Acute otitis media in children

Acute otitis media in children (acute otitis media, acute middle ear Qatar) is an acute inflammatory disease of the middle ear.

It should be remembered that at present, different terminology is used in the literature in describing chronic catarrhal otitis media. The nature of the contents in this disease is sometimes very peculiar and has a high content of blood elements, protein (or its absence), etc. You can find such names as exudative, transudative, serous, hemorrhagic, mucous otitis, "sticky" ear, etc. However, the principles of treatment do not change from this.

ICD-10 code

Diseases of the middle ear and mastoid process (H65-H75).

• H65 Pulmonary otitis media.
• H65.0 Acute middle serous otitis media.
• H65.1 Other acute non-nasal averages otitis.
• H65.9 Pulmonary otitis media, unspecified.
• H66 Purulent and unspecified otitis media.
• H66.0 Acute suppurative otitis media.
• Purulent otitis media, unspecified.
• H66.9 Average otitis, unspecified.
• H70 Mastoiditis and related conditions.
• H70.0 Acute mastoiditis.
• H70.2 Petrosit.
• H70.8 Other mastoiditis and related conditions.
• H70.9 Mastoiditis, unspecified.

Epidemiology of acute otitis media in children

Acute otitis media - one of the most frequent ear diseases in children (approaching 65-70%) is 25-40% of cases. Chronic catarrhal otitis media can be an independent disease or a stage of transition to acute purulent inflammation of the middle ear.

The frequency of acute otitis media is associated with certain general and local conditions that contribute to its occurrence in the child. The disease is more common in infancy and early childhood with a peak incidence of 6-18 months. Subsequently, the risk is slightly reduced, but at the end of childhood, almost all children in the anamnesis described at least one episode of the disease. In the first year of life, 44% of children suffer acute otitis media 1-2 times, 7.8% - 3 times or more. By 3.5 and 7 years, acute otitis media is transferred by 83.91 and 93% of children, respectively.

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Causes of acute otitis media in children

The most common pathogens are Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae (haemophilus influenzae). A certain role is also played by viruses, primarily respiratory syncytial and Chlamydia pneumoniae.

Pneumococcus and hemophilic rod are characterized by high sensitivity to beta-lactams and cephalosporins. But 35% of all pneumococci and 18% of hemophilic rods are resistant to co-trimoxazole.

What causes acute otitis media?

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Symptoms of acute otitis media in children

Serious differences in the clinical picture of acute otitis media in children and adults are noted.

Acute illness proceeds easily: the general condition does not change, there is no temperature reaction, in the anamnesis more often - ARVI. When the otoscopy of the tympanic membrane is almost not changed, occasionally determine the level of exudate. Complaints of patients - a decrease in hearing, a feeling of stuffiness in the ear. In children of early and preschool age, complaints can be absent due to fear of examination by a doctor, so the role of the pediatrician in case of suspected hearing loss should be more active, and the child should be sent to a hearing specialist for an otorhinolaryngologist.

Symptoms of acute otitis media

Classification of acute otitis media in children

Forms of acute otitis media, different in etiology, conditions of origin, clinical course, morphological character, functional disorders, consequences, complications and principles of treatment.

In addition to the typical course of the disease (detailed below), there are other options. One of them in childhood is the so-called latent course of otitis media. In this form, about a third of the diseases occur, especially in infancy.

The most characteristic for the latent flow of acute otitis media is the dulness of all the symptoms. The child has a little spontaneous pain, low temperature, hearing decreases. The otoscopic picture is atypical: only the color of the tympanic membrane changes, it becomes cloudy, as if thickened, hyperemia is limited by the injection of vessels, sometimes not in the uppermost part of the upper part, protrusions are observed, but the light reflex dissipates, the region of the mastoid process does not change; there is a dissonance with the blood picture, where high leukocytosis and an increase in ESR can be observed.

The importance of the latent acute acute otitis media is often underestimated by pediatricians. That is why a child with a prolonged, unusually flowing, difficult to treat disease should necessarily be consulted by an otorhinolaryngologist.

Often there are also violently flowing acute middle otites, while for several hours against the background of severe pain, high temperature and severe intoxication, rapid exudate formation occurs with the onset of perforation and suppuration. Sometimes in these cases it is imagined that the first stage is completely absent, the child seems to have pus from the ear, this course is usually associated with a particular virulence of the microorganism.

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Diagnosis of acute otitis media in children

Symptoms of acute otitis media are diverse and largely dependent on age, it is most difficult to establish a diagnosis in newborns and infants. An important role for diagnosis is the history. It is necessary to find out, after which there was a deterioration in the state of the child. Most often the ear infection is preceded by acute rhinitis, acute respiratory viral infection, sometimes trauma (falling from the crib), allergic diseases.

The leading symptom of acute otitis media is a strong, often sudden, spontaneous pain. It is associated with rapid accumulation of exudate in the tympanic cavity and pressure on the end of the trigeminal nerve, innervating the mucosa.

Diagnosis of acute otitis media

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Treatment of acute otitis media in children

The main thing in the treatment of acute otitis media is the restoration of the patency of the auditory tube, which is easily achieved by the use of vasoconstrictive drops in the nose and by usual physiotherapeutic procedures. Sometimes, if this does not help, apply a simple blowing of the ears through the nose (according to Politzer). Beginning with 3-4 years, and in older children with a unilateral process - catheterization of the auditory tube. Antibiotics for acute catarrhal otitis media do not apply.

Treatment of acute otitis media

Prevention of acute otitis media in children

Breastfeeding for 3 months significantly reduces the risk of acute otitis media during the first year. Given the relationship of acute otitis media with a seasonal surge in incidence, it is recommended that prevention of cold infections should be carried out according to generally accepted protocols.

Forecast for acute otitis media in children

In most cases, acute otitis media is favorable.

The danger of recurrent middle otitis media is, first, in a persistent hearing loss in young children, this largely affects the overall intellectual development and the formation of speech. If suspected of such persistent deafness, the child should be examined by a specialist, since at present there are all possibilities for an accurate audiological diagnosis. Secondly, recurrent middle otitis media can lead to the formation of a stable perforation of the tympanic membrane, that is, chronic otitis media.

[21], [22], [23], [24]