Ear inflammation in a child: how to prevent complications

Otitis media is the medical name for inflammation of the middle ear caused by infection. The disease is most common in young children, this is due to the structural features of the ENT organs in children (shorter and wider ear canal than in older children or adults). Acute otitis media is an infection that usually develops due to the accumulation of fluid in the middle ear. Otitis media can be caused by viruses or bacteria. Most children suffering from otitis media first develop acute respiratory viral infections or acute respiratory infections, which then progress to otitis media, causing inflammation and swelling in the nasal passages and eustachian tube. The risk of recurrent middle ear infections increases in children who:

• Attend a nursery or kindergarten
• Exposure to cigarette or stove smoke at home
• Have enlarged adenoids, which may interfere with drainage of the eustachian tube

Symptoms of acute otitis media usually include ear pain and fever. Otitis media with effusion (discharge of fluid or pus), also known as adhesive otitis, occurs when there is fluid in the middle ear after the infection has cleared. This condition usually does not cause pain, but may cause hearing loss in the child.

Children with acute otitis media usually improve quickly when treated with anti-inflammatory drugs and with proper care. Sometimes, if the doctor is sure that the disease is caused by bacteria, the child may be prescribed antibiotics. Children who develop adhesive otitis media and other complications may need additional physical therapy treatment.

Description of the disease

Otitis media refers to an inflammatory lesion of the ear caused by various infectious agents - bacteria, viruses or fungi.
The disease is widespread in childhood. According to statistics, before the start of school, pathology is diagnosed in 90% of children. Boys and girls under 5 years of age are especially susceptible to the disease (due to the physiological characteristics of the structure of the ear and imperfect immunity). There are 3 forms of otitis, depending on the location of the inflammation: external, middle and internal. With external otitis, the inflammatory process occurs in the auricle and external auditory canal. The location of otitis media is the middle ear area; internal otitis, respectively - the inner ear. Based on the type of discharge formed, otitis media is divided into serous and purulent.

Any form of the disease requires qualified medical care. Without proper treatment, the disease can cause serious complications and lead to sepsis, meningitis, encephalitis, inflammation of the facial nerve, hearing loss or complete hearing loss.

Complications of otitis media

Hearing loss and decrease following ear inflammation can be temporary or permanent. In addition, the advanced form of the disease leads to the following consequences:

• inflammation of the mastoid process of the temporal bone (mastoiditis);
• thrombosis of cerebral vessels;
• inflammation of the meninges (meningitis) or the substance of the brain (encephalitis);
• blood poisoning (sepsis);
• general severe intoxication;
• cholesteatoma (tumor formation).

Symptoms of otitis media

The clinical picture of otitis directly depends on the form of the course, however, symptoms common to all varieties can be identified:

• pain in the ear area;
• the presence of sulfur or purulent discharge;
• hearing loss;
• feeling of ear fullness;
• irritability and tearfulness;
• general weakness.

Otitis externa can be suspected by swelling and redness of the skin of the external auditory canal, peeling of the skin and mucous or purulent discharge from the ear.
At the beginning of the disease, the child suffers from sharp pain, which, after a while, passes and is replaced by a feeling of congestion. As a rule, with the external form of otitis, the quality of hearing does not decrease. The symptoms of otitis media appear sharply and rapidly increase. The child complains of severe shooting pain, aggravated by swallowing, coughing, yawning, etc. In addition, the patient experiences symptoms such as hearing loss, tinnitus, dizziness, increased body temperature, and purulent discharge from the ear. The following manifestations are characteristic of internal otitis: severe dizziness, often with an attack of nausea and vomiting, as well as loss of balance. In addition, the child may have tinnitus or hearing loss.

Types of exudative otitis media in children

According to their duration, ESO is divided into three forms : acute (up to 3 weeks), subacute (3 to 8 weeks) and chronic (more than 8 weeks).

According to the nature of the changes occurring in the mucous membrane of the middle ear, four forms of ESO : initial exudative, secretory, productive secretory, degenerative-secretory (with a predominance of the fibrosclerotic process).

There is another classification of ESO, which is based on similar principles (physical parameters of the contents of the tympanic cavity: viscosity, transparency, color, density and duration of the pathological process). It distinguishes four stages of ESO: catarrhal (up to 1 month), secretory (from 1 to 12 months), mucosal (from 12 to 24 months), fibrous (more than 24 months).

