Eight-year-old Basic 3 pupil of a public
primary school with ear discharge was sent home by the class teacher so
that the parents could take adequate medical care of her.
The child, on getting home, was welcomed
by the mother who offered her a cup of water, gave her a tablet of
paracetamol and rushed to a nearby chemist to get an ear drop and cotton
ball.
The next day, the young girl returned to
school and appeared strong; but a strong perception of foul odour led
the teacher to suspect that the girl had infections in the ear. She then
removed the cotton ball from her ear, after which a copious amount of
pus poured out of the girl’s ear.
The parents were advised to take her for
proper medical care. The young girl had developed a condition called
chronic suppurative otitis media, meaning she will battle ear discharge
for months or years.
Chronic suppurative otitis media, in a
lay man’s language, is chronic infection of the middle ear. It is a
common childhood infectious disease worldwide and it is the most common
cause of hearing impairment among people in the developing world.
It is characterised by drainage from the
middle ear for at least two weeks and is associated with an ear drum
perforation that is usually painless.
The discharge may be persistent or intermittent. The ear infection is usually preceded by an episode of acute infection.
Risk factors
- Increased incidence is seen in children with a history of multiple episodes of acute otitis media.
- Factors associated with low socio-economic status and inadequate
health care. These include living in crowded conditions, overcrowded
daycare attendance, etc.
- Poor nutrition and lower levels of zinc, selenium
,
calcium, and vitamin A . Frequent upper respiratory tract infections
and chronic diseases such as measles, human immunodeficiency virus (HIV)
infection, tuberculosis, diabetes, and cancer.
- Passive smoke exposure.
- Unhygienic practices such as bathing in contaminated ponds, streams
and rivers, unsterile ear piercing, and frequent cleaning of ears with
cotton buds
- Family history may also play a role in chronic middle ear infection
Causes
Chronic suppurative otitis media (chronic
middle ear infection) generally results from an acute ear infection
that is not diagnosed promptly or is inadequately treated. It easily
occurs in patients with pre-existing eardrum perforation.
The eardrum is a thin piece of skin that
is positioned between the ear canal and middle ear. The eardrum can also
serve to protect the inner ear from prolonged exposure to loud,
low-pitch noises.
It is advisable that parents are extra
careful in the use of cotton buds, as many have lost their ear drums in
the process due to trauma.
It can also occur after tympanostomy tube placement
Swimming or bathing in unclean water can lead to middle ear contamination with bacteria when an eardrum perforation exists.
Signs and symptoms
Hearing loss: The most common presenting
complaint is hearing loss, which occurs in about 50 to 60 percent of
patients with chronic ear infections. It is moderate to severe in up to
two-thirds of patients.
Hearing loss may occur in the unaffected
ear despite lack of evidence of bilateral disease; while longer duration
of ear discharge is associated with greater degree of hearing loss,
with an increased risk of hearing loss.
Ear discharge: The ear discharge may be
persistent or intermittent. It ranges from two weeks to three months.
Some patients had ear discharges for more than a year, while others may
have intermittent discharge till adulthood.
Ear pain: Ear pain is a sign of acute
infection and is not present in chronic infection. Fever, dizziness, or
ear pains are not common but when present, they alert the clinician to
consider complications of chronic ear infections.
The incidence of ear infections and
hearing impairment have increased in the past few years and this has
been largely attributed to the chronic ear infections.
Complications
Due to closeness of the ears to the
brain, most of the complications of chronic suppurative otitis media are linked
to the brain .The complications are postauricular abscess, facial nerve
paresis, mastoiditis, temporal abscess, intracranial abscess,
meningitis, otitic hydrocephalus, encephalocele and cerebrospinal fluid
(CSF) leak .
A mother will like to know if eardrops are safe for the
ear of her young daughter.
The answer to the question is simply yes,
but with conditions attached. Eardrops are safe as long as her
daughter’s eardrum is intact and not ruptured. However, there are
several things one should think about before using eardrops.
First, why is her daughter having ear
pain? Does she think she has an ear infection? There are different types
of ear infections. An infection in the middle ear is an infection
behind the eardrum. This is the classic type of ear infection that
produces pain and, often, fever.
The other type of ear infection is an
infection in the canal of the ear. Occasionally, children stick
something in their ear like a piece of paper, or a bead and it remains
there, which can cause pain.
