tag:theconversation.com,2011:/us/topics/ear-fungus-44200/articlesEar fungus – The Conversation2022-09-30T12:27:25Ztag:theconversation.com,2011:article/1892132022-09-30T12:27:25Z2022-09-30T12:27:25ZSummer swimming season may be over, but you can still get swimmer’s ear – and you don’t even need to go in the water<figure><img src="https://images.theconversation.com/files/487181/original/file-20220928-18493-p69mat.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5126%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Both children and adults are susceptible to the ear infection known as "swimmer's ear."</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-swimmer-wearing-a-bathing-cap-and-goggles-royalty-free-image/57434909?adppopup=true">Kay Blaschke/Stock4B-RF via Getty Images</a></span></figcaption></figure><p>Many forms of ear infections strike children and adults alike, but among the most common is <a href="https://doi.org/10.1093/pch/18.2.96">acute otitis externa</a>, also known as swimmer’s ear.</p>
<p>About 10% of Americans will <a href="https://www.ncbi.nlm.nih.gov/books/NBK279353/">experience swimmer’s ear during their lifetimes</a>. Adults are <a href="https://doi.org/10.3238/arztebl.2019.0224">affected more commonly</a>, and children only rarely, generally ages 5 to 12. </p>
<p>But you <a href="https://www.pennmedicine.org/updates/blogs/health-and-wellness/2018/august/swimmers-ear#:%7E:">don’t have to be swimming</a> to get swimmer’s ear. Go out jogging or walking, or do yardwork on a hot day, and moisture from perspiration can drip in your ear. However, the occurrence <a href="https://doi.org/10.3238/arztebl.2019.0224">increases fivefold in swimmers</a> – thus the reason the condition came to be called “swimmer’s ear.” It also occurs more frequently in tropical climates because of humidity and higher temperatures. </p>
<p>As doctors who specialize in ear problems, <a href="https://ent.ufl.edu/faculty-staff/faculty/rex-haberman-md/">we are actively involved</a> in <a href="https://ent.ufl.edu/faculty-staff/faculty/thomas-schrepfer-md/">research and clinical treatment</a> for children and adults struggling with ear, nose and throat problems. Practicing in the state of Florida, we’ve certainly seen our share of patients with swimmer’s ear.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/iMOmuokyyKw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">If left untreated, swimmer’s ear could cause temporary hearing loss along with bone and cartilage damage.</span></figcaption>
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<h2>Causes and symptoms of swimmer’s ear</h2>
<p>Swimmer’s ear is an infection in the external ear canal, the tube leading from the ear opening to the eardrum. Typically, swimmer’s ear occurs only in one ear, and sometimes the eardrum itself is affected. Moisture trapped in the canal leads to a break in the skin barrier and <a href="https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/otitis-externa#causes-of-otitis-externa">creates an opening for certain bacteria types</a> to enter or existing ones to overgrow. </p>
<p>One of these culprits is the bacterium <em>Pseudomonas aeruginosa</em>, which is <a href="https://www.cdc.gov/hai/organisms/pseudomonas.html">present in soil and water</a> throughout the world. These bacteria favor moist areas, such as sinks, toilets, inadequately chlorinated swimming pools and hot tubs, as well as outdated or inactivated antiseptic solutions.</p>
<p>If you have the infection, you’ll know it. Symptoms generally appear a few days after infection. The main symptom of swimmer’s ear <a href="https://kidshealth.org/en/parents/swimmer-ear.html">is severe pain</a> and discomfort.