Causes of otitis media

The main cause of otitis media is bacterial, viral and fungal infection.
In most cases, pathogenic microorganisms enter the ear from the nasal cavity or pharynx, being a complication of other infectious diseases - ARVI, tonsillitis, sinusitis, etc. However, cases of post-traumatic inflammation of the ear cavity are possible. Factors contributing to the development of otitis media:

• Violation of the integrity of the tissues of the auditory canal (scratches, abrasions).
• Eardrum injuries.
• The presence of infectious diseases of the upper respiratory tract.
• Decreased immune system of the child (may be associated with hypothermia, vitamin deficiency, chronic diseases, etc.).
• Anatomical features of the structure of the ENT organs (deviated nasal septum, short, wide auditory tube with virtually no bends, etc.).
• Poor ear hygiene (using potentially dangerous cotton swabs, matches and other objects that can damage ear tissue when cleaning ears).

Ear hurts

There is hardly a happy mother in the whole wide world whose child did not wake up at night crying and saying “ear hurts.” This is how one of the most common diseases of childhood manifests itself - acute otitis - an inflammatory process of the middle ear, located between the inner ear and the external auditory canal. According to the law of meanness, the disease occurs at the most inopportune time (at night, on weekends) and in the most inappropriate place (at the dacha, on a trip), when it is not possible to show the child to an otolaryngologist (ENT doctor), so it is very important that parents can independently provide first aid to a sick child.

Causes of otitis media in children

The most common causes of otitis in a child are:

- diseases of the upper respiratory tract,

- adenoids,

- weakened immunity,

- various viral and bacterial infections,

- hypothermia,

- allergic diseases.

Often, otitis is caused by the mother’s excessive zeal in treating a runny nose, when, when rinsing the nose, liquid is injected into the nasal cavity under pressure, which “drives” the infection into the auditory tube and further into the middle ear. The anatomical and physiological features of the structure of the child’s body also contribute to the development of otitis: the auditory tube connecting the nasopharynx with the middle ear cavity is wider and shorter in children and located more horizontally than in adults.

Knowing the causes of otitis media, you can prevent this disease. It is necessary to give your child maximum attention and care, protect him from contact with sick people, prevent hypothermia and strengthen the immune system: follow a routine, walk in the fresh air, provide adequate nutrition, do hardening from birth, do not smoke in the presence of the child.

It is not difficult for an attentive mother to suspect otitis media. The main symptom of the disease is acute pain in the ear, which the baby will let you know through his behavior, and an older child will tell you about it in words or by prolonged crying.

The infant becomes restless, cries shrilly and for a long time and even screams, and most importantly, refuses to breastfeed, since sucking movements increase the pain.

In the crib, he takes a position on his side, in which the sore ear is pressed against a soft and warm pillow, which helps reduce pain.

Quite often, in children in the first six months of life, otitis media is accompanied by an increase in temperature.

When you press on the protrusion on the auricle (tragus), the pain intensifies, and the child reacts violently - cries, pushes your hand away.

Sometimes there is redness of the ear and swelling of the tissue around it.

First aid for a child with ear pain

First of all, it is necessary to relieve pain, for which you give the child paracetamol in suspension or suppositories at the rate of 10-15 mg of paracetamol per 1 kilogram of the child’s body weight (in the absence of contraindications). Children's Nurofen, taken orally in an age-appropriate dosage or in suppositories rectally, also has a good analgesic effect.

Local treatment in the absence of ear discharge

consists of using painkillers and anti-inflammatory drops, for example, Otipax, and dry heat on the ear area.

Before introducing drops into the ear, they must be warmed to body temperature to avoid increased pain from contact of the inflamed eardrum with the cold solution. But you should not warm the entire bottle of medicine every time, since frequent warming and cooling will quickly cause the drops to become unusable. The medicine should be stored in the refrigerator, and before the procedure, dip a teaspoon in hot water, then wipe dry and drop 6-7 drops from the bottle into it. This way you will warm the amount of medicine needed for one procedure and save the bulk for future use. The medicine is instilled into the external auditory canal: 3 - 4 drops two - three times a day. Cotton pads moistened with warm otipax or camphor oil relieve pain well.

To improve the patency of the auditory tube and in case of difficulty in nasal breathing, vasoconstrictor drops are used in children's dosages (Nazivin, Otrivin, Vibrocil and others).

The sore ear loves warmth; place a soft cotton (flannelette, flannel) napkin (warm, but not hot!) on the ear area, ironed.

If purulent or bloody discharge appears from the ear, stop instilling any medications until the child is examined by an ENT doctor.

The reason to call an ambulance is discharge from the ear canal, indicating perforation of the eardrum, as well as if ear pain is accompanied by an increase in body temperature above 38.5ºC.

