Treatment of otitis in children
One father, who, along with his child, often visits my office about otitis media, during his last visit began: "My child's ears are the most expensive part of his body for me."It's true that you have to pay a lot for treatment, but if you think that healthy ears are the guarantee of normal hearing and speech, the price of good care of them will not seem so high to you.
What parents should know about the baby's ears
If you understand the anatomy of the ear and in what the ears of an infant differ from the adult's ears, you will be able to understand why infants are vulnerable to ear infections and why it is important to conduct adequate treatment. Let's go along with the pathogenic microbe on a journey from the nose or mouth to the ear to see how middle otitis occurs. The microbe enters the nose and throat and then rises along the eustachian tube to the space called the middle ear. The Eustachian tube connects the pharynx with the middle ear and serves to equalize the pressure on both sides of the tympanic membrane. If it were not for this pipe, your ears would always be painful, they would press you, and it would seem to you that they are laid, as it happens for some time, when you rise to a higher altitude or fly on an airplane. In addition to providing equal pressure, this tube also protects the middle ear by opening and closing when needed to release undesirable accumulations of fluid and microbes.
The reason that infants have ear infections more often than older children is in this small tube.
Symptoms of otitis media:
• increasingly thick and viscous discharge from the nose;
• discharge from the eyes;
• capriciousness and irritability;
• Frequent nocturnal awakenings or sudden changes in sleep patterns;
• unwillingness to lie;
• crying or piercing scream on the background of symptoms of acute respiratory disease;
• discharge from the ear;
• sudden deterioration of the condition with a cold.
Not only can it not function well enough( open and close), the Eustachian baby's tube is short, wide and runs practically on the same plane with the pharynx - all that is needed for pathogenic microorganisms and mucous discharges to easily enter the ear from the throat. As the child grows, the Eustachian tube lengthens, narrows and bends down, now at a large angle to the pharynx, and the mucous secretions to get to the ears already have to go uphill.
In case of a cold or during an allergy attack, fluid accumulates in all the airways and in the middle ear. The same mass that fills the child's nose, it turns out and behind his eardrums. This is what the doctor means when he tells you: "The baby has a liquid behind the eardrums."The medical term for this disease is serous inflammation of the middle ear( secretory otitis media).At this stage of the cold, the child can behave as quite healthy. However, a feeling of heaviness in the ear can cause sudden awakenings and irritability.
The child may not even be good at maintaining balance when walking, as the fluid splashing in the middle ear breaks the sense of balance. But usually at this stage, children under one year behave as if they just had a cold. The liquid can flow off by itself, thanks to the fact that the body's immune forces will cope with all the microbes present in the liquid, and then the child will recover. This is a good end to the story.
Often, however, there is an obstruction of the Eustachian tube, and the liquid is closed in the middle ear. There is a basic principle of the human body: any fluid that stays anywhere, usually gets infected. This stagnant liquid serves as a nutrient medium for microorganisms that multiply in this liquid, making it thick as pus. This thick liquid presses on the tympanic membrane, causing pain, especially when the child lies. This is why otitis does not make itself felt at night when the child lies horizontally, and in the daytime
the child's condition sometimes improves. Pain, capriciousness and insomnia are usual initial symptoms, sometimes( but not always) accompanied by fever, thick discharge from the nose and vomiting. You can notice less obvious signs, for example, a child receiving a breast begins to suck differently, and the child refuses to lie in a horizontal position. If the child is pulling his ear - this is not a very reliable symptom. Babies play with their ears and are especially drawn to them when their teeth are teething.
Sometimes pus under pressure breaks the eardrum, and then you notice that a thick liquid flows out of the ear canal of the child. This can happen at night, and the fluid can be confused with discharge from the nose. After the rupture of the eardrum, the child usually feels better, because the heaviness in the ear has disappeared, but still take the child to the doctor for treatment.(At a time when antibiotics did not yet exist, doctors routinely pierced the eardrums to eliminate pressure and excruciating pain.)
