What is otitis media?

Otitis media refers to the inflammation of the middle ear. When this condition is caused by an infection, it is termed “acute otitis media.” This occurs when a cold, allergy, or upper respiratory infection, combined with bacteria or viruses, leads to the buildup of pus and mucus behind the eardrum, which blocks the Eustachian tube. This results in earache and swelling.

When fluid accumulates in the middle ear without infection, it is referred to as “otitis media with effusion.” This can occur during recovery from an ear infection or just before another one develops. Fluid may remain in the ear for weeks or even months. If discharge from the ear persists or keeps returning, it may be classified as a chronic middle ear infection. Fluid can linger in the ear for up to three months following an infection. If left untreated, chronic ear infections can lead to serious complications, including temporary or permanent hearing loss.

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How does otitis media affect a child’s hearing?

All children with a middle ear infection or fluid experience some degree of hearing loss. The average hearing loss in ears with fluid is about 24 decibels, which is comparable to wearing earplugs (this level is similar to the softest whispers). Thicker fluid can lead to more significant hearing loss, reaching up to 45 decibels, which is in the range of conversational speech.

Your child may show signs of hearing loss if they have difficulty understanding certain words and tend to speak louder than usual. Essentially, a child with hearing loss from middle ear infections will perceive sounds as muffled and may misunderstand speech rather than experiencing complete deafness. However, the impact can be substantial; the child may struggle to consistently understand speech in noisy environments, such as classrooms, potentially delaying the development of crucial speech and language skills.

Types of hearing loss

  • Conductive hearing loss occurs due to issues in the external auditory canal or middle ear. This type of hearing loss is usually temporary and more common in individuals under 40. If chronic ear infections are left untreated, they can lead to conductive hearing loss, but draining the infected middle ear typically restores normal hearing.
  • Sensorineural hearing loss results from damage to the auditory division of the eighth cranial nerve or the inner ear. Historically, this type of hearing loss is more prevalent in middle-aged and older individuals; however, prolonged exposure to loud music can also cause sensorineural hearing loss in adolescents.

When should a hearing test be performed?

A hearing test should be conducted for children who experience frequent ear infections, have hearing loss lasting more than six weeks, or have fluid in the middle ear for over three months. Various medical devices are available to assess a child’s hearing, Eustachian tube function, and eardrum reliability, including otoscopes, tympanometers, and audiometers.

Do children lose their hearing for reasons other than chronic otitis media?

Yes, children can experience temporary hearing loss for reasons other than chronic middle ear infections and Eustachian tube dysfunction. These include:

  • Cerumen impaction: Compacted earwax.
  • Otitis externa: Inflammation of the external auditory canal, often referred to as “swimmer’s ear.”
  • Cholesteatoma: A growth of squamous cell epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media.
  • Otosclerosis: A disease affecting the bony labyrinth of the ear, more common in adults, characterized by the formation of soft, vascular bone, leading to progressive conductive hearing loss due to the fixation of the stapes. Sensorineural hearing loss may occur if the cochlear duct is involved.
  • Trauma: Injury to the ear or head can lead to temporary or permanent hearing loss.