Often parents of a child suffering from otitis media ask the question: is it possible to bathe and walk with him outside? This is not contraindicated, but certain conditions must be met:

• the weather outside should not be rainy, wet, windy and cold, because freezing can cause swelling of the auditory tube and nasal mucosa, and this can complicate the healing process;
• the child should not have an elevated body temperature;
• dress your child according to the weather, do not bundle him up so as not to overheat and sweat outside; he should have a hat on his head that covers his ears (but not on hot summer days);
• When swimming, be careful not to get water into your ear;
• After water procedures, the child should be in a warm room.

And don't forget! A visit to an otolaryngologist for otitis media is mandatory!

Diagnosis of otitis

Diagnosis of otitis media should be carried out exclusively by otolaryngologists.
Excessive independence of parents in making a diagnosis and its treatment can cause irreparable harm to children's health. At the initial appointment, the doctor listens to the patient’s complaints, clarifies the duration of the symptoms of the disease, the presence of factors that could contribute to the development of otitis (contacts with sick people, a history of chronic diseases, etc.). Having clarified all the details, the ENT doctor proceeds to examine the patient. The most common method for assessing the condition of a child’s ear canals is otoscopy. During the examination, the doctor examines the ears with a special backlit device - an otoscope. In addition, examination of the ear can be performed using endoscopy. The medical device endoscope allows you to examine in detail the ear canal and eardrum of a small patient under magnification. In this case, the image is displayed on the screen, video recording is possible.

Other diagnostic methods necessary to confirm the diagnosis of Otitis media:

• Audiometry – helps the doctor assess hearing acuity.
• Blowing the auditory tubes is necessary to determine the degree of their patency.
• Computed tomography allows you to examine the temporal bone and identify lesions in its structures characteristic of purulent otitis.
• Bacteriological analysis of ear discharge helps determine the type of infectious agent and select the optimal drug for treatment, taking into account the spectrum of sensitivity.

How to identify the disease?

What should parents pay attention to when the baby cannot complain about ear problems? First of all, pay attention to:

• temperature. Its presence is not always necessary. But if you have already noticed your child’s temperature is above 37.50C, then do not delay visiting the pediatrician, who, if necessary, will refer you to an ENT doctor;
• runny nose. Basically, otitis media develops due to a common cold, accompanied by the release of mucus and its entry into the auditory tube;
• sleep disturbances, poor health of the baby, capricious behavior. These signs may be associated with ear pain, so do not ignore them.

Frequent signs of otitis in children:

• earache. Sharp crying when touching the sore ear;
• possible hearing impairment;
• problems falling asleep, restless sleep;
• loss of appetite;
• digestive disorders in the form of vomiting, diarrhea.

If you suspect otitis media, you should contact a pediatric ENT doctor. The doctor will also evaluate the condition of the ears, nose and throat, as well as the child’s age and weight, in order to choose the right therapy. An experienced pediatric specialist will also advise on how to avoid the further development of inflammatory phenomena in the ear.

Treatment of otitis media

Treatment of otitis media requires an integrated approach aimed at combating the infectious pathogen, relieving unpleasant symptoms and achieving complete recovery of the patient’s body.
To achieve this, both conservative and surgical treatment can be performed. Conservative therapy involves the use of the following methods of treating otitis media:

• Thorough toilet of the ear canal.
• Taking antibiotics (if the disease is bacterial in nature).
• Using ear drops to relieve pain.
• The use of turundas with special anti-inflammatory solutions.
• Antihistamines to relieve swelling in the ear cavity.
• Antipyretics (with a concomitant increase in body temperature).

In addition, physiotherapeutic methods of treatment can be used: ultraviolet irradiation, UHF therapy, laser therapy, electrophoresis, etc. They are used after the acute process has subsided and contribute to the complete recovery of the patient and maximum restoration of damaged tissues.
In some cases, surgery may be required. The main methods of surgical treatment of otitis:

• Eardrum bypass is necessary to remove purulent fluid from the middle ear cavity.
• Tympanoplasty – helps restore damaged structures of the middle ear and improve hearing.
• Paratenthesis (tympanotomy) - used to eliminate purulent contents in the purulent form of otitis.

Treatment

When prescribing treatment for acute otitis media in children , it is important to take into account the general condition of the child, the presence of concomitant diseases, and the duration of the disease. Much attention is paid to the main cause of otitis - inflammation in the nasal cavity - rhinitis, adenoiditis, sinusitis. With timely treatment, in most cases acute otitis media resolves without the use of antibiotics. This is typical for acute otitis media in children over 2 years of age with a favorable background, when the disease is caused by viruses. For moderate and severe cases, antibiotics are almost always used, especially in children under 2 years of age. In children over 2 years of age, in the absence of severe symptoms of intoxication, pain, or body temperature above 38°C, during the day one can limit oneself to only symptomatic therapy. However, if there is no positive dynamics in the symptoms of the disease within 24 hours, it is necessary to begin antibacterial therapy.

