gentle spray, followed by gentle suctioning of secretions. If the spray is too strong, or if secretions remain trapped at the bottom of the child's nose, they are more likely to obstruct or move up the eustachian tube.

It can be helpful to raise the headboard and use a humidifier in the bedroom during colds, to prevent secretions from getting trapped in the nose.

Tubal exercises are useful to help drain the fluid. An oral decongestant for up to 1 week combined with the exercises may help unblock the ear.

It's important to assess the possibility of environmental allergies and treat them with an antihistamine when they are present.

It is also useful to treat laryngopharyngeal reflux when present, to avoid inflammation of the respiratory tract.

Flying or diving with acute otitis media or serous otitis is contraindicated and dangerous. The change in pressure could cause a perforation of the eardrum (mechanical deafness), or worse, a perforation of the inner ear membrane, leading to chronic dizziness and permanent neurological hearing loss.

Avoid using nasal sprays that are too strong , as they could travel up the eustachian tube. Similarly, avoid sniffing, using a pacifier or sucking your thumb, and above all, blow your nose thoroughly to clear the nasal passages.

Use gentle products, do tubal exercises and blow your nose well.

Avoid bottle-feeding or drinking in bed or lying down - this can cause fluid to reflux into the ears and contribute to ear infections.

Avoid smoking-smoking or exposure to irritating vapours.

The recommendations of the Canadian and American ENT and pediatric associations for tube insertion are as follows:

• 3 acute otitis media in 3 months

• 4 to 6 acute otitis media in 1 year

• serous ear infections lasting more than 3 months

• antibiotic resistance (use of intravenous or intramuscular antibiotics)

• language or developmental delay

• risk of complication (eardrum under pressure, previous eardrum perforation, immunocompromised patient, etc.)

• risk of recurrent otitis (chronic tubal dysfunction, radiotherapy to the nasopharynx, etc.)

• personal indication (must fly, other illness with risk of complications, etc.)

The tube installation involves a small incision to remove secretions that have become trapped behind the eardrum and often solidified. The person's hearing improves immediately.

Once the secretions have been removed, the tube is inserted. The tube serves to ventilate the inside of the middle ear to prevent the growth of bacteria. It also allows any fluid that may accumulate to exit the ear as quickly as possible to avoid.

Tubes help prevent serous otitis and acute otitis media.

To find out more about tubes, see our tubes page.