It’s particularly noticeable when the outer ear is tugged, or by touching the tragus – that’s the small bump at the front of your ear. Other symptoms include itchiness inside the ear, redness, swelling and drainage. A feeling of fullness, or the perception of a plugged ear, may also occur, along with disturbed balance and temporary hearing loss. </p>
<h2>Predisposition to swimmer’s ear</h2>
<p>Numerous factors can <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/swimmers-ear">predispose someone to swimmer’s ear</a>. They include a narrow ear canal, and skin diseases such as eczema or psoriasis. In addition, individuals wearing ear plugs, <a href="https://stvincents.org/about-us/news-press/news-detail?articleid=34511#">ear buds</a> or <a href="https://www.mayoclinic.org/diseases-conditions/swimmers-ear/symptoms-causes/syc-20351682">hearing aids</a> may be at an increased risk. Diabetics may also be <a href="https://doi.org/10.1016/j.amjoto.2016.04.005">more prone to the infection</a>. </p>
<p>Swimmer’s ear can also come from something getting stuck inside the ear, excessive ear cleaning or contact with chemicals in hair dye or hairspray. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="This illustration, depicting both the outer and inner ear, shows how the infection from swimmer's ear has narrowed the ear canal." src="https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485738/original/file-20220920-11468-awmqty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An illustration showing inflammation and narrowing of the ear canal.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/swimmers-ear-otitis-externa-royalty-free-illustration/1003084366?adppopup=true">ttsz/iStock via Getty Images Plus</a></span>
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<h2>Diagnosis and treatment</h2>
<p>Swimmer’s ear is diagnosed after a health care provider has gathered a thorough history and examined the inside of the ear. The ear canal will typically look red, swollen and moist. There is also a possibility of fluid drainage or the appearance of scaly, shedding skin. Depending on the degree of swelling, the eardrum may be hard to see. A sample of fluid may be removed from the ear and sent to a lab to look for bacteria or fungus.</p>
<p>Eardrops are commonly <a href="https://www.mayoclinic.org/diseases-conditions/swimmers-ear/diagnosis-treatment/drc-20351688#:%7E:">used to treat swimmer’s ear</a>. These drops often contain antibiotics to kill the infection and steroids to stop the swelling.</p>
<p>One such eardrop is <a href="https://www.webmd.com/drugs/2/drug-76594/ciprodex-otic-ear/details">Ciprodex</a>. It contains ciprofloxacin, an antibiotic, and dexamethasone, a powerful steroid. Patients will need to place about four to five drops in the infected ear canal twice a day for seven to 10 days. </p>
<p>Another commonly prescribed drop is <a href="https://www.webmd.com/drugs/2/drug-63597/floxin-otic-ear/details">Floxin</a>, which contains an antibiotic but not a steroid. It is commonly prescribed in less swollen but still infected ears. </p>
<p>Other drop preparations include <a href="https://www.webmd.com/drugs/2/drug-3715-8196/cortisporin-otic-ear/neomycin-polymyxin-hydrocortisone-suspension-otic/details">Cortisporin</a>, which contains a commonly used combination of neomycin and polymyxin B, as well as hydrocortisone. However, neomycin is also damaging to the inner ear, so doctors nowadays often turn to Ciprodex or Floxin.</p>
<p>In some cases, the ear canal is too swollen for drops to reach the infected area, so the physician may place a wick or stent in the ear canal to keep it open. This will usually be left in place for three to five days until removed by the doctor, although occasionally the wick falls out once the swelling subsides. Usually, after 10 days the infection is resolved and the ear canal skin returns to normal. </p>
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<figcaption><span class="caption">Don’t try to get the water out with a Q-tip.</span></figcaption>
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<h2>Managing a persistent infection</h2>
<p>Sometimes swimmer’s ear may not resolve after seven to 10 days of treatment with eardrops. Oral antibiotics are typically recommended if the infection <a href="https://my.clevelandclinic.org/health/diseases/8381-swimmers-ear-otitis-externa">has spread beyond the ear canal</a> or in patients with poorly controlled diabetes. Hospitalization for swimmer’s ear is rarely necessary; however, complications that can occasionally lead to hospitalization include fever, worsening discharge, extensive narrowing of the ear canal or failure of previous treatments.</p>
<p>Among the <a href="https://www.webmd.com/cold-and-flu/ear-infection/get-water-out-of-ear">precautions you can take</a> to prevent swimmer’s ear: Keep the ear canal dry. Tip your head to one side to help the water drain. Use a soft towel or cloth, or gently use a hair dryer near it. If the self-cleansing mechanism of the ear canal is impaired, then the ear canal should be cleansed by a physician.</p>
<p>Since most bacteria prefer a <a href="https://www.verywellhealth.com/ph-balance-significance-function-associated-conditions-5205825#:%7E:">pH-neutral environment</a>, reducing the pH in the ear canal can prevent bacterial overgrowth. A homemade liquid tincture can be mixed from a solution of half rubbing alcohol and half distilled white vinegar. The alcohol combines with the water in the ear and then evaporates. This removes the water while the acidity of the vinegar keeps bacteria from growing. </p>
