The most common cause of conductive hearing loss in children is otitis media, a condition of the middle ear. The middle ear is a small air filled cavity located behind the eardrum that contains the ossicles which are the smallest bones in the body that transmit sound from the eardrum to the inner ear. In the inner ear, nerves are stimulated to relay sound signals to the brain. The eustachian tube, when it functions normally, connects the middle ear cavity to the back of the throat, ventilating and equalizing pressure in the middle ear. Your ears “pop” when you yawn or swallow because the eustachian tube is adjusting the air pressure in the middle ear. Otitis media frequently occurs with respiratory infections as the nasal membranes and eustachian tube become swollen and congested.
Important Things You Should Know
- Most middle ear problems occur in the winter months.
- Smoking in the house increases the risk of middle ear infections.
- Children with respiratory allergies have a greater incidence of otitis media.
- Ear infections are second only to routine well-baby visits as the most common reason for office visits to physicians.
There are two primary types of otitis media:
- Acute Otitis Media (AOM). An AOM episode is characterized by sudden onset of ear pain that may be associated with ear fullness, fever, restlessness and hearing loss. AOM will usually respond to medical treatment. In some cases, AOM may result in a rupture or perforation of the eardrum with drainage into the ear canal. If left untreated, such ear infections may lead to more severe middle and inner ear conditions. More than 85% of all children will experience at least one ear infection. Two out of three children under the age of 3 years (67%) will experience at least one episode of AOM.
- Otitis Media with Effusion (OME). Otitis media with effusion (fluid) may follow an episode of AOM. OME also may occur without prior ear infection, when the eustachian tube is not functioning to ventilate the ear and middle ear fluid develops. In OME, fluid persists in the middle ear space, often for long periods of time, usually resulting in hearing loss. When fluid is present in the middle ear, it impedes the vibration of the tympanic membrane, as well as the movement of the middle ear bones.
The treatment of AOM usually includes antibiotics, possibly combined with other medications, as prescribed by your physician. Otitis media may respond readily to medical intervention, or the symptoms may resolve spontaneously. Once resolved, any associated hearing loss and other complications typically also resolve.
When OME is unresolved, hearing loss usually persists, and ventilation or pressure equalizing (PE) tubes may be inserted into the eardrum by your physician. These tubes may remain in the ear for several months of even a few years.
Parents are often concerned about the possibility of permanent hearing loss with recurring infections. All children should be evaluated by an audiologist to determine and document the integrity of their hearing mechanism. Complete hearing evaluations should be performed by an audiologist before and after any medical treatment.