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It becomes a matter of anatomy. The ear canal that is accessible from the outside is a short dead end sac. It functions only to capture sound and is lined with a layer of cells which produce an oily cleaning substance more commonly known as ear wax. The canal ends at the tympanic membrane which separates the outer ear from the middle ear. The middle ear contains the three small bones that make up the hearing apparatus. If there is pus or fluid in this area, hearing efficiency is reduced. The middle ear connects to the throat via a passageway called the eustachian tube. It is meant to allow air to flow into the middle air when atmospheric pressures change. But it also allows bacteria and viruses to travel into the middle ear and cause inflammation resulting in a common condition called otitis media. When the eustachian tube becomes obstructed, and these agents multiply within the middle ear, things get crowded and pain increases. Left unchecked, the pressure from the infection and inflammatory fluid will burst through the tympanic membrane. Parents will often notice a discharge from the ear at this point, but the pressure is relieved and the child appears to feel better. The hole in the tympanic membrane may heal and scar over, or it may remain open. Repeated bouts of severe otitis media could result in hearing problems. At a young age, this could impede the proper development of speech.
Otitis media is treated with antibiotics. The response is usually quick. For various reasons, some kids are plagued with multiple and recurrent middle ear infections. Myringotomy tubes are small plastic tubes placed across the tympanic membrane. It is a quick operative procedure performed by a skilled ENT specialist. The tubes maintain an opening between the outer and middle ear, so that fluids cannot build up in the middle ear. With time, the body rejects them and they fall out. The decision to place the tubes is based on numerous considerations which include frequency of infections, hearing status and response to other treatments. Guidelines suggest at least six bouts of full blown otitis media before tubes are considered. I have witnessed dramatic improvements in school performance once proper hearing has been restored with tube placement. It is never intended to be used as a method of infection prevention.
A note on earwax. Earwax begins as a fluid secreted by cells in the ear canal as a self cleaning method. The fluid is slowly pushed to the outside by small hairs lining your ear canal. When it remains in the canal too long and dries out, it takes on a hardened appearance, blocks the flow behind it and causes problems. The hairs will continue to slowly move it towards the exterior. Well meaning individuals will pick up a Q-tip hoping to clean it. To be effective, you must reach beyond the blockage and gently move it forward. Most Q-tips are about the size of the ear canal and ineffectual. They simply make things worse by moving the blockage further in and up against the ear drum where things become painful. Q-tips are for cleaning the outer ear only. For persons prone to blockage, I suggest instilling a few drops of ear cleaning oil into the ear weekly. I recommend that you do not stick anything smaller than your elbow into your ear.
Question received from a reader on 6 December, 2008: After tubes come out will they need tubes again if they still get ear infections?
Answer from Dr. Kujtan: It is sometimes necessary to re-insert tubes, and it is a judgment call made with various members of your medical team.
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