<p>Two to three drops are usually sufficient and can be applied as a preventive measure soon after the ear has been exposed to moisture. This liquid solution is not a replacement for medical treatment of an actual ear infection and is meant to be used only in people who are prone to such infections because of prolonged or frequent exposure to moisture. </p>
<p>Also, it is important to differentiate swimmer’s ear from a <a href="https://kidshealth.org/en/parents/otitis-media.html">middle ear infection</a>, the most frequent reason for the use of antibiotics in children under age 5. <a href="https://theconversation.com/a-pediatrician-explains-a-spike-in-ear-infections-this-summer-after-covid-19-restrictions-lifted-166461">Middle ear infections</a> are usually associated with a viral upper respiratory infection, and they are more often seen during fall and winter, when influenza and cold viruses are more prevalent.</p><img src="https://counter.theconversation.com/content/189213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Perhaps surprisingly, it’s possible to get swimmer’s ear without a dip in the pool, lake or ocean. Two doctors explain what this painful infection is and how to get rid of it.Thomas Schrepfer, Assistant Professor of Pediatric Otolaryngology, University of FloridaRex Haberman, Associate Clinical Professor of Otology and Neurotology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1027732018-12-09T19:08:17Z2018-12-09T19:08:17ZHow researchers assess whether medications work<figure><img src="https://images.theconversation.com/files/248953/original/file-20181205-186073-byqw7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ear infections are no fun. The OSTRICH clinical trial looked at whether oral steroid medications might help. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/view-abovebaby-crying-bed-before-bedtime-772323976?src=awe6dqAVYr9zrU9frzOTyA-1-22">from www.shutterstock.com </a></span></figcaption></figure><p><em>This article is in the series <a href="https://theconversation.com/au/topics/this-is-research-61770">This is research</a>, where we ask academics to share and discuss open access articles that reveal important aspects of science. Today’s piece explains how clinical trials assess drug effectiveness.</em></p>
<hr>
<p>Ear infections, or “<a href="https://www.childrens.health.qld.gov.au/fact-sheet-middle-ear-disease/">otitis media</a>”, can cause of a lot of pain and discomfort in youngsters. In some children, persistent infections result in hearing loss. </p>
<p>But what sort of treatment should these children have, and how can doctors work out what is actually effective? </p>
<p>Here’s where a type of research called a clinical trial is useful. </p>
<p>Let’s take a look at the “<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31490-9/fulltext">OSTRICH</a>” clinical trial, which investigated the impact of a short course of oral steroids (prednisolone) in children with persistent ear infection leading to fluid build-up in the ear, and hearing loss. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bulging-ear-drums-and-hearing-loss-aboriginal-kids-have-the-highest-otitis-media-rates-in-the-world-64165">Bulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world</a>
</strong>
</em>
</p>
<hr>
<h2>What is a clinical trial?</h2>
<p>Clinical trials are the favoured type of study for showing cause and effect. They sit near the top of the study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/">pecking order</a>, only outdone in importance by summaries of lots of clinical trials put together. </p>
<p>Clinical trials can assess impact of a medication on a disease or condition. Researchers generally test a particular treatment, and compare the outcome to a different treatment or no treatment (if it’s ethical to do so). </p>
<p>The ideal design is one when the researchers and participants do not know who is assigned to the different treatments being tested. This is referred to as blinding. </p>
<p>Blinding may not always be possible. In food trials for example (where we do most of our work), it is very hard to blind a participant from a food they need to eat. Measures can be taken to minimise the impact of this, though.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/randomised-control-trials-what-makes-them-the-gold-standard-in-medical-research-78913">Randomised control trials: what makes them the gold standard in medical research?</a>
</strong>
</em>
</p>
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<h2>The OSTRICH trial</h2>
<p>The OSTRICH trial used an approach where they tested a real medication, in this case a steroid, and compared it to a treatment that was almost the same but without the active ingredient – called a placebo. </p>
<p>The researchers worked with 389 children aged two to eight years with ear infection symptoms, fluid build up for at least three months, and with confirmed hearing loss in both ears. Two hundred kids were allocated to received oral steroids, and 189 to receive placebo for seven days. </p>
<p>With this approach they recorded the impact of the treatments on the ear canal and middle ear, and also conducted clinical tests for hearing. The parents kept a diary of symptoms, and completed questionnaires.</p>
