Ruptured Ear Drum (ER)
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Comment| Wednesday, December 3rd, 2008 | | CWK Producer |
“Sometimes it bulges so much that it actually bursts so there’s a little hole in the ear drum.”
– Kathleen Nelson, M.D., Professor of Pediatrics
Dr. Kathleen Nelson, Professor of Pediatrics, walks into the hospital examining room to meet two-year-old Ranginae Poole. The girl has had an ear infection for several days. Her pediatrician prescribed an antibiotic, which she started taking yesterday but this morning there is blood and pus draining from her left ear.
“What this is, “ Dr. Nelson explains, “is pus coming from behind the ear drum. There was probably so much pressure from behind the eardrum, where the infection was, that it actually caused a little hole in the eardrum. A little tear.”
That tear explains why there’s some blood. The doctor shows Ranginae’s mom how to clean the outside of the ear.
“You notice I am not putting this Q-tip down in the ear, I am just cleaning right around the edge as far as I can see,” Dr. Nelson explains.
The good news, Dr. Nelson explains, is that her ruptured eardrum allows the accumulated pus from the infection to drain away, relieving both pressure and pain. The problem is- where exactly is the tear?
“If it’s in the upper part of the ear drum,” Dr. Nelson says,” that’s sort of serious because it can result in significant scarring and it can affect her long term hearing.”
There’s no way to tell where the hole is, there’s too much fluid in the way. The doctor will know more after a few days of antibiotics, when the infection drains away.
“I would continue her on that medicine, especially since her temperature is down and it looks like she’s feeling pretty good. Keep her on that medicine. If the ear is still draining after three days, we need to see her again.”
Most of the time, the doctor reassures the little girl’s mom, a hole in the eardrum will heal all by itself.
Tips for Parents
Acute otitis media, commonly called an ear infection, usually starts when germs that cause colds or sore throats (either bacterial or viral infections) spread to the middle ear. Once in the ear, the infection can cause a buildup of pus or fluid behind the eardrum. The pressure on the eardrum can lead to significant pain in some children.
Acute otitis media is an inflammation of the area behind the eardrum (tympanic membrane) in the chamber called the middle ear. Deep within the outer ear canal is the eardrum. The eardrum is a thin, transparent membrane that vibrates in response to sound waves. The middle ear contains air and sits behind the eardrum. When the eardrum vibrates, tiny bones within the middle ear transmit the sound signals to the inner ear. In the inner ear, nerves are stimulated to relay the sound signals to the brain. The eustachian tube, which connects the middle ear to the nose, normally ventilates and equalizes pressure to the middle ear. When your child's ears "pop" when yawning or swallowing, the eustachian tube is adjusting the air pressure in the middle ear.
- Two out of three children under the age of 3 experience at least one episode of acute otitis media.
- Acute otitis media is the most common bacterial illness in children.
- Fifty percent of antibiotics for American preschoolers are prescribed for ear infections.
Acute otitis media is an infection that produces pus, fluid and inflammation within the middle ear. With proper medical treatment, the bacteria causing the infection can be killed. Antibiotics do not eliminate viral infections, however.
Older children often complain of ear pain, ear fullness or hearing loss. Younger children may demonstrate irritability, fussiness, or difficulty in sleeping, feeding or hearing. Fever may be present in a child of any age. These symptoms are frequently associated with signs of upper respiratory infection, such as a runny or stuffy nose or a cough. During the infection there will usually be some temporary hearing loss. As fluid and pus disappear from the middle ear, hearing improves.
- Symptoms of acute otitis media include fever, ear pain or pulling at one or both ears, irritability, decreased appetite, and/or fluid coming from one or both ears.
- Children experiencing an earache or a sense of fullness in the ear, especially when combined with fever or a prior upper respiratory tract infection, should always be evaluated by a doctor.
- Ear infections are more common in children who live with someone who smokes.
- Studies have shown that up to 80 percent of acute ear infections will clear up on their own without medical treatment.
- Children whose ear infections are not treated immediately with antibiotics are not likely to develop a serious illness.
References
- American Academy of Pediatrics
- JAMA Medical Library
- KidsHealth.org
