MOTHER AND CHILD CARE
(MAMTA KA AANGAN

Ears are important for our communication with the world. There are many important aspects of ear care in childhood, which the parents need to know and understand. Let us talk about ear care in this episode. 

Let us first start with the anatomy of the ear—our ear has mainly three parts, the outer ear, middle ear and the inner ear. What we see outside is the outer ear; this is followed by the middle and the inner ears. The eardrum or the tympanum separates the outer ear from our middle ear. The middle ear has a chain of small bones (ossicles) which connect the eardrum to the inner ear.

Sound first reaches the eardrum through the outer ear, the chain of bones in the middle ear conduct the vibrations from the ear drum to the inner ear which in turn has nerve fibers that conduct the sound waves the brain and the sound is recognized.

The middle ear is connected to the nose and throat via a narrow small tube called the Eustachian tube. Thus infections of the nose and throat can easily reach the ear.

Let us discuss the common childhood diseases of the ear.

One of the commonest diseases of the ear in childhood is otitis media or middle ear infection. The Eustachian tube in children is shorter, straighter and wider than in adults. Therefore, the chances of spread of any infection of the nose or throat to the ear are much more than in adults.

It is important to seek the doctors advise in children with colds and coughs, especially if they have fever or become irritable. Such children should have their ears examined. In acute middle ear infection, pus may fill the middle ear, and find its way out by making a hole in the eardrum. This condition should be treated immediately by a doctor.

Some children have chronic otitis media, and consequently have frequent discharge from the ear. This is often ignored by the parents and treated as a routine matter. In fact, chronic ear discharge if ignored can cause serious illness in the child. It is therefore important that each time the child has discharge from the ear, she/he should be treated.

Others have constant discharge from the ears. In such children, the infection could spread to the bone behind the ears and even to the brain. This infection could also destroy the ossicles of the middle ear and impair the hearing of the child. This is especially true if the discharge is foul smelling.

Another important problem that requires attention during childhood is deafness. Some children become hearing impaired due to lack and of care proper care at the right time (as described above) some others are born with impaired hearing. Hearing impairment is one of the most commonly found congenital ENT abnormalities. One of the reasons for this is consanguinity, i.e. marrying a cousin or close relative, for instance it is a common custom in India to marry the maternal uncle’s son. This is very common in India and also the most easily preventable cause. It is important for parents to recognize hearing impairment in children to seek early intervention. This is because hearing impairment may retard both mental and physical development.

Parents should suspect hearing impairment if the child is late in speaking—hearing impaired children cannot learn to speak simply because they have not heard speech. By 3-4 years, most children are able to speak fully well.

Congenitally hearing-impaired children too have a small capacity to hear. This can be utilized for fitting them with hearing aids in the external ear or cochlear implants in the inner ear as required. This would enable them to hear. These children can also be taught to speak by giving them speech therapy.

It is important to remember here that the maximum benefit of all these can be derived only when congenital hearing impairment is recognized before the sixth month. Parents should therefore be attuned to the hearing of their child and seek advise as soon as they find something amiss.

Question: What causes earache?
Answer: One common cause of earache is wax accumulation in the ear. As such the wax in the outer ear is produced naturally and does not normally need to be removed. Sometimes however, it accumulates in excess and can cause earache. It is better for parents not to attempt to remove wax from children’s ears, as they do not have the proper instruments to do it. Attempting to remove wax may result in damage and infection to the child’s eardrum.

Question: Children often put some small objects in their ears, what can be done for this?
Answer: Please do not attempt to remove small objects which are stuck in your child’s ears. Apart from damaging the eardrum, this can also result in driving the object further inside the ear.

Question: What are the precautions to be taken to protect children from diseases of the ear?
Answer: Here are some guidelines for prevention of ear disease in children:

1.      Newborn care: The traditional practice of putting oil in the nose and ears of children is wrong—please do not put anything in the child’s ears. Also, do not use cotton buds for cleaning your child’s ears. It is better to use the corner of a towel to do this.

2.      Restrain your child from putting fingers in her/his ear to itch. Also, take care that the child does not put objects like pencils, etc. into her/his ears.

3.      Treat any cold-cough or ear ailment in your child immediately. Never neglect any ear discharge.

4.      Recognize and treat hearing impairment early.

5.      If the child has scholastic backwardness after any ear ailment or any other illness (at any age), get the child’s ears examined.

6.      Protect your child from sound pollution i.e., loud noises form loudspeakers, crackers

We hope that you will not be able to hear even the softest complaint your child’s ear makes.