Otitis media in a child: from symptoms to treatment
A child who has reached school age and has never suffered from otitis is a rarity. This inflammatory disease of the organs of hearing is incredibly widespread in childhood.
The organ of hearing has three departments, respectively, according to the location of the inflammatory process, internal, external and middle forms of otitis are distinguished. The latter is the most common.
About the disease
Otitis media or otitis media - the disease that pediatricians and ENT doctors most often encounter. Statistics says that at the age of 5 years at least one episode of middle ear inflammation occurs in 80% of children, and by 8-9 years this diagnosis is indicated in medical records of 95% of children.
Otitis media is rather cunning: only at first glance it is harmless and easily defeated, even in home conditions. In fact, it can become recurrent, and sometimes it can lead to unpleasant consequences, complicated by facial nerve paralysis, meningitis, abscess.
In almost a quarter of cases, otitis media, which was transferred in childhood, causes hearing loss at a more mature age, up to the development of hearing loss.
Most often, otitis media starts in babies of infancy. This is due to the age features of the anatomy of the hearing organs. Up to about 3 years, the auditory tube is shorter than adults, and is wider in diameter. In this regard, from the nasopharynx in the middle part of the organ of hearing can easily get a liquid, bacteria, viruses. It can occur when sniffing, with crying, with breastfeeding, with concomitant respiratory disease.
Inside the middle ear there is a favorable environment for the rapid reproduction of microorganisms, and therefore inflammation develops quickly. As they mature, the auditory tube narrows, stretches and the frequency of otitis decreases.. Some adults never suffer from ear inflammation, but in childhood they have suffered more than once.
Types and causes
The age-related features of the structure of the ears in children largely explain why the disease most often develops in childhood. But in order for the inflammation to begin, a trigger is needed - a provoking factor.
Otitis media in children is most often a complication of respiratory disease. It most often develops on the background of acute viral infection, influenza, and measles and scarlet fever.
During an acute infection in a child, for natural reasons, the amount of nasal mucus increases (this is a kind of protection of the body), and through a short and wide auditory tube, bacteria or viruses easily penetrate into the middle hearing organ, where they cause a strong inflammatory process.
Quite often, otitis media develops in children with adenoiditis.: their nasal breathing is disturbed by enlarged tonsils, there is no ventilation of the auditory tube, and in the absence of adequate ventilation, the medium for reproduction of pathogens becomes very favorable. For the same reason, the disease begins in children with chronic rhinitis, sinusitis, with a background of sore throat or pharyngitis.
Kids are inquisitive and may well shove a foreign small object into the ear and hide this fact. Gradually, mechanical inflammation develops in the middle ear.If, for some reason, the eardrum separating the outer ear from the middle ear is injured, then it is possible that the pathogens will fall outside through the outer ear.
In the middle department of children's ears, pneumococci, haemophilus bacilli, moraxella bacteria, hemolytic streptococcus, and various fungi feel most “at ease”. It is their most often found in laboratories, when they analyze the ear discharge from a child with otitis.
Otitis media is different, it proceeds and is treated in this connection in different ways:
- Unilateral (the most common option) - only one ear is affected. By location, there are right and left-sided otitis media;
- Bilateral (it happens quite rarely) - both ears are affected;
- Acute - developed recently, just. It can be purulent (with the formation of pus in the middle ear), bullous (with the formation of bubbles) or catarrhal (non-purulent), allergic.
- Chronic - often repeated. It can be exudative, purulent and adhesive.
An ENT specialist will help to determine the exact type of the child’s ear inflammation.
Symptoms and signs
Otitis media, occurring in acute form, occurs in the vast majority of cases. Recognizing its signs is not difficult. The onset of the disease is accompanied by severe sudden pain in the ear and fever. The thermometer can show up to 39 degrees and even higher.
With acute inflammation, hearing is reduced (this is reversible if there are no complications), the child feels very bad overall - he has a headache, there are signs of intoxication. When turning the head, nodding, speaking, the earache is noticeably worse.
The pains subside, the fever subsides and in general the condition improves markedly after the purulent or serous contents begin to go out through the perforation in the eardrum. So the average department of the organ of hearing gets rid of extraneous substances accumulated there. At this stage, hearing loss, hum or tinnitus will persist. From the ear begins to "flow."
As soon as the ear discharge comes out, the eardrum begins to recover, to scar. When its integrity is fully restored, the ability to hear normally returns. The whole process from the onset of the disease to recovery can last from 2 to 4 weeks.
If episodes of otic inflammation recur in a particular baby several times a year, then they are talking about recurrent otitis media, in which the risks of complications increase markedly. But such repeated seizures themselves are always easier than acute otitis media - pain is less pronounced.
If the otitis media is adhesive or exudative, then the child may not complain about the pain at all - he may only have complaints of hearing loss and ear noise (tinnitus), while the decrease will be progressive.
The most difficult in therapy is considered to be an average chronic suppurative otitis, in which the eardrum does not have time to heal and the discharge of pus from the ear becomes periodic or constant. With this form of inflammation, hearing loss progresses, and its cure is almost impossible. The temperature rises only in the period of exacerbation.
Signs in infants
A child of a conscious age may well show and explain to parents and a doctor exactly where he has pain. And it simplifies the task of determining otitis. With babies, things are a little more complicated. Guessing that the child’s middle ear has inflamed, mother will have to independently, carefully watching the behavior of the baby.
