AN INFANT WITH A MIDDLE EAR INFECTION may rub or pull the affected ear, cry or be more fussy, have trouble hearing, and have loss of balance. An older child may complain of pain; a sense of fullness in the ear; popping, crackling, or clicking sounds on swallowing; hearing an echo when speaking; or feeling unbalanced. Allergies, sinusitis, and bacterial or viral infections from colds or flu can contribute to frequent (i.e., recurrent) middle ear infections. An overlooked contributor is obstructive sleep apnea (OSA). Scientists note that recurrent middle ear infections occur more frequently among children with OSA than among children without OSA.
The middle ear is the air-filled portion of the ear where vibrations from sound waves travel from the eardrum, through a series of three bones (commonly called the “hammer,” “anvil,” and “stirrup”), and to the cochlea (pronounced “KOHKlee uh”), a fluid-filled structure that transforms sound waves into electrical signals that are interpreted by the brain as sound.
In a middle ear infection, fluid builds up in the middle ear because of the blockage of a narrow air-filled tube called the Eustachian (pronounced “yoo-STAY- shee-uhn”) tube, which extends from the middle ear to the back of the nose. The Eustachian tube normally helps maintain proper air pressure in the middle ear and drains fluid from the middle ear.
To remove the excessive fluid from the middle ear, a physician may create a small hole in the eardrum and withdraw the infected fluid. For a child with recurrent middle ear infections (i.e., three episodes within six months or four or more episodes within one year), a physician may place a small cylindrical tube (commonly called an “ear tube”) through the eardrum to create a permanent hole and thereby prevent recurrent middle ear infections.
How OSA contributes to middle ear infections is unclear. Children with OSA frequently have enlarged adenoids and tonsils. Thus, one thought is that these enlarged tissues may contribute to Eustachian tube blockage and fluid buildup in the middle ear. For some children with OSA, removing the tonsils and adenoids eliminates OSA.
In OSA, upper airway tissues such as tonsils and adenoids block the upper airway as a child sleeps, thereby blocking airflow and causing a cessation of breathing (i.e., apnea). During the apnea episode, a child makes increasingly strong efforts to breathe. The child ultimately arouses for a few seconds to take some deep breaths. During the arousal, loud snoring or gasping may occur. The child then resumes sleep, which may set the stage for another episode of apnea. Children with OSA may struggle with daytime sleepiness, fall asleep in school, and have difficulty with concentration because of frequent arousals from sleep.
Some research indicates that treating OSA (with or without surgery) may help reduce the number of recurrent middle ear infections. If your child has recurrent ear infections and symptoms of OSA, you may want to consider having your child assessed for OSA. If OSA is diagnosed and treated successfully, the number of recurrent ear infections could be reduced.
Regina Patrick, RPSGT, RST, is a freelance writer/editor and a registered sleep technologist. She has been involved in the sleep field for more than 30 years.
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