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Pediatric Chronic Ear Infections (Otitis Media)

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Summary

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.

Causes

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.

Symptoms

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:

  • A feeling of pressure in the ear or mild ear pain
  • Fluid draining from ears
  • Low fever
  • Fussiness in infants
  • Trouble hearing
  • Trouble sleeping

Tests and Diagnosis

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:

  • Blood tests – to determine if there is a bacterial or viral infection
  • X-ray – to get a clear picture of the inside of the ear
  • Ear culture – removal of fluid or other substances from the ear to check for infection

Other tests

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.

Treatment

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.

To combat chronic ear infections, you can take these steps:

  • Be sure your child is sitting up to drink from a bottle or sippy cup.
  • If your child is still breastfeeding, continue to age 12 months or longer if possible.
  • If the infection is caused by a hole in the ear drum, avoid swimming and prevent water from entering the eardrum during shower or bath by protecting it with a cotton ball coated in Vaseline.
  • Make sure your child is not exposed to second-hand smoke or air pollution.

Sometimes surgery is the best treatment for chronic ear infections. Surgical treatment can include:

Ear tubes (Myringotomy)

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.

Surgery to remove adenoids (Adenoidectomy)

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.

Surgery to repair a hole in the ear drum.

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.

  • A myringoplasty is an out-patient procedure performed to treat smaller holes. In this surgery, the hole is covered with a small piece of special paper, gel foam or fat from your child’s ear lobe that temporarily seals the hole, encouraging the body’s normal healing processes.
  • A tympanoplasty is an out-patient procedure performed to treat larger holes and the three tiny ear bones that help your child hear, if they are damaged.

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.

Surgery to treat infection in the ear bones or a growth in the middle ear

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.

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