Q: My five-year-old son has had six ear infections in the past nine months. It seems to affect his left ear and recently I noticed that he does not always respond when spoken to. Initially, I thought that he was being cheeky with the ‘selective hearing’ but his teachers have also raised concerns about the same thing.
Can ear infections cause deafness? What should I do? Should he be admitted for intravenous antibiotics for a few days (perhaps the syrup form of treatment has not been working)?
Dr Mukuhi Ng’ang’a
Ear infections are some of the most common problems in children aged below seven. Most of the time, ear infections resolve without long-term problems but a few can be a challenge.
Complications in children
Hearing loss: Ear infections can lead to fluid accumulation inside the ear. Often, the body clears this fluid over a few weeks but in some cases, it can last months. This can lead to difficulty in hearing.
Hearing difficulties in children can lead to several other problems including:
• Difficulties speaking • Problems reading • Poor attention span • Poor learning ability • Inability to perform day to day activities independently It is very rare, however, for children to develop permanent hearing loss, even when they have had several ear infections. Permanent hearing loss occurs when the delicate structures inside the ear (bones, nerves) are damaged.
Balance problems: The inside of the ear is partially responsible for keeping one steady on their feet. Damage to the ear can lead to balance problems.
Tearing of the eardrum: The eardrum can get a perforation leading to leakage of fluid from the ear canal. The body usually repairs these perforations over a few days. A few cases, however, continue to intermittently leak for months.
Rare complications: Occasionally, ear infections can spread to the bones around the ear and even the brain.
Although most clinicians are quick to prescribe antibiotics, most ear infections do not need to be treated with them. They clear up on their own with the use of painkillers.
Antibiotics are only prescribed if:
• The ear infection does not improve after three days. • If your child is less than two years and has an infection in both ears. • If your child has a medical condition that may impair his/her immunity or put them at increased risk of complications. Remember, antibiotics are only effective against bacteria. Most ear infections in children are caused by viruses (a few by fungi). The body is capable of clearing most viral infections on its own.
In your case, there is no need to admit your child for intravenous antibiotics.
Adenoids and ear infections
The ear is connected to the back of the nose by a special tube known as the Eustachian tube. This tube allows normal secretions to drain out of the ear. If this tube is blocked, one is predisposed to ear infections. Adenoids are spongelike structures at the back of the nose. These may block the opening of the Eustachian tube leading to recurrent ear problems.
If your child has enlarged adenoids as evidenced by symptoms such as snoring, mouth breathing, nasal speech and sleep problems, talk to your doctor about surgically removing them to help deal with recurrent ear problems.
Nasal blockage, allergies and sinusitis
Most ear infections are associated with upper respiratory tract infections such as the flu. They may also flare up when the nose is full of thick secretions from inflamed sinuses or from irritation of allergies.
Cleft palate and ear infections
The bone and face structure of children with cleft palate may make it difficult for the Eustachian tube to clear secretions in the ear, leading to increased ear infections.
Vaccination and ear infections
The frequency of ear infections caused by bacteria can be significantly reduced through immunisation. Talk to your child’s paediatrician about vaccinations for influenza and pneumonia. In addition, it is also important for your child to be up to date with their meningitis vaccination.
If your child is having recurrent ear infections or if the infection has failed to respond to treatment and is causing hearing loss, he may require a surgery.
Usually, the doctor inserts a small tube (known as a ‘grommet’) through the eardrum causing fluid to freely drain from the ear and allowing normalisation of internal ear pressures.
This procedure is referred to as a tympanostomy. It usually reduces the number of ear infections your child gets. As your child grows older, this tube falls usually out leaving the eardrum well healed. If it does not fall out, the doctor will remove it.
To help avoid inner ear infections:
• Keep your child away from smoky environments. Children whose parents expose them to cigarette smoke have more ear infections than the rest of the population. • Make sure your child is up to date with vaccinations. • Young children should avoid bottle-feeding whilst lying down. • Keep your child’s allergies/sinusitis under control. • Do not stick cotton wool buds your child’s ears. • Get your child reviewed by a doctor if they have persistent nasal blockage signs such as snoring. • Teach your child good hand hygiene habits to help prevent him from getting common communicable ear, nose and throat infections.
How to help your child
Visit an ear, nose and throat (ENT) specialist who will assess your child’s ears and take a detailed medical history.
He/she will also assess your child for possible blockages such as enlarged adenoids. Carry all the medication you may have been giving your son over the past few months and the vaccination card as well.