<p>The children were followed up five weeks weeks, six months and 12 months after completion of the treatment. The primary outcome for the trial was acceptable hearing confirmed by an <a href="https://medlineplus.gov/ency/article/003341.htm">audiometry test</a> at five weeks. </p>
<p>Both the families and the researchers did not know who had the real medication until the study was finished – this is called double blinding. This time period meant that researchers had to be careful with the information they collected to avoid <a href="http://ebooks.iospress.nl/volumearticle/40076">potential errors</a>. </p>
<h2>Kids are unpredictable</h2>
<p>Even with the best laid plans, children are hard to predict. As well as looking at the effect of a medication on a disease, the number of study participants who follow all instructions and finish the study as per the plan is an important outcome. </p>
<p>Not all of the starting 389 kids finished the full 12 months of the OSTRICH trial, and this was due to a variety of reasons. Some families withdrew consent to take part, some children didn’t meet the hearing loss criteria at the outset, and some families couldn’t be contacted as time moved on. Some children didn’t always take their medication. This won’t surprise you if you have ever needed to give a child medicine – of any sort. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1066&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1066&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1066&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1339&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1339&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249122/original/file-20181205-186055-11fqaje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1339&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lots of things happen during a clinical trial that reduce your sample size.</span>
<span class="attribution"><a class="source" href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31490-9/fulltext">Francis and colleagues, Lancet Volume 392, Issue 10147, p557-568, August 18, 2018</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>In children who did complete the trial, the results showed no statistically significant difference between children treated with the steroid and those treated with the placebo drug. Assessed at five weeks, hearing was only slightly improved in the group assigned the real medication compared to the group given the placebo. </p>
<p>The study authors wrote: </p>
<blockquote>
<p>A short course of oral prednisolone is not an effective treatment for most children aged 2–8 years with persistent otitis media with effusion, but is well tolerated. One in 14 children might achieve improved hearing but not quality of life. </p>
</blockquote>
<h2>What didn’t they find?</h2>
<p>Clinical trials can only make conclusions regarding the effect of what they are testing on the group they have tested it with. </p>
<p>This study quite simply shows that in children aged two to eight, a one-week course of oral steroids has minimal impact on hearing loss in children who had hearing loss due to ear infection and fluid build up, and assessed five weeks after the treatment started. </p>
<p>The study authors can’t conclude that this same finding will apply to children outside of the two- to eight-year age group, or to other types of medications, or steroids given for different time periods. </p>
<p>The researchers commented at the end of their study report that perhaps a clinical trial of oral steroids plus antibiotics is required for children with infection and hearing loss in this age group. </p>
<hr>
<p><em><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31490-9/fulltext">The open access research paper for this analysis is Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial</a>.</em></p><img src="https://counter.theconversation.com/content/102773/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yasmine Probst receives funding from the NSW Ministry of Health and has been an investigator on previously published clinical trials with the Smart Foods Centre, University of Wollongong. </span></em></p><p class="fine-print"><em><span>Lauren Houston conducted this research with the support of the Australian Government Research Training Program Scholarship.</span></em></p>Clinical trials can assess impact of a medication on a disease. The ideal design is ‘blind’ – when the researchers and participants do not know who is assigned to the different treatments.Yasmine Probst, Senior lecturer, School of Medicine, University of WollongongLauren Houston, PhD Candidate, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/903102018-03-01T19:18:22Z2018-03-01T19:18:22ZExplainer: what are middle ear infections and how are they treated?<figure><img src="https://images.theconversation.com/files/208189/original/file-20180227-36680-nl3sv7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some children, ear infections will become a persistent problem.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crying-baby-close-shot-1034090173?src=5cJN4pvDOhFZhWnqy8hGyQ-1-1">Shutterstock/bookzv</a></span></figcaption></figure><p>Middle ear infections (otitis media) are a common and often painful condition that most children will experience at least once in their first year.