The baby reacts to a sharp pain not just with crying, but with a hysterical cry, and the child starts screaming sharply, suddenly, as soon as there is a shooting sharp earache. Neither the carrying on hands, nor the motion sickness, nor the bright toys that a few hours ago interested him so much help to calm the baby.
The baby yells not only from pain, but also from hunger, because he cannot fully eat: when sucking a breast or nipple, the pain in the middle ear becomes worse, which forces him to stop eating and resume crying. Almost the same thing happens with sleep mode. Even if the crumb falls asleep, the lull does not last long - literally until the next attack of pain in the ear. But for such a cry in an infant, there may be other reasons, and the pain may be in another part of the body.
To make sure that it’s the ears that hurt, you need to lay the baby on a flat surface and lightly with your index finger press on the small cartilage that is located at the entrance to the ear from the face. It is called a tragus. First, an adult presses on the right tragus, then - on the left.
If it is an average of otitis, then with pressure the pain intensifies, and the kid lets know about it by throwing up arms, legs, resuming a heart-rending cry. In order not to be mistaken, it is best to conduct such testing in the moments of “calm,” when the child calmed down a bit, tired.
After six months, children have in their arsenal more opportunities to demonstrate pain. Such babies with otitis media begin to not only worry and cry, but also pull at the sore ear with a pen and close it with the palm of their hand. With the appearance of such a behavioral reaction, it is necessary to measure the temperature, to conduct a test with pressure on the tragus.
Most often, the ears in babies of infancy hurt in the evenings and at night. No one knows why, but this is the case. Therefore, having heard a piercing scream in the middle of the night, you should definitely take a test with a trestle to immediately exclude or suspect otitis media.
What is dangerous disease?
Otitis is dangerous because of its complications, the likelihood of which increases with inappropriate or incorrect treatment. The later parents begin to treat otitis media, the higher the likelihood that it will not do without complications. Also, the likelihood of negative consequences increases with a severe course of the disease, even if treatment began on time.
The inflammatory process in the middle ear is dangerous in the first place by the fact that it easily passes to the inner ear, captures the labyrinth, which leads to disruption of the vestibular apparatus, dizziness, development of persistent ear tinnitus (noise), nausea and a strong decrease in auditory function until the complete loss hearing
With complicated otitis media, the temporal bone and the facial nerve may be affected.
Do not forget that the middle ear is in close proximity to the brain, and therefore the inflammatory process of the meninges may develop.
What to do?
For a baby or small child, you need to call a doctor. Older children should immediately go to the reception to the ENT. Ears are examined with the help of a special device - an otoscope. This makes it possible to find out whether there is pus in the middle ear, how severe the inflammatory process is. Also, the doctor will see if the child's eardrum is intact.
If there is pus, the ear canal is sent to the laboratory for bacteriological examination, which allows to establish the exact type of pathogen of inflammation and its resistance to antibiotics. This is important for prescribing an exact treatment.
Radiography of the temporal bones may be recommended. If the objective cause of the inflammation is not detected, the clinical guidelines of the Ministry of Health strongly recommend that a CT scan of the temporal bones be performed.
If otitis repeats frequently and the doctor suggests that the disease has become chronic, it is imperative to conduct a hearing study using audiometry.
How to help with acute pain?
Given that the pain comes suddenly, parents are interested in what kind of help they can provide to the child before being examined by a doctor. Hurry up to disappoint: There is no such medicine that can be given to a child if otitis media is suspected before being examined by a doctor.
Drops in the ears with anesthetic or anti-inflammatory effect is a good and necessary thing, but it is permissible to drip them only when the eardrum is whole, not perforated. Unfortunately, at home, it is impossible in principle to assess how much it is whole, and therefore it is necessary to refrain from burying in the ears.
Having established what kind of ear hurts, you can take the child in your arms and press your sore ear to yourself - body heat will allow to slightly reduce the intensity of the pain. Before the arrival of the doctor this measure may well be enough.
Warming and other compresses are also not a method of rendering first aid, especially since warming intensifies purulent inflammatory processes, and the presence or absence of suppuration in the ear also cannot be independently guessed.
From medicines Only febrifuges are permissible if the heat exceeds 38.0 degrees. It is better to give a remedy, the main substance of which is paracetamol.
Slightly reduce the pain in the ear before the inspection will help instillation of nasal vasoconstrictor drugs in the nose - "Nazivin", for example, partially reduces the edema of the auditory tube.
In the acute form, drops in the ears are most often prescribed on the basis of phenazone and lidocaine - they anesthetize and reduce inflammation. If there is pus, then antibiotic drops are recommended. In case of an allergic otitis, anti-allergic treatment is prescribed using an antihistamine.
If otitis media is purulent, but the eardrum under the pressure of purulent masses from the inside is not in a hurry to perforate, the membrane is punctured to facilitate the outflow of pus. This procedure is called the paracentesis of the eardrum. After cleansing the cavity, it is washed with drugs in a medical office.
After the acute inflammatory period is left behind, pneumomassage of the eardrum is recommended to improve hearing, physiotherapy, ear blowing.
It is very important to cure concomitant ENT diseases, such as rhinitis or adenoids. With their presence, even the timely treatment of acute otitis media increases the likelihood that the ear disease will become chronic, and the child will partially or completely lose their hearing.