Otitis media in children
The content of the article:
- Otitis media in children and risk factors
- Forms of the disease
- Disease stages
- Otitis media symptoms in children
- Diagnostics
- Treatment of otitis media in children
- Possible complications and consequences
- Forecast
- Prevention of otitis media in children
Otitis media in children is an inflammation of the outer, middle or inner ear. In medical practice, the term otitis media is most often applied to otitis media, as this form of the disease is the most common. The inflammatory process in the inner ear is called labyrinthitis (the inner ear has an intricate structure, which is why it is called a labyrinth).
Otitis media occurs at any age, but children are more susceptible to it, due to the anatomical features of this area. In the first three years of life, about 80% of children carry the disease, and by the age of seven, 90-95% of children. Otitis media in children is by no means a harmless disease, it can cause serious complications, and is also the main cause of acquired hearing loss.
The ear is a complex paired organ whose purpose is to catch sound vibrations (outer and middle ear), the ability to maintain body balance and determine the position of the body in space (inner ear). The inner part of the ears is located in the temporal bones of the skull, the outer one is represented by the auricles. The human ear perceives sound waves with a frequency of 8 to 20,000 Hz.
The outer ear consists of the auricle and the external auditory canal, ending with the tympanic membrane. The middle ear is represented by the tympanic cavity located in the temporal bone. The middle ear is connected to the nasopharynx by the Eustachian tube and contains three auditory ossicles (malleus, incus, stapes), which amplify sound vibrations and transmit them from the outer ear to the inner ear. The most complex section is the inner ear, which consists of the bony and membranous labyrinth. The inner ear contains both the organ of hearing (cochlea) and the vestibular apparatus. Sound vibrations are converted here into nerve impulses and transmitted to the cortical auditory center of the brain.
Source: provospalenie.ru
Otitis media in children and risk factors
Otitis media in children develops against the background of acute respiratory diseases, bronchopulmonary pathology, childhood infections, adenoiditis. A more rare cause of otitis media in children is the transmission of infection during childbirth from a mother suffering from an infectious and inflammatory disease of the urogenital tract, mastitis.
The causative agents of otitis media in children can be staphylococci, streptococci, pneumococci, Pseudomonas aeruginosa, Escherichia coli, Proteus, microscopic fungi, viruses.
The main factor contributing to the onset of otitis media in children is age-related anatomical features. The eustachian tubes in children under 7 years of age are shorter and wider than in adults, have practically no bends and are located horizontally in relation to the nasopharynx, which makes it easy for infection to spread from the nasopharynx and oropharynx to the ear.
Risk factors include:
- prematurity;
- rickets;
- artificial feeding;
- allergic diseases;
- decreased immunity;
- irrational use of antibacterial drugs;
- chemical and thermal ear burns;
- water sports;
- getting into the ear of a foreign body.
Otitis externa in children is usually caused by infection of the hair follicles in the lateral ear canal. The development of the disease is facilitated by injuries, abrasions of the outer ear, the use of plug-in headphones. Otitis externa in children is most often diagnosed in the spring-summer period, average - in the autumn-winter period.
Source: prootit.ru
Forms of the disease
Depending on the localization of the pathological process, external, middle and internal otitis media in children are determined. Otitis externa, in turn, can have a limited and diffuse form.
The course of otitis media can be acute, recurrent and chronic.
Depending on the nature of the resulting exudate, otitis media and internal otitis media can have a catarrhal or purulent form.
By the nature of the pathogen - bacterial, viral, fungal.
Disease stages
During acute otitis media in children, the following stages are distinguished:
- Catarrh.
- Purulent inflammation.
- Reparative (restorative) stage; in an unfavorable case, the transition of the disease to a chronic form.
The stage of purulent inflammation, in turn, is divided into pre- and post-perforation.
Chronic otitis media occurs with alternating stages of exacerbation and remission.