The infection takes hold when a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25434680">bacteria or virus</a> invades the middle ear. </p>
<p>Babies aged <a href="https://www.ncbi.nlm.nih.gov/pubmed/2732519">six to 12 months</a> are <a href="https://www.ncbi.nlm.nih.gov/pubmed/23905821">particularly susceptible</a> because their immune systems have yet to develop the ability to mount a defence against the offending bugs. </p>
<p>Babies’ Eustachian tubes – which drain fluid from the middle ear and the throat – are also not fully developed. This allows bacteria to build up rather than be removed from the ear. </p>
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<a href="https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=653&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=653&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208187/original/file-20180227-36696-6zssq9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=653&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Babies’ Eustachian tubes aren’t fully developed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock/Alila Medical Media</a></span>
</figcaption>
</figure>
<p>With treatment and monitoring, most children will recover quickly. But for some, ear infections will become a persistent problem. </p>
<h2>Symptoms and treatment</h2>
<p>It can be difficult to know if your child is suffering an ear infection. Common signs are pulling at their ears, irritability, fever and lack of appetite. Older children may complain that their ears are sore but it can be difficult to detect in younger children.</p>
<p>Ear infections often occur along with a cold, so children may also have a cough, runny nose or sore throat.</p>
<p>If your child is in a significant amount of pain, get their ears checked by your GP. The doctor will recommend some pain relief and ask you to monitor the condition at home for around 48 hours, by which time most acute ear infections have subsided. </p>
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Read more:
<a href="https://theconversation.com/bulging-ear-drums-and-hearing-loss-aboriginal-kids-have-the-highest-otitis-media-rates-in-the-world-64165">Bulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world</a>
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<p>If your child suffers repeated ear infections (more than three within six months, or more than four in a year) the doctor is likely to refer you to an ear, nose and throat (ENT) specialist. </p>
<p>If there is runny fluid or pus coming from their ear, it’s important to seek treatment as soon as possible, even if that means going to the <a href="http://kidshealthwa.com/guidelines/otitis-media/">emergency department</a>. Usually the pus will be removed, the ear cleaned out, and antibiotic drops prescribed. Follow-up assessments with audiologists (allied health hearing specialists) and ENT doctors will be arranged to check their hearing and if the ear drum has healed. </p>
<p>Some types of ear infections are asymptomatic, meaning there is no pain or discomfort, but the child may have problems hearing.</p>
<p>If left untreated, ear infections can cause developmental delays. So, if you are concerned about your child’s ears or hearing, even if there is no obvious sign of infection, it is important to get their ears checked.</p>
<h2>The problem with recurring infections</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/m/pubmed/25303240">Our study</a> found that more than one quarter of children have had recurring middle ear infections by the time they are three years of age. Having recurring ear infections in infancy <a href="http://www.tandfonline.com/doi/abs/10.1080/13575279.2017.1403889">dramatically increases the risk</a> of having ongoing problems with ear infections throughout childhood.</p>
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Read more:
<a href="https://theconversation.com/my-child-has-glue-ear-what-do-i-do-83815">My child has glue ear – what do I do?</a>
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<p>This can cause <a href="https://www.ncbi.nlm.nih.gov/pubmed/23906989">hearing loss</a> and impact on <a href="http://pediatrics.aappublications.org/content/106/4/725.short">school readiness</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/2387994">performance in class</a>, <a href="https://www.tandfonline.com/doi/abs/10.1080/21695717.2017.1325094">mental health</a> and overall <a href="https://www.ncbi.nlm.nih.gov/pubmed/24627408">quality of life</a>. </p>
