Roughly 80% of children will have at least one ear infection before the age of three. Almost all of them will fall victim to at least one before they turn six. And they are the most common reason why parents bring their children to the doctor’s office. Although anyone can develop an ear infection, children, and particularly those under seven years of age, are particularly susceptible. Left untreated, the long term consequences can be surprising, and severe.
What is an Ear Infection?
An ear infection, also known as otitis media (OM), is the result of fluid that builds up behind the eardrum producing bacteria and causing an inflammation of the middle ear. There are three different types of ear infections.
Acute otitis media (AOM)
This is the most common of the three and is the most frequent diagnosis in sick children. It’s particularly prevalent in infants and preschoolers. It causes parts of the middle ear to become infected and swollen due to fluid being trapped behind the ear drum. This bacterial buildup dampens the vibrations of the eardrum, typically resulting in short-term hearing loss for the duration of the infection. Severe cases may even result in a bulging or perforated eardrum – causing significant pain in the ear. If this happens, medical treatment may be required in order to treat the perforation in the eardrum.
Chronic ear drum perforations become serious when they fail to close up on their own. The perforation may become big enough that the eardrum cannot move correctly – this then affects the way sound reaches the organ of hearing, potentially causing conductive hearing loss which can be highly problematic in a child’s early language development years. Chronic ear drum perforations are treated by repairing the hole with surgery.
Otitis media with effusion (OME)
The Eustachian tube normally drains fluid from your ears to the back of your throat – otitis media with effusion occurs when this tube becomes clogged. While OME isn’t an ear infection, the two are often related – otitis media with effusion can develop when the fluid remains trapped behind the eardrum even after an ear infection has run its course. This fluid can remain in the ear for weeks, even months at a time.
Children often show minimal or no symptoms for OME. The only common sign is hearing difficulties, which can be difficult for a child to express – so watch out for any suspicious behavior (turning up the TV, speaking louder, not being able to localise sounds, tugging on the ear, etc). A doctor may be able to see the fluid when looking at the eardrum, but that is not possible in all cases. OME isn’t necessarily associated with permanent hearing loss. However, if associated with frequent ear infections, more complications can occur. These complications include,
- Cysts in the middle ear
- Eardrum scarring (tympanosclerosis)
- Damage to the ear, causing hearing loss
- Affected speech or language delay
Chronic otitis media with effusion (COME)
This is when the fluid remains in the middle ear for a long time or repeatedly returns even when there’s no active infection. This is undesirable because when left untreated, the consequences could potentially include persistent hearing loss as well as an inability of the central auditory nervous system to reach its full potential.
Signs & Symptoms of an Ear Infection
Since ear infections are so common in young children — and for many even before they begin to talk — it’s a good idea to familiarize yourself on the signs and symptoms to look out for:
- Fussy, irritable behaviour
- Problems sleeping
- Issues balancing
- Lack of appetite
- Fluid draining from the ear
- Trouble hearing
- Pulling at the ear(s)
- Red outer ear
These are often symptoms associated with upper respiratory infections such as a stuffy, runny nose or a cough. Children are prone to catching these kinds of infections when exposed to groups of kids – as in child care, school or the playground. They will first catch the upper respiratory infection which may then develop into otitis media. Other known risks consist of exposure to tobacco smoke, air pollution, and certain atmospheric conditions.
All that to say, if you child is frequently congested, it could be more than just a regular cold. It may be manifesting itself as an ear infection and is worth seeing your family doctor or pediatrician.
The Long-term Impact of Ear Infections
Those who develop any level of otitis media before the age of six months will almost always have more frequent ear infection later on in their developing years. Ear infections, although common, must be treated appropriately. Most people with middle ear infection or fluid will have some degree of temporary hearing loss. Conductive hearing loss is when the transmission of sound from the environment to the inner ear is impaired, typically from a blockage in the external auditory canal or middle ear – this can either be temporary or permanent. Either way, it will reduce the amount of language processing practice the child is benefitting from in those early developmental years. Other challenges may include:
It’s important for children to hear consistent and clear speech sounds in order to develop strong language skills. Periods of hearing loss, even reduced hearing at an early age can have a major impact on a child’s language development. Their language development can plateau – they may begin mispronouncing words, which is an issue that could persist even after the child’s hearing has recovered.
Hearing loss/reduction caused from an ear infection can make it harder for kids to listen and follow instructions, especially while in the classroom. Consistent ear infections at an early age can also impact the development of a child’s auditory pathway, making it hard for them to process what it is they’re hearing. This is known as an auditory processing deficit. Kids with this typically have trouble processing two or more instructions or pieces of information, and also have trouble understanding speech in noise. This makes it difficult for them to stay focused, and they can miss key instructions in the presence of background noise.
Due to the potential negative impact on developing auditory processing that chronic otitis media can have, it is not surprising that associated skills can also be affected. Due to the inability to break up phonemes in words, a child who has had numerous ear infections can be at higher risk for reading difficulties, including dyslexia.
What to do?
To be clear, not all ear infections will lead to these kinds of repercussions. As mentioned earlier, almost every child will face one (or multiple) ear infection at some point – but I do want to stress the importance of appropriately monitoring their hearing health. This simply means to take action when action is needed. Keep an eye (or an ear) out for any concerning behaviour, and ask your doctor about a hearing test. According to the iHear program and the American Academy of Audiology, children should be getting their hearing tested in preschool, kindergarten, grade 1, 3, 5 and either 7 or 9. A simple hearing test isn’t much to ask for, especially when it comes to the long term well-being of our children.
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Renée is a licensed audiologist and CAOHC-certified Professional Supervisor (PS/A) whose professional background includes clinical experience in cochlear implants, pediatric audiology, global hearing health, adult rehabilitation, auditory neuropathy, FM system optimization, ototoxicity, and the genetics of hearing loss. As the Director of Audiology, she is responsible for clinical applicability, audiological testing program review, education, and support guidance for SHOEBOX Audiometry.