Paediatric: Ear Infections

What are Ear infections?

Otitis externa is infection and inflammation of the ear canal (Figure 1a&b) . This occurs more often in patients who dig their ears frequently and in regular swimmers. These patients usually experience ear pain, ear discharge and sometimes hearing loss. Treatment includes cleaning of the ear (aural toilet under microscope guidance), antibiotics ear drops and keeping the ear dry till the infection resolves. Sometimes, the infection may start off from an infected hair follicle, like a pimple or boil on the skin (Figure 2a&b) .

Middle ear infections (Otitis media) are more common in children due to their immature Eustachian tube (the tube that connects the middle ear to the back of the nose) and in adults with Eustachian tube dysfunction. Eustachian tube dysfunction results in inadequate ventilation of the middle ear. Patients with middle ear infection usually experience ear blockage, ear pain and occasionally, ear discharge (if there is a hole in the ear drum). In children, they may also have fever, become restless or agitated and have significant hearing loss that may affect their speech and language development. The hearing loss is usually due to accumulation of fluid behind the ear drum (otitis media with effusion – Figure 3a). Most middle ear infections settle with a course of antibiotics and treatment of the nose if required. In patients with fluid behind the ear drum that does not resolve after a period of watchful waiting or after a course of antibiotics, a grommet tube can be placed in the ear drum to drain the fluid (Figure 3b).