Ear infections are one of the most common complaints in children. When an ear infection lasts a long time or comes and goes, it is considered chronic. Chronic ear infections can cause permanent damage to the ear including hearing loss, which affects speech development.
A chronic ear infection can cause milder symptoms than an acute ear infection. Symptoms may affect one or both ears and may be constant or come and go. Signs include:
To diagnose a chronic ear infection, your doctor will do a detailed exam of your child’s ears, nose and throat and ask about any recent illnesses.
If the results of the exam are inconclusive, your child’s doctor may insert an instrument called a tympanometer — a soft plug containing a tiny microphone and speaker — into your child's ear. The device uses sounds and air pressure to measure the eardrum's flexibility at different pressures. Other diagnostic procedures may include:
If your child has had persistent ear infections or persistent fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist to test your child’s hearing, speech skills, language comprehension or developmental abilities.
There can be a number of causes for a chronic ear infection in a child. The most common cause is a buildup of fluid and mucus behind the eardrum, which does not drain properly through the ear’s Eustachian tube.
The Eustachian tube, which connects the upper throat to the middle ear, is smaller in children, making it more difficult for fluid to drain out of the ear. Because children’s immune systems are not as developed as an adult's, it makes it harder for them to fight infections. Infection can also result from a hole in the ear drum, or skin growing in the middle ear and mastoid bone.
Children are more prone to ear infections between ages 2 and 4, when their Eustachian tubes are shorter and narrower and prone to blockage. But boys and those with a family history of ear infections are more at risk for chronic ear infections. Environmental factors like second-hand smoke and lying down to drink from a bottle or sippy cup can also contribute to chronic ear infections.
To combat chronic ear infections, you can take these steps:
If your child is diagnosed with a chronic ear infection, treatments may include a combination of over-the-counter pain medication and ear drops. In rare instances, antibiotics may be prescribed.
Sometimes surgery is the best treatment for chronic ear infections. Surgical treatment can include:
For some chronic ear infections, placement of ear tubes are recommended. These tiny tubes are inserted into the eardrum to help with air exchange in the middle ear, allowing trapped fluid that causes infection to drain. The procedure is done under general anesthesia and takes less than 30 minutes. The tubes stay in for about six months to a year and fall out on their own.
If the adenoids are enlarged, surgical removal of the adenoids may be considered, especially if your child continues to have ear infections.
The adenoids are glands located in the roof of the mouth, behind the soft palate where the nose connects to the throat. If the adenoids become infected and enlarged, they can obstruct the Eustachian tubes which connect the middle ear to the back of the nose, and cause chronic ear infection. Surgery to remove the adenoids is done under general anesthesia.
If your child is diagnosed with a hole in the ear drum, the size of the hole will determine the type of procedure used to treat it.
The hole is patched with a graft of your child’s own tissue. This tissue is slipped behind or on top of the hole in the eardrum. To hold the tissue in place, the surgeon packs a tiny wad of special material behind it. This material slowly dissolves over several months while the eardrum heals.
Sometimes a tympanoplasty can be performed completely through the ear canal. But when the ear canal is too small or the hole is too large to be completely seen through the ear canal, the surgeon must reach the eardrum through an incision behind the ear. Because the incision is behind the ear, no scar is visible after it heals.
If the bones that help your child hear are damaged, during this procedure those bones are repositioned or replaced with a titanium prosthesis. Sometimes the hole is fixed first and a second procedure, six months later, is performed to repair the hearing bones.
Other complications of ear infections can include the formation of a skin-lined cyst (called a cholesteatoma) in the middle ear. Or, the infection spreads into the tiny mastoid bone in the middle ear. In either case, surgery called a mastoidectomy can be performed to stop the infection and prevent serious complications.
The surgeon will reach this area of the ear by an incision behind the ear. If the ear drum also needs repair, that will be done during the procedure, as well. Because the incision is behind the ear, no scar is visible after it heals. Sometimes a second surgery is needed to restore hearing, and this surgery is usually performed six to 12 months later.