Prevention of otitis

In order to prevent the occurrence of otitis media, it is necessary to follow preventive measures:

• Strengthen the child’s immunity - provide a balanced diet, spend enough time in the fresh air, play sports, and harden up.
• Timely eliminate infectious diseases of the upper respiratory tract - rhinitis, sinusitis, tonsillitis, etc.
• To clean your ears correctly - do not insert the cotton swab further than the external auditory canal (the formation of wax is a natural protective process).
• Seek medical help at the first manifestations of otitis media.
• Do not self-medicate!

Treatment of otitis in the SM-Doctor clinic for children and adolescents means first-class professionalism of doctors, high-tech equipment and advanced methods of hearing restoration.

Diagnosis of exudative otitis media in children

To diagnose EOS, an audiological examination is carried out at the Federal State Budgetary Institution National Medical Research Center of the Federal Medical and Biological Agency of Russia in the Department of Pediatric ENT Pathology, which consists of acoustic impedance testing and tone threshold audiometry. For patients with this pathology, acoustic impedansometry is characterized by a tympanometric curve of type “B” and the absence of ipsi-reflexes, which reflects a violation of the transmission of the sound signal along the chain of auditory ossicles due to the pathological contents of the middle ear (exudate); on the audiogram - an increase in air conduction thresholds to 30-40 dB, mainly at low frequencies, bone conduction is not changed. In the case of a recurrent course of exudative otitis media, specialists from the Department of Pediatric ENT Pathology necessarily prescribe the patient a computed tomography (CT) scan of the temporal bones to obtain a reliable picture of the airiness of the middle ear cavity, the condition of its mucous membrane, the chain of auditory ossicles, the windows of the labyrinth and the bony part of the auditory tube, density and localization of pathological contents.

To identify the causes contributing to the occurrence of ESO, the patient in the Department of Pediatric ENT Pathology of the National Medical Research Center of the Federal Medical and Biological Agency of Russia undergoes an endoscopic examination of the nasal cavity and nasopharynx or an X-ray examination of the nasopharynx (in young children if endoscopy is not possible) and paranasal sinuses.

What is the auditory tube?

The auditory tube is an organ that belongs to the middle ear system, connecting it to the nasopharynx. In the literature, its three main functions are distinguished:

1. Regulating or equalizing pressure in the middle ear.
2. Isolation and evacuation of fluid constantly forming in the middle ear.
3. Protection of the middle ear from contents (viruses and bacteria, allergic substances, food) in the nasopharynx.

Unfortunately, these functions work very poorly in children.

Prevention

Some studies suggest that not breastfeeding is associated with a risk of acute otitis media in children. Perhaps GV prevents the colonization of the nasopharynx by pathogenic flora. Studies have confirmed that the microflora of the nasopharynx of bottle-fed children is populated by colonies of pathogenic microorganisms. An additional role may be played by secretory immunoglobulins present in milk, as well as the active work of muscles during sucking.

Vaccination.

In some cases, patients may be recommended vaccination to prevent recurrent otitis media. This tactic is discussed together with the attending physician. But it should be noted that the use of vaccines against influenza virus and pneumococcus is associated with only a slight decrease in the incidence of acute otitis media.

Antibiotic prophylaxis.

The decision on antibiotic prophylaxis should be made based on an analysis of a complex of factors in each specific case. Prophylactic use of antibiotics helps reduce episodes of otitis media for the duration of its use. Indications for therapy include recurrent otitis media, early onset of the disease (up to 6 months), and a family history. Negative consequences of antibiotic prophylaxis include colonization of the nasopharynx with antibiotic-resistant strains.

Shunting.

The decision about the need for bypass surgery should be made taking into account the individual characteristics of the individual patient, as well as the possible risks of this procedure. When deciding whether to perform this surgical intervention, it should be taken into account that bypass surgery is not recommended if there is exudate in the tympanic cavity for less than 3 months from the date of diagnosis.

Measures to avoid water getting into the ear canal - using earplugs, avoiding water sports - may not be used in children with shunt surgery.

Why does the eustachian tube not work well in children?

The most rapid development of the auditory tube occurs in the first 2 years of life:

• in infants, the auditory tube has a horizontal position and very short dimensions (17.5 mm);
• by 2 years, the auditory tube has a length from 17.5 to 37.5 mm, as well as an inclination angle from 10 to 45 degrees;
• The configuration of the auditory tube in 7-year-old children is no longer different from that of an adult.

The horizontal position of the auditory tube makes the middle ear more vulnerable to infection.

Do not forget about congenital pathologies, such as Down syndrome or cleft palate (cleft palate); they lead to changes in the structure of the auditory tube, exposing the ear to frequent otitis media.