Chronic Middle Ear Infection in Children
(Chronic Otitis Media)
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Chronic middle ear infections can be caused by acute middle ear infections, blockage of the eustachian tube, injuries, burns, or placement of tubes through the eardrum.
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Children usually have hearing loss and ear discharge.
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A doctor diagnoses chronic middle ear infection based on examination findings.
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Treatment usually includes antibiotic drops and sometimes antibiotics taken by mouth, insertion of ear tubes, or both.
(See also Overview of Middle Ear Infections in Young Children and Otitis Media (Chronic) in adults.)
Causes
Chronic middle ear infections can be caused by an acute middle ear infection (usually several), blockage of the eustachian tube (the tube that connects the middle ear with the nasal passages), crushing or penetrating injuries to the ear, thermal or chemical burns, or blast injuries. Additionally, children who have head and face abnormalities resulting from chromosomal disorders, such as Down syndrome or cri du chat syndrome, or who have a cleft palate have an increased risk of chronic middle ear infections.
Chronic middle ear infections may flare up after an infection of the nose and throat, such as the common cold, or after water enters the middle ear while bathing or swimming in children who have a perforated eardrum or tubes. Usually, flare-ups result in a painless discharge of pus from the ear (see Ear Discharge). The pus may have a very foul smell.
Complications
Persistent flare-ups may cause
Polyps are noncancerous (benign), smooth growths that protrude from the middle ear through the perforation and into the ear canal.
Persistent infection can destroy parts of the small bones in the middle ear that connect the eardrum to the inner ear and conduct sounds from the outer ear to the inner ear (the ossicles), causing hearing loss.
A cholesteatoma is a noncancerous (benign) growth of white skinlike material in the middle ear. A cholesteatoma can destroy nearby bone and soft tissue and can eventually cause complications such as facial paralysis and abscesses in the brain or between the brain and the skull.
Symptoms
Diagnosis
A doctor diagnoses chronic middle ear infection based on examination findings (for example, when pus drains out of a hole in the eardrum or skinlike material accumulates in the hole or in a pocket in the eardrum). Samples of the pus are sent to a laboratory where bacteria can be grown (cultured).
If a doctor suspects a cholesteatoma or a complication, imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) are done.
Treatment
Doctors first clean any debris from the ear. At home, parents apply ear drops containing an antibiotic and possibly a corticosteroid. Children who have a severe infection are given antibiotics taken by mouth.
If infection lasts or comes back despite the use of antibiotics, doctors may, after a period of time, do a myringotomy with insertion of ventilating (tympanostomy) tubes. If the eardrum is damaged, surgery to repair the eardrum (tympanoplasty) may be done.
A cholesteatoma is removed surgically.
