Acute otitis media

Proven content

Acute otitis media is a common bacterial infection caused by the spread of infection from the nose, nasopharynx through the Eustachian tube and into the tympanic cavity. The proboscis in children is relatively short and lies more horizontally, which makes it easier to spread the infection in this way. That is why children get otitis media more often than adults.

Acute otitis media – definition

Acute otitis media is a disease characterized by inflammation that affects both the mucosa and parts of the middle ear. This condition develops suddenly, showing symptoms of local or general inflammation, and leads to the formation of purulent discharge in the tympanic cavity. A bacterial infection occurs when an infection spreads from the nose, nasopharynx, through the Eustachian tube and into the tympanic cavity. There is also the concept of recurrent acute otitis media, in which the disease appears in the patient three or more times within six months.

Every time your ear hurts, it is worth going to the family doctor in the first place. You can make an appointment today at halodoctor.pl.

Causes of acute otitis media

1. The ailment usually appears as nasopharyngeal infection through the Eustachian tube due to viral infection of the upper respiratory tract.

2. Occasionally, infection may result from the external auditory canal through perforation of the tympanic membrane or ventilation drains.

3. The cause of infection in most patients is mixed, because it is caused by viruses:

1. influenza A
2. RSV,
3. rhino- and adenoviruses,
4. paragrypy.

In addition, bacteria such as: H. influenza, M. catarrhalis oraz S. pneumoniae (most cases). Bacteria that contribute to otitis live earlier in the nasopharynx, which puts you at increased risk of acute otitis media during a viral infection.

Other factors influencing otitis media:

1. cleft palate,
2. the presence of a third almond that blocks the nasopharynx,
3. passive smoking,
4. inadequate social and economic conditions,
5. obstruction of the Eustachian tube due to inflammation and the presence of secretions,
6. an allergy that causes swelling of the mucosa at the mouth of the Eustachian tube.

Eustachian tube and otitis media in children

Abnormal function of the Eustachian tube that connects the nasopharynx to the middle ear is of great importance in otitis media. In childhood, the structure of the Eustachian tube is responsible for the frequency of the disease at this age. Toddlers are more likely to experience upper respiratory tract infections and swelling of the pharyngeal tonsils. Moreover, their immune system is not fully formed. Other factors that increase the risk of acute otitis media in children include:

1. genetic predisposition;
2. no breastfeeding;
3. being in nurseries and kindergartens (breeding ground for infections);
4. autumn-winter period;
5. allergy,
6. decreased immunity,
7. abnormalities of the Eustachian tube.

The frequency of acute otitis media

The disease has occurred in most children at least once in their lives, and the highest number of cases occurs between the sixth and eighteenth month of life. In children 7 years and older, acute otitis media attacks much less frequently. The recurrent disease mainly affects children before the age of two (in about 15%) who have a predisposition to otitis and have otitis exudate.

Acute otitis media – symptoms

Acute otitis media is characterized by the following symptoms:

1. severe pain in the ear with a throbbing nature (usually attacks while sleeping),
2. a feeling of fullness in the ear,
3. fever (about 25% of patients),
4. hearing impairment,
5. effusion (leakage of pus from the ear)

Symptoms in children:

In young children, the pain is manifested by reaching with the hand to the affected ear, anxiety, crying or screaming. These symptoms, especially pain, increase until the eardrum ruptures and the contents of the tympanic cavity flow through the opening in the membrane. In addition, there is high temperature and sleep problems, sometimes diarrhea and vomiting may also occur. The younger the child is, the less characteristic symptoms are.

When should you see a doctor?

Pain relievers such as paracetamol may be given to children 2 years of age and older who do not have craniofacial defects, recurrent otitis and Down syndrome. If symptoms persist after taking medication, consult your doctor immediately. On the other hand, younger children under 2 years of age and those with severe otitis media, such as high temperature, diarrhea and vomiting, should be checked by a doctor immediately after the onset of symptoms. You can order a pediatrician’s home visit on the HomeDoctor platform.

Acute otitis media – diagnosis

The diagnosis of this disease is mainly based on otoscopic examination, which involves endoscopy and then evaluation of the ear. It can be performed by a pediatrician, but a better solution will be consultation with an ENT specialist. Otoscopic examination reveals inflammatory changes and their intensification, e.g. the presence of purulent contents in the tympanic cavity, redness of the tympanic membrane or its thickening. You may also see a leak in the external ear canal.

The most recognized symptom is the visible protrusion of the membrane to the outside and its redness. On the other hand, purulent changes in the ear canal are visible when the tympanic membrane is perforated.

In addition, purulent discharge that remains in the ear can lead to conductive hearing loss, which is diagnosed by reed tests or whispering tests. Tonal audiometric testing is rarely performed, especially in children who have earache and generally feel unwell. However, if there are doubts as to the correct diagnosis, a tympanometric test is performed.

Treatment of acute otitis media

The ailment may disappear spontaneously in most children, so most often it is recommended to simply observe the child and possibly administer painkillers and antipyretics. The antibiotic should only be started if there is no improvement within a day or two. The first painkillers can be given to your child when acute otitis media is diagnosed (no matter if an antibiotic is prescribed or not). The most commonly used are ibuprofen or paracetamol. On the other hand, antibiotic therapy is prescribed in patients:

1. having little access to medical care,
2. with leakage from the ear,
3. having a high fever
4. with vomiting,
5. under 6 months of age,
6. under 2 years of age and coexisting bilateral otitis media,
7. with a predisposition to recurrent otitis media,
8. with Down syndrome,
9. with craniofacial defects,
10. with immune disorders.

If, despite the use of antibiotics, there is no improvement within a week – amoxicillin with clavulanic acid or ceftriakosn should be administered intravenously or intramuscularly.

Surgical procedure

There may be times when it is necessary to incision the eardrum. It is a procedure performed under general or local anesthesia. Incision of the tympanic membrane can be used both for diagnostic (e.g. collecting material for microbiological examination) or therapeutic purposes (e.g. preventing complications or removing residual secretions).

Indications for incision of the tympanic membrane:

1. the acute course of the disease in infants and children,
2. severe pain in the course of acute otitis media, accompanied by high fever and a raised eardrum,
3. the development of inflammation when taking an antibiotic (for other reasons),
4. paralysis of the VII nerve or labyrinthitis as an intra-temporal complication,
5. lack of effectiveness of antibiotic therapy,
6. patients with otitis media and immune deficiencies.

The complications of acute otitis media include mastoiditis, characterized by reddening of the skin and an emphasis on the soft parts. Additionally, the facial nerve is paralyzed and the face is distorted, as well as facial dysfunction on the side of the affected ear.

How to prevent acute otitis media?

1. Avoid being in a smoky room and protect your child from it. Many scientists believe that cigarette smoke paralyzes the cilia in the respiratory system, which impairs its cleansing, which leads to frequent infections.

2. Remember to wash your and your children’s hands often. This reduces the risk of getting the flu.

3. Vaccinate your child against flu every year.

4. You may consider having a pneumococcal vaccine in children. According to American studies, vaccinated children have a lower incidence of acute otitis media.

5. Avoid feeding your baby in a horizontal position.

The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.