Readers need to understand that Eustachian tube Irritation [ETI] is a concept, not a medically proven condition.
Most doctors now accept that reflux can make babies irritable. Most accept that acute ear infection can also make a baby distressed. However the Eustachian tube Irritation concept goes much further and looks at a combination of problems that cause a specific group of symptoms that are seen in many distressed babies.
THE CONCEPT OF ETI
When infants have the combination of gastroesophageal reflux [GOR] and allergy [or a family history of allergic problems] they are at risk of developing Eustachian tube dysfunction [ETD] and later, middle ear infections and/or middle ear effusions [MEE].
Eustachian tube dysfunction occurs when the pressure in the middle ear becomes negative. This is described in detail in the chapter about the ear. ETD can cause pain, especially when the infant is lying down, and when sucking.
Infants with Eustachian tube Irritation have a consistent pattern of symptoms [i.e., behaviours noticed by parents] and signs [i.e., findings on examination]. These are described in detail in the chapter called Eustachian tube Irritation–the condition.
The pattern of behaviours can be explained by understanding gastro oesophageal reflux [GOR], allergy, ETD and middle ear problems.
ETI can have many consequences and these are discussed in this book.
….GOR and allergy/intolerance in more detail in later chapters but will describe briefly what I mean by reflux and allergy at this stage….
GASTRO OESOPHAGEAL REFLUX [GOR]
Reflux may be overt or covert. As the names imply, overt reflux is obvious vomiting. Covert reflux is not obvious: it is often referred to as ‘silent’ reflux.
Refluxing needs to be distinguished from positing, which is milk overflow. The milk that comes back up as positing is fresh [undigested] milk that often comes up when the baby brings up wind within a few minutes of a feed. Positing does not cause a problem since the milk is virtually unchanged.
Overt reflux is obvious episodes of vomiting. It is the [usually] small curdy vomits that occur after feeds, sometimes for many hours after a feed, occasionally up to the time of the next feed. Milk may come up with very little force and just be seen in the infant’s mouth. Occasionally, if there is only a very small amount of fluid refluxing, parents may mistake the curds for saliva. However the sour/acid smell of refluxed milk is different from saliva. For some infants….
Eustachian tube Irritation [ETI] is the name of the concept that I have developed to describe a specific cause of infant distress.
Infants with gastro oesophageal reflux have chemical irritation of the back of the nose and throat from acid and enzymes from the stomach.
Infants who have an ‘allergic’ tendency produce more swelling and mucus than other infants.
The combination of reflux and allergy predisposes an infant to develop irritation—causing swelling and increased mucus at the opening of the Eustachian tube [ET].
The irritation interferes with ET function, causing negative pressure to develop in the middle ear, called Eustachian tube dysfunction [ETD]. This is often followed by middle ear infection and/or effusion.
The infants present with specific symptoms related to combinations of reflux, allergies/intolerances and middle ear problems.
Infants with ETD have pain on lying down and when trying to suck vigorously. They often have feeding and sleeping problems and are often more comfortable when sucking a dummy, fist or thumb.
Early and severe middle ear problems make these infants prone to problems for their longer-term development….