Ear infections are one of the most common reasons young children see a doctor. In this video, ENT surgeon Dr John Charles Hodge explains why they happen so often, why antibiotics frequently don’t help, and when grommets are worth considering.
What is a middle ear infection?
A middle ear infection (otitis media) is an infection behind the eardrum. It is very common in young children, whose immune systems and Eustachian tubes are still developing.
Key points from the video
- Why young children get them. Young children have developing immune systems, lots of exposure to viruses at child care, and Eustachian tubes that don’t reach adult size and function until around five or six.
- Antibiotics often don’t help much. Although around 90% of ear infections turn bacterial, around 20 children need to be treated with a course of oral antibiotics for one to get better a day sooner.
- When to escalate. One or two infections a year is part of childhood. Three infections in six months, or four in a year, is the point to consider grommets.
- How grommets help. A grommet is a small tube placed in the eardrum under general anaesthetic that lasts about nine months. It reduces infections, allows early detection, and lets antibiotic ear drops work directly at concentrations about 500 times higher than oral antibiotics.
- Clearer hearing sooner. With no fluid trapped behind the eardrum, children hear clearly sooner, which is good for speech and language development. Around 1% of grommets cause a reaction and need to be removed.
Video transcript
Hi, my name is John Charles and I’m an ear, nose and throat doctor, and I’m here to talk to you today about middle ear infections and their treatment in young children.
It’s very common for young children to get ear infections. The immune system isn’t as good as in adults, and they get a lot of exposure to viruses at child care. The cornerstone of a healthy middle ear is an adult functioning Eustachian tube, which obviously kids don’t have. A child’s Eustachian tube becomes adult in size, shape and function by the time they’re five or six.
Interestingly, the index illness, the runny nose and things that kids get, is viral, but when it goes up to the ear, about 90% turn bacterial. So your kid gets an ear infection, you take them to the GP, they get a 10-day course of antibiotics, and it basically doesn’t do much. The reason for that is that you’ve got to treat 20 kids to get one of them better a day quicker.
So one infection a year, two infections a year, I think you can accept that as what a child gets. That’s part of the process. Three infections in six months, or four infections a year, and then you need to escalate your management. The escalation is the insertion of grommets.
That’s a little bit of plastic that you put in the eardrum under general anaesthetic. It lasts about nine months, and it basically replaces the Eustachian tube. It reduces the number of ear infections kids get by one or two. But what it actually does, first of all, is early detection. If your kid gets a runny nose and then stuff starts coming out of the ear through the grommet, you know they’ve got an ear infection. You can now give them antibiotic ear drops. The concentration of antibiotics you’ll get behind the eardrum is 500 times higher than with oral antibiotics, so it’s very, very effective. And those antibiotic drops don’t go anywhere else. They don’t go to the liver, they don’t go to the gut, and they don’t cause rashes.
Then when the infection goes, there’s no fluid behind the drum, so they get clarity of hearing much sooner, which is good for speech and language development. That’s all the good stuff. The bad stuff is that probably 1% of grommets are a bit of a nuisance. They cause a foreign body reaction and need to be taken out. But that still leaves 99% doing an effective job.
Hopefully that was helpful.
Talk to Dr Hodge about your child’s ear infections
If your child keeps getting ear infections and you’d like to discuss whether grommets could help, book an appointment or get in touch with the rooms.
This information is general in nature and is not a substitute for personalised medical advice. Please speak with your GP or specialist about your individual situation.