Some may have small boil in the ear;
while ear wax can build up to cause discomfort. There are also other
less common causes of ear pain related to skin issues or infections that
are not actually in the ear.
The second thing to think about is the
type of eardrop you’re using, as there are many different brands. Some
eardrops are actual antibiotics and treat infections in the ear canal.
Antibiotic eardrops require a prescription from the doctor.
There are eardrops that just help relieve
ear pain topically. Such eardrops may not be helpful since pain
medications that are taken by mouth, like ibuprofen or paraetamol, work
just as well if not better.
Although ear wax is usually not a problem
(unless a doctor is having difficulty seeing the eardrum), there are
also eardrops that help dissolve ear wax. In general, do not try to
clean out your child’s ear wax with a cotton swab!
The ear canal is small and you could
accidentally rupture your child’s eardrum. There are several different
“ear wax dissolving drops” that you can try instead.
Overall, I would recommend that even
before you try the eardrops, take your daughter to her doctor. Usually, a
doctor can quickly look inside the ear to determine the cause of pain.
In addition some procedures such as ear
syringing and ear washing may be dangerous. Always ask or confirm from
your healthcare provider that your eardrum is intact before the ear is
washed or syringed or before you apply the eardrop.
This material may directly affect the
inner ear and the nerve that sends hearing impulse to the brain – the
result being infections and hearing impairment.
Last week, I defined chronic suppurative
otitis media (chronic ear infection) as a common childhood infectious
disease worldwide and explained that it is a common cause of hearing
impairment.
I also warned that it is characterised by
hearing loss, painless drainage of fluids from the middle ear for at
least two weeks, and perforation of eardrum. The painless ear discharge
can be recurrent or persistent and may last for years.
Since younger children may not be able to
explain their feelings, the parents will need to be observant to
identify some signs that will help the doctor to diagnose the condition.
Such signs are listed below:
Younger children may pull at their ears,
while older children may complain of earache or headache. Again, the
child may have difficulty sleeping or wake often during the night; he or
she may have fever, or the outside of the ear may appear red and
sensitive to touch.
Ear examination
Discharge can range from purulent to
fetid to cheese-like, and can fill the ear canal. A large central
perforation of the eardrum may be seen in most people affected. This is
visualised with the aid of an instrument used in examination of the ear
called otoscope
The diagnosis is based upon consistent
clinical findings (e.g., hearing loss and chronic ear discharge). Ear
swab for culture is also done. CT scan may be requested in some cases to
rule out other abnormalities.
Treatment
A torn (perforated) eardrum will usually
heal by itself within six or eight weeks. The eardrum is a skin-like
structure and, like skin that is cut, it will usually heal.
In some cases, a doctor may prescribe
antibiotic medicines if there is an infection or risk of infection
developing in the middle ear while the eardrum is healing.
A small procedure is an option to treat a
perforated drum that does not heal by itself. Also, a surgical
operation called tympanoplasty to repair the eardrum is done to improve
hearing.
Also, swimmers may prefer to have a
perforation repaired, as getting water in the middle ear can increase
the risk of having ear infection.
Using eardrops
Wash hands thoroughly with soap and
water, gently clean ears with a damp face cloth and then dry the ears.
Warm the drops to near body temperature by holding the container in the
palm of the hand for a few minutes.
If the drops are a cloudy suspension,
shake the bottle well for 10 seconds, check the dropper tip to make sure
that it is not chipped or cracked, draw the medication into the
dropper, or hold the dropper-top bottle with the dropper tip down.
Tilt the affected ear up or lie on the
side. Pull the ear backward and upward (or if applying on a child
younger than three years of age, pull backward and downward) to open the
ear canal. Apply the correct number of drops in the ear.
Gently press on the small skin flap over
the ear to help the drops to run into the ear canal. Keep the ear tilted
up for a few minutes or insert a soft cotton plug in the ear. Replace
and tighten the cap or dropper right away, and wash the hands to remove
any medication.
In conclusion, have your child vaccinated
with the pneumococcal vaccine. It reduces the incidence of otitis media
(middle ear infections) and should be given to all babies from infancy.
Kindly talk to an Ear, Nose, Throat
surgeon for more on chronic ear infections.
