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Chronic Middle Ear Infection in Children

(Chronic Otitis Media)

By

Udayan K. Shah

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Medically Reviewed Apr 2022 | Modified Sep 2022
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Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection.

  • 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.

  • Children usually have hearing loss and ear discharge.

  • A doctor diagnoses chronic middle ear infection based on the history and examination findings.

  • Treatment usually includes antibiotic drops and sometimes antibiotics taken by mouth, insertion of ear tubes, or both.

A Look Inside the Ear

Inside the Ear

Causes

Chronic middle ear infections can be caused by an acute middle ear infection Acute Middle Ear Infection in Children Acute middle ear infection is a bacterial or viral infection of the middle ear, usually accompanying a cold. Bacteria and viruses can infect the middle ear. Children with ear infections may... read more Acute Middle Ear Infection in Children (usually several), blockage of the eustachian tube (the tube that connects the middle ear Middle Ear The ear, which is the organ of hearing and balance, consists of the outer, middle, and inner ear. The outer, middle, and inner ear function together to convert sound waves into nerve impulses... read more with the nasal passages Nose and Sinuses The nose is the organ of smell and a main passageway for air into and out of the lungs. The nose warms, moistens, and cleans air before it enters the lungs. The bones of the face around the... read more ), 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 Down Syndrome (Trisomy 21) Down syndrome is a chromosome disorder caused by an extra chromosome 21 that results in intellectual disability and physical abnormalities. Down syndrome is caused by an extra chromosome 21... read more Down Syndrome (Trisomy 21) or cri du chat syndrome Cri-du-Chat Syndrome Cri-du-chat syndrome is a chromosomal deletion syndrome in which part of chromosome 5 is missing. (See also Overview of Chromosome Disorders.) Cri-du-chat syndrome is a rare syndrome in which... read more , or who have a cleft palate Cleft Lip and Cleft Palate A cleft is an opening that can form in the lip (cleft lip), roof of the mouth (cleft palate), or both if the tissue does not join together completely during pregnancy. Cleft lip and cleft palate... read more Cleft Lip and 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 Common Cold The common cold is a viral infection of the lining of the nose, sinuses, and throat. Many different viruses cause colds. Usually, colds are spread when a person's hands come in contact with... read more , 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 Ear Discharge Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have... read more ). The pus may have a very foul smell. Long-term exposure to air pollution and poor hygiene related to living in a low-resource community can also increase the risk of chronic middle ear infections.

Complications

Persistent flare-ups may cause

  • Polyps of the middle ear

  • Destruction of bones in the middle ear

  • Cholesteatoma

Middle ear 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 ossicles, which are 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, causing hearing loss Causes Causes .

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

Children usually have hearing loss and ear discharge. There is usually no pain unless a complication has occurred.

Children who have a cholesteatoma may have fever, dizziness (vertigo), and/or an earache and may also have white debris in the ear canal.

Diagnosis

Treatment

  • Antibiotic ear drops

  • Sometimes antibiotics taken by mouth

  • Sometimes myringotomy

  • Surgical removal of any cholesteatoma

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 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.

Myringotomy: Treating Recurring Ear Infections

During a myringotomy, doctors make a small opening in the eardrum to allow fluid to drain from the middle ear. Then they place a tiny, hollow plastic or metal tube (tympanostomy tube, or ventilating tube) in the eardrum through the opening. These tubes balance the pressure in the environment with that in the middle ear. Doctors recommend ventilating tubes for some children who have had recurring ear infections (acute otitis media) or recurring or persistent collections of fluid in their middle ears (chronic secretory otitis media).

Placement of ventilating tubes is a common surgical procedure that is done in a hospital or doctor’s office. General anesthesia or sedation is usually required. After the procedure, children usually go home within a few hours. Antibiotic ear drops are sometimes given after the procedure for about a week. The tubes usually come out on their own after about 6 to 12 months, but some types stay in longer. Tubes that do not come out on their own are removed by the doctor, sometimes under general anesthesia or sedation. If the opening does not close on its own, it may need to be closed surgically.

Children with ventilating tubes may wash their hair and go swimming, but some doctors recommend children do not submerge their head in deep water without using earplugs.

Drainage of fluid from the ears indicates an infection, and the doctor should be notified.

Myringotomy: Treating Recurring Ear Infections
Ear Tubes
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    When sound waves reach the ear, they are gathered by the funnel-shaped outer ear and channeled into the middle ear. At the opening to the middle ear, sound waves hit the tympanic membrane, or eardrum. The resultant vibrations then travel through the middle ear and the fluid-filled inner ear where they are converted to signals that are sent to the brain.

    Occasionally the middle ear can become clogged and infected. Children are especially susceptible to this condition because they have shorter, more narrow eustachian tubes, the tube which allows the middle ear to drain. As fluid and pressure build within the ear, the child may experience pain and hearing impairment. When the infections become long lasting or recur repeatedly it may be necessary for the child to have a tympanostomy.

    In this procedure, a small incision is made in the tympanic membrane and the built up fluid is drained out. A small tube is then inserted into the incision to allow continuous drainage over a period of a few months. Eventually the incision begins to heal and the tubes fall out naturally as the hole in the eardrum closes.

    There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery.

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