OTITIS MEDIA IN CHILDREN: SYMPTOMS & TREATMENT

 Otitis media in children is a closed eardrum infection , common in children aged 1-3 years. The disease progresses silently, with few symptoms, so it is often not detected in time, leaving negative consequences on hearing, thereby affecting language development as well as learning and intellectual development in children.

What is otitis media?

Otitis media with effusion is an inflammation of the middle ear mucosa with the presence of discharge in the ear cavity. In terms of time, otitis media can be classified into three types:

• The acute form occurs within the past 3 weeks.
• Subacute form, the disease lasts from 3 weeks to 3 months.
• Chronic form when the disease lasts more than 3 months.

The cause to the illness

The most common causes of otitis media are:

Tubal occlusion: Blockage of the eustachian tube results in loss of air in the ear cavity and therefore negative pressure, so the permeation is sterile.

Bacterial otitis media: 40% of bacteria are present in otitis media with effusion. This hypothesis is based on studies with bacteria in ear canal cultures or elevated levels of antibodies against Staphylococcus pneumoniae, Hemophylus influenzae and Disphteroides.

Viral otitis media: Some studies support the hypothesis of adenovirus etiology: influenza-like virus type 1, 2, 3; herpes; adeno-virus; coxsaki b4…

Signs of otitis media in children

Signs of otitis media are mainly hearing loss depending on age, which has different manifestations.

In young children: detection of otitis media when the patient has an upper respiratory tract infection or when the parent complains:

• Young children do not turn their heads in the direction of the sound.
• Children respond slowly or poorly to language learning and development.

Older children: otitis media is detected when the child hears in the class is not clear or there is discomfort in the ear.

Therefore, parents or teachers notice that children have abnormal expressions when listening or dictating, so they should send their children to have a hearing test.

Symptoms of otitis media when examining otoscope show typical amber eardrums, with vascular veins, often concave but sometimes convex eardrums. The image of the eardrum is very diverse, can be seen:

• The eardrum is normal or has lost its detachment.
• Image of water level or water bubbles behind the eardrum.
• The eardrum is slightly concave, losing its shine.

Other images you can see:

• The eardrum is concave with the malleus shortened, and the short protrusion.
• Milky white on the bottom with a few veins
• Rarer: bluish-gray color of the eardrum.
• Chalk white with a few white notes
• Change or loss of light triangle.
• On examination, reduction or loss of eardrum mobility with speculum SIEGLE is found.

Nasopharyngeal examination: check for VA inflammation, overgrowth.

Nasal examination: check for the presence of a potential foci of inflammation.

Treatment of otitis media in children

The principles of treatment

• It is necessary to distinguish the causes of otitis media.
• Treatment of otitis media with effusion in children is comprehensive, combined: systemic, local.
• Medical treatment is the first priority, if unsuccessful, then surgical treatment.

Medicines for the treatment of otitis media in children

• Use antibiotics for 7-10 days, some common antibiotics to treat otitis media such as Ampicillin, Cephalosporin, Macrolide. Note to avoid antibiotics that are toxic to the ear.
• Anti-inflammatory drugs for otitis media are commonly used such as corticosteroids 5mg/kg/day for 2-5 days.
• Anti-edema, mucolytic drugs used to treat otitis media are: Maxilase, Rhinathiol, Mucomys, ...
• Combined local treatment: specific desensitization, antihistamine .

Local treatment

• Clearing the upper airway: daily nasal hygiene for children with nasal wash, sea salt spray (Sterimar), vasoconstrictor (Otrivil, Coldi B).
• Daily Valsalva maneuvers or weekly eustachian tube catheterization are effective in mild otitis media.
• Surgical treatment when medications for otitis media in children do not respond.

Complications of otitis media with fluid retention

Otitis externa in children may clear up on its own within 10-20 days or with proper treatment. Hearing is restored. However, in many cases, despite being properly treated, otitis media still recurs and causes the following complications:

• Infection: Seborrheic otitis can become a chronic suppurative otitis media, causing perforation of the eardrum and prolonged discharge.
• Fibrosis in the ear cavity: This is a condition where the ear canal forms a concave pocket of the eardrum in varying degrees.
• Atrial Fibrosis: The eardrum forms white patches in the connective layer.

Prevention

Young children are the most susceptible to ear diseases, so to effectively prevent otitis media, parents need to do a few things well:

• Keep the child warm, do not let the child have a prolonged upper respiratory tract infection.
• Clean the nose and throat and clear the nose when children have acute episodes of nasopharyngitis
• If the child has VA or enlarged tonsils causing airway obstruction, causing recurrent inflammation, the VA should be removed and tonsil removed.
• Periodic otolaryngology examination for children from 6 months of age and older to detect and treat early otitis media

Above is the knowledge about otitis media in children. Hopefully, through this article, readers will have more useful knowledge to help prevent and treat otitis media effectively.