<p>Hearing loss as a result of ear infections can also persist into adulthood. The effects get worse with age and hearing <a href="https://www.ncbi.nlm.nih.gov/pubmed/25401378">declines at a faster rate than those without recurrent ear infections</a>. </p>
<h2>How to reduce the risk</h2>
<p>Keeping children’s vaccinations up-to-date is important for reducing the risk of ear infections and many other diseases. The introduction of the PCV-13 pneumococcal vaccine for all children at two, four and six months of age has resulted in a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25159581">dramatic reduction</a> in middle ear infections. </p>
<p>For those who are able to, breastfeeding is another way. Breast milk contains antibodies to some of the bacteria that cause ear infections. Exclusive breastfeeding for more than four months has been <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/25303240/">found</a> to decrease the risk of ear infections. </p>
<p>Focusing on wiping runny noses and washing hands (after going to the toilet, before eating, after changing nappies, and after wiping noses) can <a href="https://www.ncbi.nlm.nih.gov/pubmed/10742313">reduce</a> the spread of infections. Parents and carers can also teach these good hygiene practices to children. </p>
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Read more:
<a href="https://theconversation.com/cleaning-your-hands-may-be-more-complicated-than-you-think-26315">Cleaning your hands may be more complicated than you think </a>
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<p>Good infection control practices are especially important for young children with <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/25303240/">older siblings</a>, those who live in <a href="https://www.ncbi.nlm.nih.gov/pubmed/21593705">overcrowded living conditions</a>, and for those who <a href="http://www.tandfonline.com/doi/abs/10.1080/13575279.2017.1403889">attend childcare centres</a>, where the risk of ear infections is higher.</p>
<p>Parents should keep children with active ear infections away from other children, including from school and childcare centres, as much as possible until they are well.</p>
<p>If you’re unsure whether your child has an ear infection, or if it has returned, talk to your GP so it can be identified and treated early.</p><img src="https://counter.theconversation.com/content/90310/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brad Farrant receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Chris Brennan-Jones receives research funding from the NHMRC and the Western Australian Department of Health. </span></em></p>Middle ear infections (otitis media) are a common and often painful condition that
most children will experience at least once in their first year.Brad Farrant, Adjunct Research Fellow in Early Childhood Development, The University of Western AustraliaChris Brennan-Jones, NHMRC Health Professional Research Fellow, Telethon Kids Institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/838152017-10-12T19:11:32Z2017-10-12T19:11:32ZMy child has glue ear – what do I do?<figure><img src="https://images.theconversation.com/files/188489/original/file-20171003-18144-1c11wf7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Repeated ear infections and prolonged episodes of glue ear can result in permanent hearing loss.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Around <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12741/full">one in four Australian children</a> will have recurrent ear infections in their first three years of life. This decreases as children get older. But by the time children start school, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27037737">one in ten</a> will still have glue ear, which could have a significant impact on their early learning. </p>
<p>Glue ear is a form of ear infection also known as otitis media with effusion. It occurs when the middle part of the ear (behind the ear drum) fills with a sticky, glue-like fluid instead of air. This fluid dampens the vibrations made by sound as it travels through the eardrum and to the cochlea – the spiral-shaped part of the ear where the vibrations are converted to signals sent to our brain, allowing us to hear. </p>
<p>For children with glue ear it is like someone has turned down the volume of the world. This is why these children may appear to have selective hearing.