Meanwhile, in the doctor's office
A doctor looks in the child's ear and sees a red bulging eardrum that answers the question,why did not anyone sleep last night. The pediatrician prescribes antibiotic treatment for at least ten days;type and dosage depend on the severity of the inflammatory process and the child's response to antibiotics in the past. Then the doctor says a very important phrase: "And we'll see your child's ears in ten days or two weeks."Remember three important points: follow the instructions, follow the instructions, follow the instructions.
The field of one or two days of antibiotic treatment, the child should be slightly better. If there is no improvement for forty-eight hours, be sure to contact your doctor, and even earlier, if the child's condition worsens. At the first glance at ear inflammation in your child, the doctor tried to pick up an antibiotic accordingly with the type of infection, but only the reaction of the child's organism will show whether it was the right choice. But do not expect an instant effect: it may take twelve to twenty-four hours for an antibiotic to act. And the temperature, if available, can last another one or two days. Antibiotics do not lower the temperature. They kill germs, and when the microbes disappear, the temperature drops.
Suppose your child began to feel much better, even almost completely recovered, after three days of taking antibiotics. Are you tempted to finish the treatment right now? Do not do
How to help small ears in flight
Here are a few ways to prevent or minimize discomfort in your ears when you travel with your child through the air. When taking off and landing, give the child a breast or bottle or something else to suck or drink. If the child is asleep during take-off, there is no need to wake him. When taking off, the ears do not lay as much as when landing. That's when the plane sits down - this is the only time when you need to wake a sleeping baby. During sleep, eustachian tubes do not equalize the pressure so effectively. If the child has a cold, or his nose is clogged, give him an oral decongestant or dip into the nose( drops recommended by your doctor) half an hour before takeoff. To moisten the over-dried air in the cabin, put a sponge moistened with warm water in front of your child's nose to provide moisture to the small airways.
this! Microbes are most likely still in the body and will cause a new inflammatory process if you stop treatment too soon. Being conscious parents, you will finish the prescribed treatment with antibiotics until the end. Now maybe one of the two. The child can get better, but he has not completely recovered, and you again go to the doctor for a second examination of the ear and, possibly, another course of treatment. Or it seems that the child is perfectly healthy. You look at the calendar. And he reminds you that for today you have a visit to a doctor for a second examination of the ear. But you start to argue: the child seems to have completely recovered, a doctor's visit is so expensive, and you have plenty of other things to do. Reconsider the temptation to cancel the visit to the doctor and still check the child's ears. That's why. In most cases, otitis media does not heal completely after the first course of treatment with antibiotics. If you cure inflammation, this can lead either to that nothing bad will happen and the ear will recover completely by itself, without further treatment, or to the fact that in the remaining stagnant middle ear of the infected fluid inflammation will again break out, and youagain have to go to the doctor.
Another, more terrible option is the possibility that an untreated infection can remain in the ear for weeks, even months, while the child can feel perfectly healthy. In some cases, if the child is lucky, this fluid may leak out months later. But in most cases, the infected fluid with a slowly current inflammatory process that remains in the middle ear without treatment for months becomes adhesive - the medical term for this situation is adhesive( adhesive) otitis media - and requires the removal of
by its surgical route( drainage).If you bring the treatment to its end, having achieved that the child's ears have become completely clean, thereby reducing the risk of hearing loss and the need for drainage.
On subsequent visits to the doctor, it is not always easy to examine the child's ears. Today, an obligatory procedure was the examination of tympanic membranes after suffering otitis with a tympanogram: a rubber probe that painlessly enters the external ear canal of a child, measures the vibration of the tympanic membrane and determines the presence or absence of fluid in the middle ear. Only then the doctor can declare that the child has completely recovered after the otitis.
Prevention of otitis
Suppose this situation is repeated with increasing frequency and severity over the next year, which often happens in young children. Here are ways to prevent otitis media, or at least reduce the incidence and severity of middle ear inflammation.
