Ear infection can be chronic, prevent it

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.