The ear is one of the most valuable assets given to man by nature. But due to ignorance and carelessness, people expose it to chronic infections. The middle ear is the part that efficiently transmits sound waves from the outer air to the inner ear. Chronic infection/inflammation of the middle ear may be associated with perforation of the tympanic membrane which aids hearing. When infected, purulent or mucopurulent discharge from the ear and one may also feel dizzy. Bacteria mostly cause chronic ear infections, though other microbes are also implicated. Streptococcus pneumonia is the most common microbe causing it. Others are Pseudomonas aeorginosa, H. influenza and Moraxella catarahallis, Respiratory synctial viruses which cause common cold also lead to chronic middle ear infections. Perforation can develop in the middle ear due to long standing infection and inflammation.Using pins or needles, objects for scratching inside the ears, recurrent cold and sneezing, presence of water in the ear as occurs during a shower or swimming are some of the common risk factors for causing chronic infections of the ear. The problem starts with pain but intensifies as pus builds up behind the ear. As the quantity of pus increases, there is a visible purulent discharge. There may also be associated headache and high fever. Lymph nodes surrounding the ears can become enlarged and painful as infection drains in to them. Untreated, the infection may spread to the brain substance and its coverings causing grave sickness and even paralysis of body parts and coma. Microbes can spread to the lungs causing pneumonia. In the blood stream, the infection can become generalised resulting in septicemia. Long standing infection damages the ear causing deafness. It is a major cause for preventable deafness in young adults. A person of any age or gender can develop chronic middle ear infection. Children are more susceptible as they have a short tube connecting the throat to the middle ear. Bottle feeding done with the toddler in a supine position is another risk factor to acquire this infection. Once children develop a chronic ear infection, they are prone to develop complications unless treated adequately. Chronic earache along with pus discharge suggests chronic infection of the middle ear. Visualizing by otoscope confirms it. The microbes responsible for the infection can be identified by means of microscopic examination and culture of the pus discharge. Treatment Adequate course of a suitable antibiotic in form of tablets or local ear drops helps in healing of the infection. Chronic and resistant infections need surgical intervention. One can prevent developing chronic ear infections. The ear should not be pricked in any way. Similarly it is important to keep the ears dry. While swimming or taking a shower, ears should be plugged with cotton or covered by other means like using a shower cap. Protection of the ears against droughts of cold or hot air also helps in avoiding inflammation and infection of middle ear. Steam inhalation done regularly is useful in curing symptoms of common cold. It also helps in preventing inflammation and congestion of the ear internally. If a baby is bottle fed, he should not be kept supine with head flat on the bed as this tends to cause ear infections. On experiencing any itching or pain with or without discharge in the ear, it is wise to consult and take adequate treatment before development of chronic infection. Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital rachna212002@yahoo.co.uk
