Another ear ache. Is it time to see an ENT?

Your baby is fussy, she’s running a temperature, and you’re no doctor, but she’s still pulling at her ear. Do you take her in? Do you wait it out? Will it be antibiotics? Again?

Parenthood is hard, and this scenario is one all too familiar to parents of young children. According to the National Institutes of Health, “ear infections (otitis media) are the most common reason why parents bring their children to the doctor.” Why is that, you ask? Let’s talk about how the body works for a moment.

Think about how many changes take place from birth through the first year. Children often gain 15-30 pounds, their brains expand, their limbs stretch out, their torso extends, and that’s just what we can really see. The ear, nose, and mouth all grow and expand too. A tube called the eustachian tube, running from the middle part of the ear, right behind the ear drum, to the back of the throat also grows and changes direction. As a matter of fact, it shifts from lying almost horizontally (even with the ground) to lying diagonally (tilting), but it takes a few years. During that time, fluid doesn’t drain as well as it does in adults. Fluid buildup from allergies, upper respiratory infections, sore throats, or viral colds may end up sitting in the space right behind the ear drum, keeping it moist and warm. This is the perfect environment for infection-causing bacteria to grow.

What if it’s just one or two ear infections? When is it time to see the ear, nose and throat doctor to take care of that fluid? I asked one of our trusted ENTs, Natalie Roberge, M.D., to weigh in on this one for some guidance.

“It is time to think about seeing the ENT when a child has had 3-4 antibiotics or more for ear infections in a six-month period, especially if the fluid does not clear in the ears between the infections or if there is speech delay. Consulting an ENT is also recommended if the fluid behind the ear drum does not clear up after 3 months, even if the child has not had any infections or antibiotics. Some children need to be evaluated sooner if there is significant speech or developmental delay.”

What happens if I wait to address the frequent ear infections? I talked to Bari Pham, audiologist for Cook Children’s to field this one!

“Frequent ear infections, or even just having chronic fluid in the middle ear, can have a significant impact on a child’s brain growth. Consistent access to sound is necessary to develop neural pathways that support listening and speech development. If we deprive the brain of auditory information the child is at risk for delays in speech and language skills, literacy skills and academic struggles.”

Frequent ear infections can hinder speech and language development. Think about it: Sound moves freely through air, but add water or fluid, and the sound slows down. It becomes muffled, and the intensity (or the loudness) gets turned down. So what exactly does that mean for speech?

Sounds can be easily confused, especially the high frequency or “sharp” sounds we make with our mouths. Take the “t” sound for example. It’s made with a short burst of air, inside our mouths (so it’s not visible from the outside), and we don’t add our voice like we do for a vowel sound such as “ee.” It’s a high frequency, and sometimes, very quiet sound. It’s easily missed with fluid in the middle ear.

One of our own ICU nurses (who happens to be my awesome sister), is a patient of Dr. Roberge’s and reflects on a similar situation with her son. “{His speech} is muffled. It’s not clear, and I think the ear infections prevented him from saying more.” She gives the following advice to fellow parents: “Make sure to follow what your doctor recommends as far as making appointments and keeping follow-up appointments. Don’t be opposed to frequent rechecks. It can only help!”

So you’ve followed the directions of your medical professionals. Your child’s speech is still not clear, and they still seem to lack understanding. Now what? Speak with your pediatrician about a speech and language evaluation with your friendly speech-language pathologist. We’re happy to help!