Child care: Chronic middle ear infection

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Chronic middle ear infection develops after recurrent infections that impairs the eardrum or results to the formation of a cholesteatoma which promotes the development of infection.

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What are the possible causes?

A chronic middle ear infection can be triggered by an acute infection, crushing or penetrating ear injuries, Eustachian tube blockage, blast injuries or chemical burns. In addition, children who have face or head abnormalities due to chromosomal disorders such as Down’s syndrome or cleft palate face a higher risk for a chronic middle ear infection.

This infection can also erupt after an infection of the throat or nose such as common cold or when water enters the middle ear while swimming or bathing among children who have a perforated eardrum. In most instances, the flare-ups can cause a painless drainage from the ears and the pus might have a very foul smell.

Chronic middle ear infection
This infection can also erupt after an infection of the throat or nose such as common cold or when water enters the middle ear while swimming or bathing among children who have a perforated eardrum.

Possible complications

If a child has recurrent ear infections, the following complications can occur:

  • Polyps – non-cancerous, smooth growths that protrude from the middle ear via a perforation and into the ear canal
  • Persistent infection – this can damage regions of the small bones in the middle ear that links the eardrum to the inner ear and transmit sounds from the outer ear to the inner ear, resulting to hearing loss
  • Cholesteatoma – this is a non-cancerous growth of white, skin-like material in the middle ear. It can damage the adjacent bone and soft tissue and eventually trigger complications such as brain abscess and facial paralysis.

What are the indications of a chronic middle ear infection?

Among children, they usually experience hearing loss along with drainage from the ear. There is no pain unless a complication has developed. Take note that children who have a cholesteatoma might have white debris within the ear canal.

How is it diagnosed

The doctor can diagnose the ear infection based on the findings during the assessment. A sample of the pus is sent to the laboratory for analysis. In case the doctor suspects a cholesteatoma or a complication, imaging studies such as CT scan or MRI might be carried out.

Management

The doctor might initially clean any debris present in the ear. Irrigation of the ear is performed using a bulb syringe and a solution of sterile water and vinegar at least 3 times daily.

Parents can also apply ear drops that contain corticosteroids and an antibiotic 2 times a day for 14 days. Children who have serious infections are given antibiotics orally for 10 days. In case the infection lasts or recurs despite the administration of antibiotics, the doctor might perform myringotomy with insertion of ventilating tubes. If the eardrum is impaired, surgery to fix the eardrum might be carried out. As for a cholesteatoma, it is taken out surgically.

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