Acute otitis media is a typical disease of infants and young children. The peak of illness falls on 6-13 months of age, in which the lowest resistance to viral and bacterial infections is the lowest. A clear decline in disease is observed after the age of 7, along with the strengthening of the immune system, which reaches the maturity of approx. 12 years.
Bacteria cause swelling of the eardrum (2) and severe pain. The microbes cause swelling of the eardrum (2) and severe pain.
Collecting in the middle ear (brown color), the serous and purulent fluid emphasizes the eardrum separating the middle ear from the external ear. As the exudation increases, its chronicity and other complications, conductive hearing disorder appears. An increasing amount of exudative fluid that exudates the eardrum may eventually cause its disruption and formation of the opening - the so-called perforations. A secretion starts to drain from the ear, but painful pain disappears.
Otitis media in children - causes and diagnosis
Symptoms of acute otitis media
1. The dominant symptom of acute inflammation is severe, piercing ear pain, which intensifies at night.
2. There is also headache, tinnitus, hearing impairment. When asked about the symptoms, the child adds to the description of the disease that something "hurts" and "disturbs" in the ear. Adults who suffer from acute otitis include "pulsing and distending pain".
3. Pain symptoms (so-called local) are accompanied by systemic symptoms:
- fever; in small children often high, reaching 40 oC;
- sometimes vomiting, diarrhea, insomnia and general breakdown.
The course of the disease in infants and young children
In infants and young children, the systemic manifestations dominate: insomnia, irritability, crying, lack of appetite, high temperature; rarely worsening runny nose, sometimes vomiting and diarrhea. The system of young children does not "realize" the location of the place of infection and painful inflammation, just like an adult's body. Hence the lack of feelings of earache and speech - "something disturbs" in the ear.
Age and symptoms
In infants - local symptoms may be latent. The younger the child, the more severe the above-mentioned systemic symptoms of acute otitis - fever, vomiting, insomnia, etc.
Symptoms in older children and adults
Older children and adults are dominated by local symptoms: ear pain - pulsating, expanding, at night and in a supine position; sometimes a headache. In addition, there is a hearing impairment, tinnitus, etc. A characteristic symptom is leakage from the ear.
Can you identify the disease visually?
For the parents of a sick child, a visual diagnosis of acute otitis media is not available. Only an experienced ENT doctor with the help of a special medical optics (otoscopic, with enlarged image) flawlessly notices the characteristic change of the eardrum of the ear - from pearly gray to bloodshot due to inflammation. However, a misleading picture of the disease is possible - crying of the infant, necessary manipulations in the ear canal (earlier cleansing of secretions and wax) - cause transient congestion of the eardrum. A characteristic leak from the ear in the form of "pulling" mucopurulent secretion is helpful in diagnosis. Rare purulent secretion, without mucus, is not a diagnosis, because it can come from the skin of the auditory canal.
Diagnostic difficulties
Pain in the ear area is caused by many causes.These may include: pharyngitis and tonsillitis, mumps, toothache, ear wax, lymphadenitis, trauma, external auditory canal laryngosis, foreign body in the ear, etc. Therefore, doubts of the doctor or the pediatrician in the diagnosis of acute otitis media should verify the ENT specialist.
ACUTE INFLAMMATION OF THE CENTRAL EAR (AUS)- TREATMENT
Antibiotic therapy of acute otitis media
Although approximately half of the patients with inflammation resolve spontaneously, it is not known which patient has this chance. For this reason, as well as due to the toxicity of bacterial infection and the possibility of complications - in most cases antibiotic therapy is used. The use of antibiotics alleviates the symptoms of the disease; it shortens its course and significantly reduces complications and reduces relapse. Due to the rate of disease development and the long waiting time for bacteriological seeding, an antibiotic is usually used which is effective against the majority of bacteria infecting the middle ear.
Caution with antibiotic therapy!
A very important event was the recent edition (by the end of 2004) of new guidelines for the treatment of AIDS in the American Academy of Pediatrics and the American Academy of Family Physicians. The guidelines recommended the abandonment of immediate antibiotic therapy and the zamist of this so-called vigilant waiting for 48-72 hours to develop the disease. In the meantime, analgesic and antipyretic treatment with paracetamol and / or ibuprofen was recommended.
Treatment of symptoms of acute otitis media - general principles
Inflammation and edema cause acute pain and obstruction of the auditory tube. In addition to antibiotics, painkillers and nasal drops are used. In addition, topical decongestants are administered to suppress nasal mucosa and nasopharyngeal tissue to improve the patency of the Eustachian tube - ear drops, ear wraps, etc. The so-called blowing.
Treatment of symptoms of acute otitis media with discharge - a general rule
When there is a discharge of discharge from the ear in the treatment, it is very important to have proper hygiene of the auditory canal, which involves, for example, a systematic change of dressings. You can also use ear drops, saved by a doctor. Domestic herbal remedies, warming oils, etc. are not recommended.
Surgical treatment - elimination of causes of exudate
If 3 months of pharmacological treatment turns out to be ineffective - the goal of the first treatment should be to remove the exudate from the middle ear. The method used is suction drainage of the tympanic cavity. A special tube is then placed through an incision in the eardrum. If despite this inflammation recur, consideration should be given to removing the third almond (when it is overgrown), as well as the elimination of other potential causes, such as correction of the nasal septum, removal of polyps, etc.
Treatment of otitis media without exudate
This form of eardrum is rare. It is characterized by the occurrence of auditory canal and tympanic membrane on the skin of vesicles or blisters containing serous or serous-bloody content (Myryngitis). This form is found mainly in the course of influenza, measles, mumps, chickenpox and infectious mononucleosis. The main complaint is very severe ear pain, noise and hearing impaired. Pain usually lasts for 3 to 6 days. Treatment involves the use of analgesics, anti-inflammatory drugs and a large amount of vitamin C. Because the cause of the disease are viruses do not use antibiotic therapy. Do not pierce or cut the follicles. After a few days, self-healing occurs and complications are rare.
Treatment of systemic (general) symptoms
In the case of systemic symptoms of otitis media - high fever, headache - non-steroidal anti-inflammatory drugs (nlpz) are helpful. Drugs are used from the group of analgesics, anti-inflammatory, antipyretic antihistamines. For children, the standard is safe to use paracetamol, which has antipyretic effect, as well as ibuprofen, which under the supervision of a doctor can be used from 3 months of age. In adults, the antipyretic effect of nlpz can be supported by the administration of highly anti-inflammatory salicylates, ibuprofen, naproxen, etc. In children, salicylates are banned because of the risk of a complication - Reye's syndrome. This disease, although rare, poses a threat to the child's life.It usually occurs directly a few days after having had flu or chickenpox complicated by otitis, when the child was previously administered acetylsalicylic acid to relieve symptoms and reduce fever.
Paracentesis - incision of the eardrum
In the course of acute mucositis, the discharge of purulent mucus, mucous secretion, etc. in the middle ear occurs in children. Exudate secretion in children may last up to 2 weeks. The discharge is the cause of conductive hearing impairment. The collecting exudate emphases the eardrum separating the middle ear from the external ear - which in the end may cause its disruption. In small children, in the case of severe symptoms of the disease (or its complications), it may be necessary to incision of the eardrum, called paracentesis, which brings a lot of relief.
Ed. RED
Literature
1. The inflammation of the middle ear in children by prof. dr hab. n. med. Grażyna Niedzielska from the Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University in Lublin; Medycyna Rodzinna - 9 (1/2000)
2. Advances in the therapy of ACUTE CENTRAL ELASTANCE (AU) 2005 MP ONLINE
3. Medical encyclopedias, Internet.
