Alla Gordina, MD, FAAP 
Article Title
Ear Infections and Hearing Loss in Post-Institutionalized (PI) Children 
Posted Date

Ear and sinus infections are the most common problems seen in the post-adoption period. These conditions are usually under-diagnosed and under-treated. Complications of ear infections are numerous and can severely affect the adopted child and the whole adoptive family.

1. Why do PI children have so many ear infections? Any child, who attends day care early on is at a higher risk of having upper respiratory infections - colds, runny nose, congestions. When one considers that orphanages are big "permanent child care centers", many inferences can be made. The practice of bottle- propping the bottle and the use of large holes in the nipples (both of which are standard practices in the orphanages) can lead to the "flooding" of the Eustachian tube (a tiny canal, connecting the ear and the mouth cavity). Poor follow-up (ear drum should be examined only by an ENT doctor; there are no otoscopes in the orphanages) can lead to persistent effusions (collection of the thick sticky "fluid" behind the ear drum). A lot of the PI children do have multiple and early allergies, both food and environmental, which predispose them to persistent hard- -to- treat ear infections. Because it is so hard to diagnose and follow-up ear infections, your child's medical would not contain adequate information. For any mentioning of ear infection on the medical, you should add at least 10. So, if there was not any information - consider 5-10 as your start-up point. The stress of adoption and exposure to outside viruses and bacteria can make your child more vulnerable and less protected.

2.Why are those infections so hard to treat? Number one, you don't know how many undiagnosed ear infections the child has had in the past. You also don't know what antibiotics were used and how many times. Believe me, a lot of antibiotics were used, a lot of times. Even more, some of those antibiotics, were very powerful, and known to damage hearing and therefore are very rarely used here, in the United States. Therefore, the first ear infection after adoption IS NOT the first ear infection for this child and it should not be taken lightly.

3. What are the possible complications of persistent ear infections and effusions?

    - Permanent or temporary hearing loss is extremely common.
    - Language delays.
    - Behavior problems because of pain - oh, this pain is real! and please do remember about the very high pain threshold in PI children.
    - Behavior problems because of the frustration secondary to the expressive and comprehensive language delays.
    - Learning disabilities.
    - Problems with balance which can affect gross motor development (the balance apparatus is located in the so-called inner ear. Poor balance can be a more reliable sign of the ear infection then pulling on the ear) ?
    - Poor appetite, vomiting and diarrhea.
    - Poor weight gain.
    - Frequent upper respiratory infections.
    - Frequent and more severe exacerbations of reactive airway disease/asthma. Allergies.
    - Resistance to multiple antibiotics.
    - Sleep problems
    - Possibility of mastoiditis (infection in the bone air cells behind the ear) and meningitis (think about it, only a thin layer of bone is separating the middle ear from the brain tissue).

4. What are the possible complications of prolonged antibiotic use? Delay in the resolution of the above problems. Higher probability of permanent damage to the middle ear. Allergies. Resistance to multiple antibiotics. Dysbacteriosis (yes, it does exist, that's why your doctor recommends yogurt and lactobacilli). Prolonged diarrhea.

5. What and when to do? It is extremely important to convey be treated extremely aggressively in a very timely fashion, with the "big gun" antibiotics from the very beginning (remember, that is the first bout of ear infection in the US, not in this child's life) and if infection is not cleared - early referral to the ENT specialist with EARLY surgery for ear tube placement at least (with the removal of adenoids and tonsils if necessary).

If any problems arise with the insurance company - write them a letter, explain the specifics of the situation, be your child's advocate. The formal hearing testing should be performed on all adopted children. Objective tests (OAE and BAERs) are preferred to the subjective booth test. Here are the latest recommendations of the American Academy of Pediatrics on hearing testing of infants and children (February 2003):

While reading the recommendations, please note indications for screening (Table 1) as well as the descriptions and especially limitations of all hearing tests (Table 3). Fair language acquisition should not defer treatment and/or testing of your child.

6. For those who are still waiting for your first or second trip. Be sure to get as much information from the orphanage as possible. Write everything down. Absence of information on the medical and normal exam by the ENT in the orphanage does not exclude the possibility of a problem. Exact dates of the disease on the medical (Bronchitis, 02.02.2002-03.20.2002) usually mean hospitalizations. Don't be afraid to ask questions. The worst thing which can happened - they refuse to answer, but this way you can get the information you would NEVER be able to obtain later.

    - How often was your child sick with the colds?
    - How long does it take him/her to "shake off" the cold?
    - What helps?
    - Was the baby ever hospitalized since the original admittance to the orphanage?
    - What were the diagnoses?
    - What he/she was treated with?

This article was originally posted at in March 2003

The information appearing here is intended for educational purposes only. It should not be used as a substitute for professional medical advice tailored to your child's individual needs. If you have questions or concerns regarding your child's physical or mental health, please seek assistance from a qualified healthcare provider.

GLOBAL PEDIATRICS is an international adoption medical support service that has specialized in assisting families adopting from the Former Soviet Union through every step of the adoption process for the past ten years. Dr. Gordina's unique professional background and attention to detail ensure the highest possible level of service. She is recognized by her patients and peers as a leader and pioneer in the field and has presented her adoption-related research at sessions of the AAP, JCICS, NACAS and other meetings. Dr. Gordina has both participated in and organized several humanitarian missions to pediatric clinics and orphanages in the Former Soviet Union. For all questions regarding our services please check 
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