It’s All In Your Head: Chronic Ear Infections in Children
Ear infections are one of the most common medical complaints in children. When an ear infection lasts a long period of time or recurrently comes and goes, it is labeled chronic. Chronic ear infections can cause permanent damage to the ear including hearing loss, which impacts speech development.
What are the common signs and symptoms of chronic ear infections?
A chronic ear infection can cause milder symptoms than an acute ear infection. Symptoms may affect one or both ears and may be constant or come and go. Signs include:
- A feeling of pressure in the ear or mild ear pain
- Fluid draining from ears
- Low fever
- Fussiness in infants
- Trouble hearing
- Trouble sleeping
How are chronic ear infections diagnosed?
To diagnose a chronic ear infection, your doctor will do a detailed exam of your child’s ears, nose and throat and ask about any recent illnesses.
If the results of the exam are inconclusive, your child’s doctor may insert an instrument called a tympanometer — a soft plug containing a tiny microphone and speaker — into your child’s ear. The device uses sounds and air pressure to measure the eardrum’s flexibility at different pressures. Other diagnostic procedures may include:
- Blood tests – to determine if there is a bacterial or viral infection
- X-ray – to get a clear picture of the inside of the ear
- Ear culture – removal of fluid or other substances from the ear to check for infection
If your child has had persistent ear infections or persistent fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist) to test your child’s hearing.
What are the causes of Pediatric Chronic Ear Infections?
Fluid buildup
There can be many causes for a chronic ear infection in a child. The most common cause is a buildup of fluid and mucus behind the eardrum, which does not drain properly through the ear’s eustachian tube.
Eustachian tube size
The eustachian tube, which connects the upper throat to the middle ear, is smaller in children, making it more difficult for fluid to drain out of the ear. Because children’s immune systems are not as developed as an adult’s, it makes it harder for them to fight infections. Infection can also result from a hole in the ear drum, or skin growing in the middle ear and mastoid bone.
Age
Children are more prone to ear infections between ages two and four, when their eustachian tubes are shorter and narrower and prone to blockage.
Risk factors
But boys and those with a family history of ear infections are more at risk for chronic ear infections. Environmental factors like second-hand smoke and lying down to drink from a bottle or sippy cup can also contribute to chronic ear infections.
How are Pediatric Chronic Ear Infections treated?
Prevention
To combat chronic ear infections, you can take these steps:
- Be sure your child is sitting up to drink from a bottle or sippy cup.
- If your child is still breastfeeding, continue to age 12 months or longer if possible.
- If the infection is caused by a hole in the ear drum, avoid swimming and prevent water from entering the eardrum during shower or bath by protecting it with a cotton ball coated in Vaseline™.
- Make sure your child is not exposed to second-hand smoke or air pollution.
Medication
If your child is diagnosed with an ear infection, treatments may include a combination of over-the-counter pain medication and antibiotics may be prescribed.
Surgical options
For some chronic ear infections, placement of ear tubes are recommended. These tiny tubes are inserted into the eardrum to help with air exchange in the middle ear, allowing trapped fluid that causes infection to drain. The procedure is done under gas anesthesia and takes less than 30 minutes. The tubes stay in for about six months to a year and fall out on their own.
In some instances, an adenoidectomy in addition to ear tubes is recommended. The adenoids are glands in the roof of the mouth, behind the soft palate where the nose connects to the throat. If the adenoids become infected and/or enlarged, they can obstruct the eustachian tubes which connect the middle ear to the back of the nose, and cause fluid to build up behind the ear drum. Surgery to remove the adenoids is done under general anesthesia.