Otitis media symptoms in children
The main symptom of otitis media in a child is ear pain. Its intensity and other symptoms depend on the form of the disease. Otitis media in children most often occurs in two forms - acute, proceeding violently, with pronounced symptoms and general intoxication, or latent (latent), which is detected by chance, usually already at the stage of chronicity. The latter form is characteristic of children under one year old.
Source: pediatriya.info
Acute otitis externa in children usually debuts with an increase in body temperature, severe itching in the external auditory canal and severe local pain, which intensifies when talking, while eating, at night. The child refuses to eat, tries not to talk, interferes with the examination of the affected ear (palpation is painful). With limited otitis externa in children, the ear canal is partially or completely blocked by an enlarged furuncle, which leads to a slight hearing loss. Sometimes regional lymph nodes increase, swelling appears in the behind-the-ear region, and the auricle protrudes.
External acute diffuse otitis media is characterized by diffuse inflammation in the external auditory canal, the tympanic membrane may be involved in the pathological process. Patients complain of a feeling of fullness in the affected ear, itching, pain. The pain can radiate to the lower and upper jaw, temples, nape, spread to half of the head from the side of the affected ear. The external auditory canal is hyperemic, edema leads to its slit-like narrowing. Discharge from the ear is absent or insignificant. Perhaps involvement in the inflammatory process of the auricle.
Acute otitis media in children usually begins with a sharp, shooting pain in the ear. The body temperature rises to 38–40 ˚С, and the general condition suffers. Children become lethargic, restless, capricious, shake their heads, refuse to eat. Young children often have dyspeptic symptoms (vomiting, diarrhea). Hearing in the affected ear decreases, there is a feeling of congestion. At this stage, there is no discharge from the ear. They appear later, 1–5 days after the onset of the disease, when the tympanic membrane is perforated and the exudate is poured out. This brings relief - acute pain subsides, body temperature normalizes, general condition improves, but hearing is still reduced. Purulent discharge lasts 5-7 days. With the cessation of suppuration, the symptoms of otitis media disappear, the tympanic membrane is scarred,hearing is restored. The duration of acute otitis media in children is on average 2-3 weeks.
For chronic suppurative otitis media in children, the presence of persistent perforation of the tympanic membrane is characteristic. Relapses (exacerbations) occur several times throughout the year, usually under the influence of a decrease in immunity due to a viral infection, intestinal pathologies, hypothermia. The clinical picture at the same time corresponds to acute otitis media, but is less pronounced. Children complain of pain in the ear, its congestion, mucous or mucopurulent discharge, noise in the ear. With the course of the pathological process, hearing loss progresses.
Source: gorlonos.com
In the case of a latent course of otitis media in children, clinical signs of the disease are absent or poorly expressed. There may be spontaneous ear pain, congestion, hearing loss, subfebrile condition. Hyperemia of the tympanic membrane is limited to the injection of blood vessels, no protrusion is noted, the zone of the mastoid is not changed.
Otitis media (labyrinthitis) in children is manifested by dizziness, nausea and vomiting, partial or complete hearing loss in the affected ear, ringing in the ear, and impaired coordination.
Diagnostics
Diagnostics begins with the collection of complaints and anamnesis, as well as an objective examination of the patient.
The main method of instrumental diagnostics for suspected otitis media in a child is otoscopy, which makes it possible to determine edema, hyperemia, protrusion of the tympanic membrane, as well as its breakthrough (if any) and suppuration.
To determine the type of pathogen, a laboratory bacteriological study of secretions from the ear canal is carried out.
X-ray examination of the temporal bones reveals a decrease in pneumatization of the middle ear cavities. To clarify the diagnosis, computed tomography of the temporal bones can be performed. If you suspect the development of intracranial complications, you may need to consult a pediatric neurologist.
For recurrent or chronic otitis media in children, auditory function is assessed by means of audiometry or acoustic impedance measurement, as well as determination of the patency of the Eustachian tube.
Differential diagnosis of otitis media in children is carried out with teething, eczema of the external auditory canal, mastoiditis, mumps, cranial nerve palsy, etc.
