Q. How to clean the ear?

A. Ear can be cleaned by itself because of migratory capacity of skin of ear canal. If you scratch ear often you will get more wax and sometimes you may injured the eardrum.

Q. Why do children get ear infections?.

A. A. Young children are prone to ear infections (called "otitis media") because of their developing head and neck structures. One of these developing structures is the eustachian tube, a small connection between the back of the ear and the back of the nose. This structure allows for the regulation of air pressure, ventilation, and drainage from the middle ear space into the back of the nose. Unfortunately, the eustachian tube is not very well developed in some children. Reflux (or back-up) of infected fluid from the nose into the ear may occur. Likewise, the eustachian tube sometimes does not drain well and allows material to build up in the ear.

There are several other reasons why children get ear infections. Children are much more prone to upper respiratory infections of all kinds. Other risk factors include young age, day care attendance, smoking in the household, and lack of breast feeding. A combination of these risk factors, plus a poorly developed eustachian tube, often leads to otitis media in a young child. Most children will have had one to two cases of otitis before age two.

Fortunately, children develop and grow. The eustachian tube usually reaches adequate function between the ages of 5 and 7, which coincides nicely with a dramatic decrease in the frequency and severity of ear infections in children. The peak incidence of otitis media is in the age range of 12-24 months. Some children begin their history of ear infections at an earlier age, before their first birthday. This may indicate a longer and more severe history of otitis media.

Ear infections are caused by bacteria and viruses. The usual scenario is for the young child to get an upper respiratory infection caused by a virus. This leads to seeding of bacteria in the back of the nose and the ear, through the eustachian tube. Most middle ear infections are caused by bacteria. Unfortunately, bacteria are beginning to develop resistance to the more commonly prescribed antibiotics. Resistant rates for infection are specific to different communities in different areas of the country, depending upon the type and variety of the usual bacterial flora in a particular area.

Q. How common are ear infections?

A. Ear infections are becoming much more commonly diagnosed. Between 1975 and 1990, the number of ear infections diagnosed in doctors' offices tripled to about 25 million. Treatment for an ear infection is the second most common reason for a child's visit to a physician's office, after the well child exam. Ear infections also occur with upper respiratory infections, including tonsillitis, pharyngitis, sinusitis, and bronchitis.

Q. How are ear infections treated?

A. Lots of different treatments have been tried; some controversy still exists over the use of different types of medications and when surgical intervention may be appropriate.

Antibiotics remain the most frequently prescribed medications for otitis media. Different types of antibiotics are used, and new ones are being developed. This is important because of the newer resistant bacteria that have come to the forefront. Some of the newer antibiotics may be slightly more effective than older ones in treating otitis media.

Antibiotics are generally used for 5-14 days of therapy, depending on the clinical situation and the severity of illness. Dosing schedules are becoming shorter as we gain more knowledge about the natural history of otitis media. Some medications are used as initial therapy, and others have been chosen for more broad-spectrum use to help treat persistent infections and resistant bacteria. Physicians generally make choices about the type of antibiotic to use based on several factors, such as a patient's history (including any allergies), safety issues, and cost. It is not unusual for ear infections to be treated with many different types of antibiotics over a long period of time, perhaps several months, in an effort to clear the infection and fluid in the middle ear.

Decongestants and antihistamines, in conjunction with antibiotics, were commonly used in the past for the treatment of otitis media. It has been well documented that decongestants and/or antihistamines are of little benefit for the treatment of routine ear infections in children who do not have allergies.

Oral steroids have been tried, on occasion, for the treatment of middle ear infections and fluid. These medications decrease swelling of tissues. It has been difficult to determine exactly which group of patients might benefit from these medications. The use of steroids for new or acute ear infections is not indicated. Likewise, treatment with steroids in the patient who has had chronic otitis and fluid in the middle ear for many months is of little benefit.

The placement of tympanostomy tubes (ear tubes) is the most commonly performed surgical procedure in young children. It is generally reserved for children whose infections have not responded to multiple courses of antibiotics or when complications occur, such as severe retraction of the eardrum, scarring of the eardrum, hearing loss, and intermittent perforation of the eardrum. Placement of the tubes is usually an outpatient procedure.

Adenoidectomy is sometimes indicated in the treatment of chronic otitis media. This is done in conjunction with placement of ear tubes as an outpatient procedure. The indications for adenoidectomy remain controversial. Generally, this procedure is suggested when initial placement of ear tubes has failed and reinsertion is being considered. It is recommended in older children (above age 4) and when there is documented nasal obstruction, sinusitis, or recurring upper respiratory infections. In general, tonsillectomy is not recommended for the treatment of otitis media.

Q. What about hearing loss in the child with recurring ear infections?

A. Whenever there is fluid in the middle ear space, there is a high likelihood for hearing difficulties. Fortunately, this is treatable with the use of antibiotics or by placing ear tubes to drain the middle ear space. It is important to have hearing evaluated, especially when considering a recurring history of ear infections and the possibility of placement of tympanostomy tubes. Most hearing loss caused by ear infections and middle ear fluid is readily treatable. On rare occasions, children with recurrent ear infections develop permanent hearing loss.

Q. What is Sinuses?.

A. The paranasal sinuses are air-filled pockets located within the bones of the face and around the nasal cavity. Each sinus is name for the bone in which it is located:

  Maxillary (one sinus located in each cheek)
  Ethmoid (approximately 6-12 small sinuses per side, located between the eyes).
  Frontal (one sinus per side, located in the forehead)
  Sphenoid (one sinus per side, located behind the ethmoid sinuses, near the middle of the skull)

Each of these pockets has an opening that connects to the nose. This opening is called an ostium. The paranasal sinuses are covered with a special lining (or epithelium). The lining secretes mucus, a complex substance that keeps the nose and sinuses moist. The sinus epithelium is ciliated; that is, each cell on its surface has a cilium, which is a relatively long structure that has the capacity to push sinus mucus. This movement of mucus (which is known as mucociliary clearance) is not random; rather, it is programmed so that the mucus moves along in a specific pattern. The sinus do not ‘drain’ by gravity-it is an active process.