Repeated ear infections and prolonged episodes of glue ear can result in permanent hearing loss. The impacts on a child’s development stretch well into adulthood. </p>
<p>So what should you do if your child has glue ear? And how can you prevent them getting it in the first place?</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=653&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=653&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188488/original/file-20171003-12138-1wbgave.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=653&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">One theory is that glue ear persists after having a cold if the Eustachian tubes are unable to clear the mucus.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<h2>Why do kids get it?</h2>
<p>Otitis media can run in families and we know there is some genetic susceptibility to this disease. However, research has also shown <a href="https://www.ncbi.nlm.nih.gov/pubmed/25514446">cases of glue ear</a> in Australian children peak during winter months, related to the increase in colds, and at the start of the school year, when children may be exposed to new bugs from other kids. </p>
<p>The exact cause is poorly understood, but bacteria and viruses associated with <a href="https://www.mja.com.au/journal/2009/191/9/otitis-media-viruses-bacteria-biofilms-and-vaccines">coughs and colds</a> are often the initial cause of ear infections. </p>
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Read more:
<a href="https://theconversation.com/health-check-what-is-the-common-cold-and-how-do-we-get-it-60857">Health Check: what is the common cold and how do we get it?</a>
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<p>One theory is that glue ear persists after a cold has cleared due to a dysfunctional Eustachian tube, which links the back of the throat to the middle ear. When mucus eventually clears from the nose and throat after a cold, the theory proposes that instead of draining from the ear through the Eustachian tube as it should, it gets stuck in the middle ear, resulting in glue ear.</p>
<p>Bacteria also develop something called <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0053837">biofilms</a> (slime) as a protection. This can make the bacteria up to 1,000 times more resistant to antibiotics, meaning they can’t be effectively treated. These bacteria are also able to hijack a child’s immune response, making immune cells spit out a sticky net of DNA that, instead of killing the bacteria, creates the sticky glue that provides the bacteria with a home. </p>
<p>Together these increase the ability of glue ear to persist or re-occur. This results in longer periods of hearing loss and leaves children at a greater risk of developmental problems. </p>
<h2>How can it be treated and prevented?</h2>
<p>There is no silver bullet that will prevent glue ear. But you can do to some things to reduce the risk of persistent glue ear. </p>
<p>These include reducing exposure to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053406/">cigarette smoke</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/16645502">making sure your child has had all their vaccinations</a>. Encouraging children to wash their hands and other healthy hygiene habits, like <a href="http://doyouhear.org.au/wp-content/uploads/2011/09/Breathe-Blow-Cough.pdf">blowing their noses</a>, are also important. Research has also shown <a href="http://onlinelibrary.wiley.com/doi/10.1111/coa.12652/full">breastfeeding your child</a> has some protective benefits from otitis media.</p>
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<a href="https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188497/original/file-20171003-3782-j107fg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">It’s important to encourage your child to wash their hands and blow their nose.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Vaccines (in particular, pneumococcal conjugate vaccines) can help reduce ear infections and subsequent glue ear. But current vaccines can cover only a small proportion of the possible bugs that cause ear infections. New vaccines are <a href="https://www.telethonkids.org.au/our-research/early-environment/infection-and-vaccines/vaccine-trials-group/">being developed</a> against this bug and also a bug called nontypeable <em>Haemophilus influenzae</em>, which is now the main cause of ear infections in children.</p>
