The majority of children will have at least one and often more ear problems during childhood. This may take the form of an ear infection following a poolside holiday, glue ear causing deafness and requiring grommet insertion and in less common cases children may end up having episodes of repeated ear infections or otorrhoea. Most childhood ear infections are due to acute otitis media whereby the bugs that cause general winter-time coughs and colds ‘set up shop’ in the middle ear and cause the typical pain, fever and irritability followed by discharge of pus through a hole in the eardrum and often almost instantaneous relief from the symptoms.
A recent clinical negligence case that I was instructed to provide an expert opinion on involved a 7 year old girl who had been seen by her GP on several occasions with a discharging ear. On each of these occasions, the girl was prescribed antibiotic drops and appeared to make a good recovery. She was, however, referred to the local audiology department due to Mum’s concern about hearing loss. A subsequent examination identified glue ear for which he was referred to the local ear, nose and throat department to discuss further management options. For a variety of reasons, the girl was seen again in the audiology department and GP practice but did not see an ENT doctor until approximately 18 months later. At that time, she was noted to have some wax in her left ear and a moderate hearing loss on that side. She was listed to come in for grommets and adenoidectomy in order to ventilate the middle ear and drain out the offending fluid but at the time of surgery she was noted to have some polypoidal tissue arising from the superior (attic) region of the ear. This was biopsied and the results of the biopsy and a subsequent CT scan led to the diagnosis of cholesteatoma for which she underwent a modified radical mastoidectomy operation which left her with a long term conductive hearing loss in the left ear.