Acute otitis media

Acute otitis media is a common bacterial infection resulting from the spread of infection from the nose, nasal part of the throat through the auditory tube to the tympanic cavity. The trumpet in children is relatively short and lies more horizontally, which facilitates the spread of infection by this route. Therefore, children suffer from otitis media more often than adults.

Acute otitis media - definition

Acute otitis media is a disease that is characterized by an inflammatory condition including both the mucous membrane and the middle ear elements. This condition develops suddenly, giving the symptoms of local or general inflammation and leads to the formation of purulent discharge in the tympanic cavity. A bacterial infection arises when the infection from the nasal part of the throat is spread through the auditory tube into the tympanic cavity. There is also the concept of recurrent acute otitis media, then the disease appears in the patient within six months three or more times.

Causes of acute otitis media

1. The disorder usually appears as an infection from the nasopharynx of the throat through the auditory tube due to a viral infection of the upper respiratory tract.

2. Sometimes the infection may result from the side of the external auditory canal through perforation of the tympanic membrane or ventilation ducts.

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

• influenza A,
• RSV
• gut and adenoviruses,
• parainfluenza.

In addition, bacteria such as H. influenza, M. catarrhalis and S. pneumoniae have the influence on inflammation (the most cases). Bacteria that affect ear infections earlier live in the nasopharynx, which during an infection causes an increased risk of acute otitis media.

Other factors affecting otitis media:

• cleft palate,
• presence of a third almond that blocks the nasopharynx,
• passive smoking,
• inadequate social and economic conditions,
• obstruction of the eustachian tube due to inflammation and the presence of secretion,
• allergy causing swelling of the mucous membrane in the mouth of the Eustachian tube.

The auditory trumpet and otitis media in children

Abnormal activity of the Eustachian tube, which connects the nasopharynx with the middle ear, is of great importance in otitis media. In childhood, how the auditory tube is built is responsible for the frequency of the disease at this age. In infants there are more frequent infections of the upper respiratory tract and swelling of the tonsils of the throat. In addition, their immune system is not fully formed. Other factors that increase the risk of acute otitis media in children may be:

• genetic predisposition;
• lack of breastfeeding;
• being in nurseries and kindergartens (breeding ground for infection);
• autumn and winter period;
• allergy,
• decreased resistance,
• abnormalities of the Eustachian tube.

Frequency of acute otitis media

The disease in most children appeared at least once in life, and the highest number of cases falls on the period between the sixth and eighteenth month of life. In children over the age of 7, acute otitis media attacks much less frequently. The recurrent disease is mainly related to children before the age of two (approximately 15%) who are predisposed to ear inflammation and who may have exudative ear infection.

Acute otitis media - symptoms

Acute otitis media characterized by the following symptoms:

• severe ear pain with a pulsating character (usually attacks during sleep),
• feeling of fullness in the ear,
• fever
• (approximately 25% of patients),
• hearing impairment,
• exudate (oil leak from the ear),

Symptoms in children:

In small children, the pain manifests itself by reaching out with a handle to a sick ear, anxiety, crying or screaming. These symptoms, especially pain, intensify until the eardrum ruptures and the tympanic cavity exits through the membrane opening. In addition, there is high temperature and sleep problems, sometimes diarrhea and vomiting may also occur. The younger the child is, the more pronounced the symptoms are.

When should I go to the doctor?

In children who are 2 years of age and who have no craniofacial defects and recurrent otitis and Down syndrome, analgesics, such as paracetamol, can be given. If the symptoms do not go away despite the administration of medication, you should immediately consult a physician. However, younger children under the age of 2 and those with a history of severe middle ear inflammation, e.g. high temperature, diarrhea and vomiting, should be seen by a physician immediately after the onset of symptoms.

Acute otitis media - diagnosis

Diagnosis of this disease is based mainly on the otoscopic examination, which consists of colonoscopy and subsequent assessment of the ear. It may be carried out by a pediatrician, but a better consultation will be with an ENT specialist. The otoscopy allows to reveal inflammatory changes and their intensity, e.g. the presence of purulent content in the tympanic cavity, redness of the eardrum or its thickening. Also leakage may occur in the external auditory canal.

The most recognized symptom is a very visible convexity of the membrane on the outside and its redness. On the other hand, purulent lesions in the ear canal are visible when the eardrum has been perforated.

In addition, the purulent secretion that is in the ear may lead to conductive hearing loss, which is diagnosed by means of reed tests or whispering tests. A tonal audiometric test is rarely performed, especially in children who have ear pain and general malaise. However, when doubts arise as to the proper diagnosis, the tympanometric examination is performed.

Treatment of acute otitis media

The disease may disappear spontaneously in the majority of children, therefore it is usually recommended to simply observe the child and administer any analgesics and antipyretics. Antibiotic should be implemented only if no improvement occurs within two days. The first painkillers can be given to the child at the time of diagnosis of acute otitis media (no matter if the antibiotic has been prescribed or not). Ibuprofen or paracetamol are the most commonly used. Antibiotic therapy is prescribed in patients:

• having little access to medical care,
• with leakage from the ear,
• having a high fever,
• with vomiting,
• under 6 months of age,
• under the age of two and coexisting bilateral middle ear inflammation,
• with predisposition to recurrent otitis media,
• with Down's syndrome,
• with craniofacial defects,
• with immune disorders.

If, despite the use of antibiotics, no improvement occurred within one week, intravenous or intramuscular administration of amoxicillin with clavulanic acid or ceftriacanine should be given.

Surgical procedure

There may be situations in which it is necessary to incision the eardrum. It is a procedure performed under general or local anesthesia. The incision of the tympanic membrane can be used for diagnostic purposes (e.g. taking material for microbiological examination) or for therapeutic purposes (e.g. prevention of complications or removal of residual discharge).

Indications for eardrum incision:

• acute course of the disease in infants and children,
• severe pain in the course of acute otitis media, accompanied by high fever and prominent eardrum,
• the development of inflammation when taking an antibiotic (for other reasons),
• nerve palsy VII or labyrinthitis as a complication of intrauterine,
• lack of effectiveness of antibiotic therapy,
• patients with otitis media and immune deficiencies.

The complications of acute otitis media include mastoiditis characterized by reddening of the skin and bulging of soft parts. In addition, facial nerve paralysis and facial distortion and facial disorders on the side of the affected ear occur.

How to prevent acute otitis media?

1. Avoid being in smoke-filled rooms and protect your child from it. Many scientists believe that cigarette smoke paralyzes cilia in the respiratory system, which disturbs its cleansing, and this leads to frequent infections.

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

3. Every year a child strain against influenza.

4. You may consider a vaccine for children against pneumococcus (PCV7 and PCV13), which also contain components against diphtheria. According to the American studies, children who have been vaccinated have a lower incidence of acute otitis media.

5. Avoid feeding the baby horizontally.