- What
are ear infections?
Ear
infections (otitis media) occur when fluid accumulates
behind the eardrum and becomes infected. This area is
called the middle ear. Ear infections are the most common
illness affecting children. About 70% of children have
at least one bout of otitis media before their third
birthday. It is estimated over 24.5 million episodes
of otitis media occur per year in the United States.
- Why
do ear infections occur?
Most
investigators feel that an immature eustachian tube predisposes
children to otitis media. The eustachian tube is a narrow
tube running from the air pocket behind the tympanic
membrane to the back of the nose. In children the eustachian
tube is shorter than in adults and allows bacteria and
viruses to enter the middle ear. In young children, the
eustachian tube is almost horizontal. This positioning
interferes with drainage. In addition, the muscles of
the palate which open the eustachian tube with swallowing
or jaw movement are less well developed. The eustachian
tube is also physically small in young children. All
these factors may lead to eustachian tube blockage. As
a child grows, the eustachian tube enlarges, angles down,
and reaches adult development at approximately age six.
- How
do I know if my child has sinusitis?
The
diagnosis of childhood sinusitis is difficult. A child's
symptoms often are not much different from a common cold.
Testing can also be equivocal. X-rays and CT scans are
not always helpful due to age-dependent differences in
sinus development. An x--ray or CT scan may also look
abnormal when a child simply has a viral upper respiratory
infection. Cultures of the nose can be misleading as
he bacteria obtained from the front of the nose are usually
different from those infecting the sinus. The character
of nasal drainage may also be misleading. Clear drainage
is most commonly associated with allergy, but can occur
with viral or bacterial infection. If the mucus dries
out, it will not only be thicker, but may turn white,
yellow, or green, regardless of cause. There doesn't
seem to be a reliable way to determine the cause of nasal
drainage simply by its color.
It is presumed that a child has acute sinusitis if the
child has cold-like symptoms, lasting more than ten days.
If the child has chronic symptoms, lasting more than
a few months, the presumption is that the child has chronic
sinusitis.
- What
causes infant hearing loss?
Hearing
loss occurs in two general types. Sensorineural or "nerve" deafness
occurs due to abnormalities of the inner ear (cochlea)
or of the hearing (acoustic) nerve. There are numerous
causes of this form of hearing loss. Sensoineural hearing
loss is the most common disability noted at birth. It
occurs with a frequency of about 6 per 1000 births, or
approximately 14,000 cases in the U.S. per year. This
form of hearing loss is permanent and sometimes progressive.
Early detection and treatment is, therefore, extremely
important. Conductive hearing loss may occur if the movement
of the eardrum or hearing bones is restricted, limiting
sound transmission to the inner ear. For example, an
ear infection may result in fluid filling the air space
behind the eardrum and limiting its motion. This type
of hearing loss is generally reversible with treatment.
However, a prolonged conductive hearing loss can also
be detrimental.
- Is
it hard to assess my baby's hearing?
Determining
a baby's ability to hear is more difficult than it initially
seems. Parents are generally very sensitive to the way a
child responds to verbal stimulation and may become suspicious
of a hearing problem. General developmental "landmarks" have
also been established and used by physicians to monitor hearing
and language development.
Until recently these behavioral assessments were the only
way to evaluate a baby's hearing. These methods often picked
up hearing loss late, missed subtle degrees of hearing loss,
and were frequently inaccurate. Infant hearing loss is often
a subtle problem-- it has no obvious symptoms and can easily
be confused with other developmental problems. Unilateral
(one ear) hearing loss, for example, may be impossible to
detect by behavioral methods. Late treatment of hearing loss
may not allow a child to fully compensate and develop normal
language and learning skills. What is needed is an accurate,
objective test of infant hearing.
- How
can my baby's hearing be tested?