Treatment of otitis media in children
The approach to the treatment of otitis media in children depends on the form of the disease.
With otitis externa, in most cases, local therapy is sufficient, which consists in a thorough toilet of the ear with its treatment with antiseptics, infrared irradiation of the affected area, sometimes it is advisable to use warming compresses. To open a boil with limited external otitis media, it may need to be excised, after which the ear is washed with an antiseptic solution.
With otitis media, general therapy is carried out: antibacterial, antihistamines, nonsteroidal anti-inflammatory drugs are prescribed. In case of catarrhal inflammation, anti-inflammatory drugs in the form of ear drops are locally prescribed, with purulent - the ear is washed with an antiseptic solution (this procedure is performed on an outpatient basis by a doctor). In order to relieve the edema of the Eustachian tube and the possibility of an outflow of inflammatory exudate, vasoconstrictor drugs are used in the form of a nose drop.
In the case of a prolonged absence of perforation of the tympanic membrane with otitis media, there are indications for paracentesis - a puncture of the tympanic membrane with a straight or lance-shaped needle bent at an obtuse angle. The puncture site is outlined during otoscopy, the operation is performed under local anesthesia, the needle is not inserted too deeply to avoid injury to the inner wall of the tympanic cavity. Next, a cotton swab is placed in the ear canal, which is replaced as it is saturated with exudate. After the cessation of suppuration, the edges of the puncture grow together. With a properly performed paracentesis, complications, as a rule, do not occur.
With the progression of hearing loss against the background of conservative treatment of otitis media, tympanoplasty may be required - an operation that consists in sanitizing the middle ear cavity and restoring the position of the auditory ossicles.
Treatment of chronic recurrent otitis media is carried out in two stages. The purpose of the first stage is to eliminate the exacerbation. For this purpose, a thorough toilet of the ear, sanitation of the upper respiratory tract, and ear blowing are carried out. The task of the second stage is to prevent relapse. In this case, the establishment of the etiological factor of the disease is of paramount importance. So, the correction of the mother's nutrition in otitis media in infants in some cases leads to the cessation of relapses.
Treatment of internal otitis media in children is carried out in a hospital setting. The patient is shown bed rest. Antibacterial drugs of a wide spectrum of action are prescribed (then antibiotic therapy is corrected taking into account the sensitivity of the pathogen), diuretics, as well as drugs that stimulate blood circulation. In some cases, surgical treatment of internal otitis media is indicated, the purpose of which is to eliminate a purulent focus.
The complex of therapeutic measures for otitis media in children after acute inflammation subsides can include ultra-high-frequency therapy, ultraviolet radiation, laser therapy, ultra-high-frequency therapy, phonophoresis, electrophoresis. To improve the functions of Eustachian, they sometimes resort to blowing the ears according to Politzer, pneumatic massage of the eardrum.
Possible complications and consequences
Complications of otitis media in children usually develop in case of untimely or inadequate treatment, as well as in severe disease (usually in immunocompromised patients). Possible complications of otitis media include decreased or complete hearing loss, facial nerve palsy, damage to the temporal bone, brain abscesses, encephalitis, meningitis, sepsis.
Forecast
With timely diagnosis and adequate treatment, the prognosis is favorable. If the patient has immunodeficiency states, background diseases, the prognosis worsens. With the development of intracranial complications, a lethal outcome is not excluded.
Prevention of otitis media in children
In order to prevent otitis media in children, it is necessary:
- timely and competent treatment of diseases of the ENT organs;
- avoiding trauma to the external auditory canal and eardrum, foreign bodies entering the ear;
- teaching children how to blow their nose correctly (one nostril, then the other);
- avoiding water getting into the ears, especially in children prone to recurrent otitis media;
- refusal to use for ear hygiene items that are not intended for this;
- general strengthening of the body (hardening, healthy eating, walking in the fresh air, sufficient physical activity, etc.).
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
