Acute otitis media in children

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

It should be remembered that currently in the literature different terminology is used to describe chronic catarrhal otitis media. The nature of the contents in this disease is sometimes very peculiar and is characterized by an increased 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.

ICD-10 code

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

• H65 Non-suppurative otitis media.
• H65.0 Acute serous otitis media.
• H65.1 Other acute non-purulent otitis media.
• H65.9 Non-suppurative otitis media, unspecified.
• H66 Suppurative and unspecified otitis media.
• H66.0 Acute purulent otitis media.
• H66.4 Suppurative otitis media, unspecified.
• H66.9 Otitis media, unspecified.
• H70 Mastoiditis and related conditions.
• H70.0 Acute mastoiditis.
• H70.2 Petrosite.
• H70.8 Other mastoiditis and related conditions.
• H70.9 Mastoiditis, unspecified.

Epidemiology of acute otitis media in children

Acute otitis media is one of the most common ear diseases in children (approaching 65-70%), accounting for 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 incidence of acute otitis media is associated with certain general and local conditions that contribute to its occurrence in a child. The disease is most common in infancy and early childhood, with a peak incidence at 6-18 months. Subsequently, the risk decreases slightly, but by the end of early childhood, almost all children have at least one episode of the disease in their medical history. In the first year of life, 44% of children suffer from acute otitis media 1-2 times, 7.8% - 3 times or more. By 3.5 and 7 years, 83.91 and 93% of children, respectively, suffer from acute otitis media.

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Causes of Acute Otitis Media in Children

The most common pathogens are Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae (hemophilus influenzae). Viruses also play a role, primarily respiratory syncytial virus and Chlamydia pneumoniae.

Pneumococcus and Haemophilus influenzae are highly sensitive to beta-lactams and cephalosporins. However, 35% of all pneumococci and 18% of Haemophilus influenzae are resistant to co-trimoxazole.

What causes acute otitis media?

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Symptoms of Acute Otitis Media in Children

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

The acute disease is mild: the general condition does not change, there is no temperature reaction, the anamnesis most often includes ARVI. During otoscopy, the eardrum is almost unchanged, the level of exudate is occasionally determined. Patients complain of hearing loss, a feeling of congestion in the ear. In young and preschool children, complaints may be absent due to fear of examination by a doctor, therefore the role of the pediatrician in suspected hearing loss should be more active, and the child should be referred to an otolaryngologist for a hearing test.

Symptoms of acute otitis media

Classification of acute otitis media in children

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

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

The most characteristic feature of the latent course of acute otitis media is the obscuring of all symptoms. The child develops a slight spontaneous pain, low temperature, and hearing is reduced. The otoscopic picture is atypical: only the color of the eardrum changes, it becomes cloudy, as if thickened, hyperemia is limited to vascular injection, sometimes only in one, more often the upper section, protrusions are not observed, however, the light reflex seems to dissipate, the mastoid process area does not change; there is a dissonance with the blood picture, where high leukocytosis and increased ESR can be observed.

The importance of latent acute otitis media is often underestimated by pediatricians. That is why a child with a protracted, unusually progressing, difficult to treat disease must be consulted by an otolaryngologist.

Often there are also violently proceeding acute otitis media, where within a few hours against the background of severe pain, high temperature and severe intoxication, rapid formation of exudate occurs with the onset of perforation and suppuration. Sometimes in these cases it is imagined that the first stage is completely absent, as if the child immediately has pus from the ear, such a course is usually associated with the special virulence of the microorganism.

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Diagnosis of acute otitis media in children

Symptoms of acute otitis media are varied and largely depend on age; it is most difficult to diagnose newborns and infants. Anamnesis plays an important role in diagnosis. It is necessary to find out what caused the deterioration in the child's condition. Most often, ear disease is preceded by acute rhinitis, acute respiratory viral infection, sometimes trauma (falling from a crib), allergic diseases.

The leading symptom of acute otitis media is severe, often sudden spontaneous pain. It is associated with rapid accumulation of exudate in the tympanic cavity and pressure on the endings of the trigeminal nerve, which innervates the mucous membrane.

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 to restore the patency of the auditory tube, which is easily achieved by using vasoconstrictor drops in the nose and regular physiotherapy procedures. Sometimes, if this does not help, simple blowing of the ears through the nose is used (according to Politzer). starting from 3-4 years, and in older children with a unilateral process - catheterization of the auditory tube. Antibiotics are not used for acute catarrhal otitis media.

Treatment of acute otitis media

Prevention of acute otitis media in children

Breastfeeding for 3 months of life significantly reduces the risk of acute otitis media during the first year. Given the association of acute otitis media with a seasonal surge in morbidity, it is recommended to carry out prevention of colds according to generally accepted protocols.

Prognosis for acute otitis media in children

In most cases of acute otitis media - favorable.

The danger of recurrent otitis media is, firstly, in persistent hearing loss in young children, which significantly affects general intellectual development and speech formation. If such persistent hearing loss is suspected, the child should be examined by a specialist, since at present there are all the possibilities for an accurate audiological diagnosis. Secondly, recurrent otitis media can lead to the formation of persistent perforation of the eardrum, that is, to chronic otitis media.

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