In the
past, newborn hearing screening was restricted to "high risk" infants
whose medical problems or family history suggested a high
possibility of hearing impairment. In about 1980, accurate,
automated means of newborn and infant hearing assessment
were developed. These tests have been refined and now are
widely available. These tests, delivered by audiologists
or trained technicians are:
ABR (Auditory Brainstem
Response) which measures a baby's brain waves in
response to a click presented to the ear.
OAE (Otoacoustic Emissions) which
record sounds generated by normal hearing ears.
Both tests are painless, rapid methods to effectively screen
an infant's hearing. As they are reliable and inexpensive,
a larger number of infants can be screened. Using "high risk" criteria,
only 5% of newborns were screened for hearing loss in 1993.
The goal of hearing specialists in 1998 is to screen every
baby's hearing.
- What
are Otoacoustic Emissions?
Originally
detected in 1977 by David Kemp using a click stimulus, otoacoustic
emissions are sounds generated within the cochlea of nearly
all normal-hearing ears by active bio-mechanical process
within the outer hair cells. Since OAE's are present in normal
ears, it can be assumed that the absence of an emission is
a sign of irregular cochlear function which could result
in hearing loss.
Otoacoustic emissions testing provides you with a fast, non-invasive
method of testing for cochlear pathology. What's more, by
monitoring a cochlea's natural processes, OAE testing is
completely objective - making it ideal for testing "hard-to-test" patients
such as infants or neurologically-impaired children.
The OAE probe, similar to a tympanometry probe, contains
a speaker (or speakers) and a microphone. Eartips are used
to tightly seal the ear canal. An acoustic stimulus is sent
from the probe speaker or speakers to the ear canal through
the middle ear into the cochlea. Outer hair cells in the
cochlea become excited by the stimulus and react by generating
and emitting an acoustic response. This emitted response
then travels in a reverse direction from the cochlea back
to the ear canal, where it is detected by the probe microphone.
Unfortunately, this emitted response is very small in amplitude
and gets mixed-in with other biological and environmental
sounds present in the ear canal. Since the probe microphone
detects all of these sounds, it is necessary to employ signal
averaging techniques to separate the emitted response (signal)
from these other sounds (noise).
The middle ear is an importnat factor in the amount of activating
stimulus that reaches the cochlea - as well as the amount
of emitted response that returns to the probe. Therefore,
it is helpful to perform tympanometry screening in conjunction
with OAE measurements wherever possible.
- What
is Tonsillitis?
Tonsillitis
occurs when the tonsils become infected. This may be caused
by bacteria or viruses. Generally under preschool age children
develop viral tonsillitis while older children and adults
are affected by bacterial infections. Viruses can also lead
to bacterial infections secondarily. Common symptoms your
child may experience with tonsillitis are:
- Sore throat
- Fever
- Pain or difficulty in swallowing
- Swollen neck glands
- Ear pain
- Bad breath even after you have brushed your teeth
- Bright red tonsils
If you looked at your child's throat with a flashlight during
an episode of tonsillitis, the tonsils would be red, swollen,
and sometimes have a white-yellow exudate on the surface.
A throat culture may be helpful to diagnose bacterial tonsillitis. Click
here for more information on methods for removing tonsils.
- What
are Adenoids?
Adenoids
are collections of lymph tissue very similar to tonsils,
found in back of the nose. As they are located near the entrance
to the breathing passages, it is thought that their function
is to sample or catch inhaled bacteria or viruses. In early
childhood this process is important in the formation of the
body's immune system to fight infection. This function diminishes
with age and is probably of minimal importance after three
years of age.
Common symptoms your child may experience with adenoids are:
- Difficulty breathing through nose
- Feels as though nostrils are pinched
- Breathing noisily
- Snoring
- Stop breathing during sleep
Adenoids shrink or atrophy as children enter adolescence
or young adulthood. Long-term investigations have shown no
loss of ability to fight infection or disease in children
who have had their adenoids removed. Click
here for more information on adenoid removal procudures.
- What
is the treatment for Protruding Ears?