<p>Once glue ear is identified, there will usually be a <a href="http://www.aafp.org/afp/2013/1001/p435.pdf">“watch and wait”</a> period of around three months. This is particularly important if glue ear is identified during one of the peak periods when it may resolve by itself without intervention. Antibiotics may offer very <a href="http://www.cochrane.org/CD009163/ENT_antibiotics-otitis-media-effusion-glue-ear-children">limited benefit</a> and <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/B8A6602C7714B46FCA257EC300837185/%24File/Recommendation-for-clinical-guidelines-Otitis-Media.pdf">will not be recommended</a> in many cases.</p>
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Read more:
<a href="https://theconversation.com/health-check-should-kids-be-given-antibiotics-in-their-first-year-61289">Health Check: should kids be given antibiotics in their first year?</a>
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<p>For children who have persistent glue ear, a small operation commonly known as <a href="https://www.kidshealth.org.nz/grommets-tympanostomy-or-ventilation-tubes">grommet insertion</a> is performed. Grommets are devices that ventilate the middle ear and prevent fluid accumulating. These surgeries are one of the <a href="http://www.healthinfonet.ecu.edu.au/key-resources/bibliography?lid=13789">most common surgical procedures</a>, with over 30,000 performed every year in Australia. </p>
<p>Grommets are usually an effective treatment for glue ear and improve hearing almost immediately. However, like any surgery, there are risks and potential complications. </p>
<p>New drug therapies are also being developed, including one that <a href="https://www.telethonkids.org.au/news--events/news-and-events-nav/2016/may/a-new-job-for-a-specialised-drug/">dissolves the glue</a> in glue ear. This may reduce the need for repeat grommet surgeries in cases of persistent glue ear. </p>
<h2>Why is it such a problem?</h2>
<p>One of the key challenges in treating glue ear is to identify it in the first place. It can be hard for parents to <a href="http://www.rch.org.au/kidsinfo/fact_sheets/Glue_Ear/">spot the signs</a>, which can include hearing difficulties (such as your child asking you to repeat words) and occasional pain and pressure. Undiagnosed and untreated glue ear can have serious developmental consequences for children. </p>
<p>A recent <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/HearingHealth/Report_1">parliamentary inquiry</a> into hearing health has suggested all children be screened for hearing loss during their first year of school. This could be hugely beneficial in identifying children with glue ear who have no other obvious signs. </p>
<p>Aboriginal children experience more ear infections, longer periods of glue ear, and more severe hearing losses than other children. In fact, Aboriginal children in Australia have the highest rates of otitis media in the world. </p>
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Read more:
<a href="https://theconversation.com/bulging-ear-drums-and-hearing-loss-aboriginal-kids-have-the-highest-otitis-media-rates-in-the-world-64165">Bulging ear drums and hearing loss: Aboriginal kids have the highest otitis media rates in the world</a>
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<p>Initiatives to provide early identification and treatment for ear infections and glue ear, such as the <a href="https://www.telethonkids.org.au/our-research/early-environment/infection-and-vaccines/ear-health/a-cohort-study-of-otitis-media/">Nyoongar Djarli Waakinj</a> ear health program at the Telethon Kids Institute in Perth, the <a href="http://www.ruralhealthwest.com.au/about-us/publications/wa-child-ear-health-strategy">WA Child Ear Health Strategy </a>and other programs like <a href="https://www.childrens.health.qld.gov.au/chq/our-services/community-health-services/deadly-ears/">Deadly Ears</a>, are helping to reduce the developmental impact of otitis media and close the gap for ear health in Aboriginal children.</p><img src="https://counter.theconversation.com/content/83815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Brennan-Jones receives funding from the NHMRC CRE for Ear and Hearing Health of Aboriginal and Torres Strait Islander People (CRE_ICHEAR). </span></em></p><p class="fine-print"><em><span>Ruth Thornton receives funding from the BrightSpark Research Foundation in the form of a research fellowship, as well as from the NHMRC, the Western Australian Health Department and the Princess Margaret Hospital Foundation in the form of research grants . </span></em></p>Children with glue ear constantly struggle to hear at school, which may leave them frustrated, disengaged and unlikely to reach their full potential.Chris Brennan-Jones, Senior Research Fellow, Telethon Kids Institute, The University of Western AustraliaRuth Thornton, BrightSpark Foundation Research Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.