Chronic middle ear effusion - a possible cause of protracted vomiting and failure to thrive in infancy

Infection of the middle ear along with fluid collection is a common occurrence among babies and children. When fluid collection persists for three months or more, it is considered chronic effusion. This chronic condition can affect development of language, reduce hearing ability, and cause learning, social, and emotional problems. The symptoms of this chronic condition are often vague (fullness in the ear and passing hearing loss) and may go undetected, especially in babies and young children. Protracted vomiting is not usually associated with chronic middle ear effusion, but in babies, this vomiting is a major diagnostic problem. Three cases are presented of babies with severe and persistent vomiting, which resulted in failure to thrive. The babies were 8, 9, and 10 months of age. They were admitted to the hospital for failure to thrive, and underwent extensive testing. Each child had a chronic middle ear effusion that was the cause of the persistent vomiting. When myringotomy tubes were inserted to chronically drain the fluid from the ear, rapid improvement followed; vomiting stopped and progressive weight gain began. In each case, on examination the typical signs of chronic middle ear effusion were noted, but the treating physician was reluctant to consider this as the cause of the severe vomiting and failure to thrive. Better awareness of the fact that chronic otitis media with effusion can cause persistent vomiting should result in earlier diagnosis and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)