Written By: Alan Greene, M.D.
Ear infections aren’t Italian anatomist Bartolommeo Eustachio’s fault, but you can thank him for identifying the structure that makes babies and young children more ear infection prone than older children and adults. In the mid-1500s he correctly described the tube that runs from the middle ear (just behind the ear drum) to the throat. For his discovery, the Eustachian tube was named after him. Like many medical terms, this name is not particularly helpful in practice. Let me tell you what is …
What Does the Eustachian Tube Do?
When the Eustachian tube is functioning properly, it is closed most of the time. This keeps bacteria from the nose and throat from entering the tube. Nonetheless, it’s extremely important that it opens when you swallow to keep the air space in the middle ear at the same pressure as the air around you and to drain normally occurring middle ear secretions.
The opening of the Eustachian at just the right time allows the eardrum to move freely, which is necessary to have effective hearing. When the tubes do open, the secretions that are normally made in the middle ear drain, along with any bacteria that are in the tubes. It’s a very efficient, mostly well designed, system.
Infected Ears and Eustacio’s Tube
When fluid is trapped in the Eustachian tube it is no longer able to do the job it was designed to do. It doesn’t keep pressure constant when you swallow and it doesn’t drain properly, leading to a full feeling in the ears.
Once things start to go wrong with this elegant system of equilibration and evacuation, things can go downhill quickly. Normal middle ear secretions and bacteria trapped in the tube can grow, leading to greater fullness, pain and in some cases, bacterial infection.
How do Eustachian Tubes become Blocked?
Ear infections often go hand in hand with respiratory infections, but they are not the only potential cause. Irritants (especially cigarette smoke) and allergies can also be culprits. They can all inflame the lining of the tube causing swelling and increased secretions – a bad combo. They can also cause enlargement of the glands near the opening of the tube, blocking flow at the outlet. Sudden increases in air pressure (such as descent in an airplane or on a mountain road) can both squeeze the tube closed and create a relative vacuum in the ear. Drinking while lying on one’s back can also block-off the slit-like tube opening of the Eustachian tube. While most of us don’t drink in this position, some babies do, but you can see why it’s not a good idea.
Babies, Young Children, and Ear Infections
Babies are given a boost of their mother’s immunity at birth, but that starts to wane when they are around four to six months old. In the following months and years their immune systems learn to recognize and ward off cold viruses. During this learning period babies and young children get more colds than they do as they grow.
If that wasn’t bad enough, it turns out, the Eustachian tube is shorter, more horizontal, and straighter in babies and young children than it is in older children. The tube is also floppier, with a tinier opening that’s easier to block.
That’s why ear infections are worse for kids who:
- Reach four to six months old in winter when viruses are at their peak
- Are in daycares where they are exposed to more viruses
- Live with or are cared for by someone who smokes
- Drink from a bottle while lying on their back
What’s a Parent to Do?
A perfectly happy baby may go to sleep normally, then in the middle of the night, wake up screaming in pain. The first time it happens to a new parent, it can be frightening.
For parents with ear infection prone children, recurring ear infections can lead to sleepless nights, repeated trips to the pediatrician, and round after round of (often unnecessary) antibiotics. I discuss when to skip antibiotics and when they’re indicated [insert title of blog post], but for now I want to tell you about two things parents can do as soon as they suspect an ear, including one gentle natural remedy and one healing ritual I’ve worked with Bambini Furtuna to create.
1. Relieve pain
- For decades doctors have been prescribing Tylenol for ear infection pain relief. This is still considered safe and effective, but not what I prefer as a first line of ear infection pain relief.
- For centuries many cultures have used a few drops of herbs in oils for topical ear pain relief. In my practice I’ve used this as well.·
2. Help the Eustachian tube drain
- Babies are comforted by being held. When a baby has ear pain, holding the baby upright and gently jostling not only makes them feel loved, but may help reduce pressure in the ear as gravity helps open up the Eustachian tube just a bit.
- Warm compresses on or around the ear can help the fluid become thinner making it easier to drain.
Of course, if pain persists, call your child’s pediatrician.
For more information about ear infections, listen to our podcast here.