Freedom From Chronic Ear Infections - The role of allergies and the way to a cure

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People with chronic ear infections usually have allergies that play a key role in blocking the Eustachian tube.

Diseases of the middle ear in childhood

Other factors that can lead to otitis media include exposure to cigarette smoke, cold or flu which are especially common in day care centers , bottle-feeding while lying down, and pre-existing upper respiratory conditions. The doctor will ask detailed questions about your child's symptoms, previous ear infections, family history of allergies, and potential exposure to environmental allergens.

The doctor will then examine your child's ears with an otoscope, which allows the doctor to see the eardrum and look for inflammation and fluid build-up.

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Early treatment and prevention of otitis media is important, because of the associated hearing loss. Some cases of otitis media require antibiotic treatment, but many do not. An acute ear infection deserves pain relief, either from oral medicines or from ear drops. If your child has recurrent otitis media due to bacterial infection, the doctor may recommend giving antibiotics as a preventive precaution. If your child's recurrent or chronic otitis media continues to be a problem, the doctor may refer you to an ear, nose and throat specialist who can discuss surgical remedies like insertion of tubes in the ears or removal of the adenoid glands.

Click the icon to see an illustrated series explaining the insertion of an ear tube. If the doctor finds that your child's symptoms are caused by allergies, the doctor may refer you to an allergist who can then recommend steps to prevent symptoms, such as allergen avoidance , allergy medication , or immunotherapy. Diagnosis and management of acute otitis media.

Diagnosis and treatment of otitis media. Am Fam Physician. Teschke R, Schulze J. Risk of kava hepatotoxicity and the FDA consumer advisory. Wald ER. Acute otitis media and acute bacterial sinusitis. Clin Infect Dis. Print Page. Request an Appointment. Tympanosclerotic plaques Figure 1b Fig. These are found especially in patients with long-lasting VT. Removal of tympanosclerotic plaques can cause subtotal perforation of the eardrum. Different transplants can be used for the reconstruction of the eardrum in childhood. We prefer the perichondrium alone for smaller and one perichondrium-cartilage-piece for bigger perforations in an underlay technique Figure 1c Fig.

For subtotal eardrum perforations, the palisade technique by Heermann is recommended [ ], [ ]. To stabilize the transplant, in particular in the front quadrants, many techniques have been suggested [ ], [ ], [ ]. After gaining experience with these methods, the Gelita sponge turned out to be the solution to this problem [ ].

Studies on the success of tympanoplasty in children with CSOM with a high evidence level are rare. Due to the heterogeneity of study populations, a comparison between the related techniques is not possible.

Otitis Media

Factors like age, dimension and localization of the perforation, the surgical technique used, the transplant, function of the TA, and otorrhea play a role. Table 6 Tab. The success of tympanoplasty in children with CSOM depends on many different factors. Age seems to be the most important factor based on the current data.

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Generally, surgical intervention in children should not be executed before the age of 6 years. The decision to undergo an operation should be considered individually and after detailed informing of the parents. In the following sections, some important aspects of clinical findings and treatment of these adhesive processes will be illustrated. In particular, it will be demonstrated whether a conservative therapy or a surgical therapy should be considered. Basically, an adhesive process or a retracted pouch is meant to be an invagination of the TM in the direction towards the middle ear Figure 2 Fig.

In the literature, different classifications are recommended, which should be consulted for therapeutic decision-making. In this regard, the classifications orientate themselves, amongst others, along biological characteristics self-cleaning-retained, aggressively growing , the place of origin pars tensa-pars flaccida , its progress age, existence of chronic otitis media , or along the performance during the Valsalva maneuver fixated, non-fixated. A frequently applied classification was suggested by Tos and Poulsen [ ] Table 7 Tab.

Practice Essentials

On the basis of the size of the retraction, the following general progress performances can be resumed in the literature: slight retractions type I are usually temporary appearances and often show a tendency to complete restitution; type II and type III show dynamic performance. Mostly, improvement occurs; ca. Type IV retractions do not show a tendency for restitution and ca. There are basically three courses of action in the treatment of TM retraction [ ], [ ]:.

In the literature, basic elements that can influence the strategy of treatment are mentioned Table 8 Tab. None of these elements on their own are a determining factor for surgical indication. Microscopic finding of the TM is an important criterion for decision-making. In case of non-observable retractions, the additional use of an endoscope is recommended [ ]. Surgery should be performed if the base of the retraction is not visible with the microscope or detritus is found endoscopically.

In comparison with adulthood, adhesive processes in childhood show a much higher proliferation tendency. In case of conductive hearing loss, surgical treatment is recommended.

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In case of beginning retractions, some authors recommend the insertion of VT [ ]. Others think that VT can only bring improvement for a short time with regard to hearing and that they have no influence on the course of disease. In addition, VT can promote the development of atrophy and calcified platelets [ ].

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  • The final surgical therapy of adhesive processes includes definite excision or removal of the retraction, which is usually combined with an accidental perforation of the TM. Therefore, a tympanoplasty or reinforcement of the TM with an autogenetic transplant like fascia, perichondrium, or cartilage is required see also 2. In particular, in case of extended adhesive processes type III or IV , a tympanoplasty is recommended in the literature [ ], [ ], [ ], [ ]. A cholesteatoma is a form of chronic otitis media that also presents the appearance of squamous epithelium in parts of the middle ear.

    Based on the pathogenesis and the symptoms, it is differentiated between the rare congenital cholesteatoma CC and the more common acquired cholesteatoma in childhood [ ], [ ].

    Food Allergies May Be Linked to Ear Infection

    Embryologically, a CC is a dermoid that is located medial of an intact TM. The CC is usually attached to the mucosa of the middle ear anterior to the handle of the malleus and has to match the following criteria according to Derlacki and Clemis [ ]:. After the modification of Levenson et al. In human fetus, it could be demonstrated that epithelial fractions, which are usually resorbed, appear in middle ear cavities until the 33 rd week of gestation. The theory indicates that genuine cholesteatoma develops due to the disposition and lack of resorption of these epithelial fractions [ ].

    The pathogenesis of acquired cholesteatoma has not been fully clarified yet. During the 20 th century, four classical theories have been established [ ]:. Immigration: growth of squamous epithelium of the auditory canal through a marginal perforation of the TM into the middle ear.

    Retraction: formation of an expansive retraction pouch due to a functional disturbance of the tube with loss of self-cleaning mechanism; development of tensa cholesteatoma. Proliferation: papillary growth of the basal cell layer in the area of the pars flaccida.

    Metaplasia: transformation of the mucous epithelium of the middle ear into squamous epithelium due to chronic inflammatory stimulus. For the formation of an attic cholesteatoma, nowadays a combination of the theories of retraction and proliferation is favored [ ]. Besides these reasons, an acquired cholesteatoma can also be formed due to trauma i. The annual incidence of cholesteatoma in children is specified as 3 per , inhabitants. The prevalence in Europe is stated to be 0. However, there are considerable ethnic and regional differences. Among the Inuit, the disease is very rarely [ ]. In children with palatine cleft, the risk of developing the disease is 20 times higher, so that the risk of the formation of cholesteatoma in these patients is 2. Primary diagnosis of the CC is made at the age of 5 years 5.