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.
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 <http://www.uptodate.com/contents/selenium-pediatric-drug-information?source=see_link>, 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
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.
Due to closeness of the ears to the brain, most of the complications of chronic suppurative otitis media <http://emedicine.medscape.com/article/859501-overview> 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 .
To be concluded.