‘What did you say then, Mum?’

Press, 5 December 1985, Page 16

‘What did you say then, Mum?’

•T 'JPRIP ME- - (JUIDL

by

MAVIS AIREY

A reader writes:

"As secretary of our local kindergarten I realise hearing tests are being extended to preschoolers now. I would be keen to know more about ear infections in children, and what ‘fluid in the Eustachian tubes’ means. "It seems more children are having tubes put in their ears of late. I can’t help wondering if such operations could be unnecessary, as it seems possible a child's ear, nose and throat functions may improve and develop at different ages."

Parents should take earache seriously if they want a good quality of life for their children, advises a leading Christchurch ear, nose, and throat specialist.

Common ear infections such as “glue , ear” are a

major cause of deafness in young children, and in some cases may cause permanent damage if not treated. Glue ear

Glue ear occurs when there is a build-up of fluid in the middle ear, the area behind the eardrum. The middle ear is normally filled with air, drained by the Eustachian tube connecting the ear to the back of the nose and throat. If the Eustachian tube becomes blocked for some reason, such as a bad cold, or increasing air pressure as an aircraft comes in to land, it causes a vacuum effect in the ear. This is why we yawn or suck sweets to equalise the pressure in our ears during an aircraft descent, the specialist points out. If the Eustachian tubes do not open, fluid can build up in the middle ear, causing swelling and deafness.

Up to the age of seven or eight, many children have problems with fluid in the middle ear because the Eustacian tube is not functioning normally, the specialist says. Most of them will grow out of it. One reason is simply that the Eustachian tube grows bigger as the child grows and is less easily blocked. Another is that the lymphoid tissue, such as in tonsils and adenoids, is more prominent in the early years. Young children also get more upper respiratory tract infections.

The specialist agrees that glue ear seems to be more common than it used to be. One reason is that it is more readily diagnosed. Health Department screening of children from the age of three through kindergartens and schools picks up a third of the cases he sees. Infants regarded as at risk are also tested for nerve deafness, and some of them are found to have fluid in the ears.

Glue ear is also fairly common in adults, he finds.

Many children whom parents and teachers find naughty, irritable, moody or unable to concentrate at school turn out to have glue ear, the specialist says. “If you made a random test of young children, 14 to 15 per cent would have some problem with the Eustachian tube. “In most cases it’s not bad enough to operate. It’s

only in the two or three per cent of cases where the problem persists that we operate.” Since the late 19505, when the operating microscope was developed, the treatment for glue ear has been to insert ventilation tubes.

For adults, this can be done under local anaesthetic, but children are hospitalised and given a light general anaesthetic. A nick is made in the eardrum, the fluid is sucked out, and a tube, like a tiny cotton reel with a flange at each end, is inserted. This acts like an artificial Eustachian tube, allowing the swelling caused by the vacuum to decrease.

As the eardrum heals, it expels the tube. This can take anything from six to 18 months.

During this time, children have to take care not to get swimming pool water or

bath water into their ears, since any water getting in could cause infection.

However, having tubes in the ears does not mean an end to showering or swimming. Doctors recommend using ear plugs or cotton wool covered in vaseline and a swimming cap. Diving and jumping in the pool are discouraged. For the overwhelming number of children, a single insertion of tubes is all that is necessary, the specialist finds. About 10 per cent need a second intervention.

He denies that inserting tubes has become a fashionable operation, done even when it is not strictly necessary.

“It is true that if you wait until the age of seven or eight, 70 per cent of children will outgrow their deafness. But in the meantime it will cause them problems, and a small per-

centage will get chronic ear disease,” he says. “As far as doing something about the child’s deafness is concerned, inserting tubes is the only treatment. The criteria for inserting them hasn’t changed over the past 25 years.”

Viral infection

The other most common middle ear infection the specialist finds among children is acute suppurative otitis media, when the child wakes with a searing earache and a high temperature.

This is an acute middleear infection caused by a virus coming up the Eustachian tube from the back of the nose. Once in the middle ear, it has nowhwere to go. The resulting tension in the ear is what causes the pain.

It is a serious matter. If it is left untreated, the eardrum may rupture, leaving a permanent hole. The virus may also infect the mastoid and enter the brain and inner ear.

The development of antibiotics has revolutionised treatment of this infection, the specialist says. Previously, there were complications in 30 per cent of cases. Now he finds the complication rate, in our society at

least, is infinitesimally small. Outer ear infection A common outer ear infection is characterised by itchiness and a discharge, what the specialist des-

cribes as “an almost eczema-type condition.” It can be treated locally. If you have any subjects you want to read about in this column, write to Mavis Airey, Parents’ Survival Guide, Home and People Page, “The Press,” P.O. Box 1005, Christchurch.