Understanding Ear Tubes and Their Sensory Implications for Children
It seems like many of the children in my life are getting ear tubes. While getting ear tubes placed is a routine and common procedure for pediatricians and ENTs, there are important sensory implications that parents should be aware of.
What Causes Frequent Ear Infections in Children?
Ear infections can be caused by a myriad of issues. One of the reasons children get more ear infections than adults is that their Eustachian tubes, or the tube that connects the middle ear to the nose and throat are smaller, narrower, and more horizontally oriented than adults. This, along with the exposure to more germs and immature immune systems, make it easier for fluid and bacteria to build up in the middle ear.
What Are Ear Tubes, and Why Does My Child Need Them?
Ear tubes are designed to prevent recurring ear infections. If a child experiences more than 4–6 ear infections in a year or has an ear infection that doesn’t improve after multiple rounds of antibiotics, ear tubes are often recommended. These small tubes are placed in the eardrum to help drain fluid from the middle ear and allow air to flow in and out, preventing further fluid buildup. Ear tubes also help equalize pressure in the inner ear.
How Frequent Ear Infections Affect the Vestibular System
The vestibular system is a key sensory system that detects motion and changes in head position, playing a vital role in balance, muscle tone, motor development, and sensory regulation. This system consists of the peripheral system within the inner ear and the central nervous system, where the brain and spinal cord process input from the inner ear’s receptors.
The peripheral system includes three semicircular canals that detect rotational movement (think of shaking your head) and otolith organs that sense linear motion (like walking or bouncing). These structures contain tiny hair cells that shift in response to movement, triggering nerve signals that are sent to the brain.
When a child experiences an ear infection, these hair cells may be dampened, preventing them from moving freely. This can lead to difficulties with balance, coordination, and overall vestibular processing. Additionally, the child may experience muffled sounds, which can impact language development.
What Can I Do to Support My Child?
If your child has had frequent ear infections, it’s important to ensure they’re receiving enough vestibular input to help their nervous system process and respond to sensory information. Activities that provide vestibular input include swinging, sliding, bouncing, dancing, rocking, and head inversions.
What Should I Be Aware of After Ear Tube Placement?
After ear tube placement, your child may be able to hear more clearly, but they could also become fearful of loud or unexpected sounds. Be mindful of this if you’re in loud or crowded areas. You can help ease their fear by labeling sounds and involving them in controlling the noise. For instance, if the sound of running bathwater overwhelms them, let your child help turn the faucet on and off to control the sound.
Your child might also become more tolerant of vestibular input after the procedure—or they could feel overwhelmed by it. Signs of overwhelm include dysregulation, fear of heights, or avoidance of movement. In these cases, offering deep pressure tactile and proprioceptive feedback can help. This could include activities such as giving a bear hug, engaging in heavy work (e.g., pushing or pulling heavy objects), or playing with playdough or putty.
When introducing vestibular input, start with linear, predictable movements and avoid spinning or head inversions. If your child seeks more movement, allow them to engage in these activities, but watch for signs of overwhelm, such as dilated pupils, flushed skin, or sweating. You can help regulate their response by “sandwiching” vestibular activities with activities like jumping, squeezing, or placing gentle pressure on their head, or encouraging them to suck on a water bottle or hard candy.
Therapy Considerations
Occupational therapists (OTs) should be aware of recurring ear infections, as these can affect a child’s balance and motor development. If a child is delayed in crawling or walking, ear infections or ear tube placement may be a contributing factor. Since ear tubes eventually fall out, it’s important for providers to be aware of their placement and whether they’ve come out to monitor any changes or challenges in the vestibular system.
Speech therapists should also consider any potential changes in auditory processing skills when working with children who have had frequent ear infections or ear tube placement.
Conclusion
Being prepared for ear tube placement can help you and your child navigate the process more smoothly. If you have ongoing concerns about your child’s motor development or sensory processing skills, consider reaching out for an occupational therapy evaluation to ensure their needs are fully addressed.