Breastfeed as long as possible. In children receiving breastfeeding, otitis occurs less frequently.
Fight with allergens. Allergens cause fluid production, which serves as the
nutrient medium for bacteria and other pathogens and may appear in the middle ear. Become a personal detective for your child to search for allergens to determine which of your child's allergens can be affected most likely. The most frequent are nasal allergies( or respiratory allergies): cigarette smoke, dust, animal dander. Pay special attention to the release of the room in which your child sleeps, from fluffy and soft toys that collect dust( see tips on how to clean the child's bedroom of soft toys and dust).Food allergies, especially dairy products, also contribute to the development of otitis media.
Change the immediate environment of the child. Maybe your child spends a lot of time with colds? Children in kindergartens catch colds more often. Think about transferring a child to a kindergarten with fewer people in a group or in a kindergarten at home, in which the teacher strictly isolates sick children from healthy or sends sick people home.
Feed the baby in an upright position. If your child is breastfeeding, feed him upright or at least at an angle in
How to prevent otitis
• Breastfeed.
• Get rid of allergens.
• Minimize contact with sick children.
• Feed in an upright position.
• Treat acute respiratory infections as soon as possible.
• Keep the nasal passages clean.
• Assign frequent re-examinations.
• Try to give antibiotics daily for prevention.
• Use surgical treatment.
forty-five degrees. This reduces the risk of leakage from the pharynx into Eustachian tubes of milk or a mixture that can cause inflammation in the tubes or in the middle ear. Breastfeeding in the supine position rarely leads to otitis, since the swallowing mechanism is different in this case, and breast milk has less irritating effect on the tissues of the middle ear. But if your baby who receives a breast often has otitis media, never feed lying.
Begin to treat a cold as early as possible. Note the order in which the common cold usually passes into your child's otitis. If the typical pattern of events is as follows: a watery liquid flows from the nose and the child plays cheerfully, then a thick discharge forms in the nose and the child becomes capricious, which eventually develops into acute otitis media a few days later - it makes sense to see a doctor as soon as possible, before the cold passed into the otitis.
Keep your nasal passages clean.
Treat the nose with steam and rinse to make it easier to remove thick secretions.
Recurrent Otitis
Suppose you resorted to all of the above preventive measures, and your child
still continually visits the doctor's office with relapses of otitis and begins to show signs of worsening behavior such as chronic irritability. Such changes in behavior are common in children with frequently recurring ear infections, simply because they feel bad or do not hear well, and therefore behave badly. Once you manage to cope with the constant inflammation of the ear, parents first notice that the child has become better behaved.
The whole complex of preventive measures, including supporting courses of antibiotics and surgical intervention, is aimed at simply gaining time until the immunity of the child grows stronger and the Eustachian
pipes develop. Most of the children come out of age, fraught with inflammation of the ear, to three or four years.
Long-term antibiotic treatment
A recent breakthrough in the prevention of recurrence of otitis has been the use of mild antibiotics in small doses once or twice a day for one to six months, especially in the winter months.
Parents tend to be reluctant to give their child antibiotics for such a long time, but consider alternatives. A weak antibiotic in small doses is tolerated by the baby's organism more easily than periodic courses of antibiotic treatment with an ever-increasing dosage, because over time the child may develop resistance( resistance) to the usual antibiotic. Antibiotics used for prevention, similar to those that some children take daily for twenty years to prevent rheumatic fever, do not give dangerous side effects. Without these preventive measures, a child with chronic otitis may experience temporary hearing loss at the same time that good hearing is necessary for optimal speech development. Ear inflammations that happen too often or permanently
Consistency of treatment with relapsing otitis
For proper treatment and prevention of ear inflammation, it is important to go through each step in a timely manner. If the first three stages are passed correctly, most children with relapses of otitis fourth step, surgical treatment, is not required.
Stage one. Treat every ear inflammation as soon as it appears
Continue treatment and promptly come to repeated appointments to the doctor until the inflammation completely disappears and the tympanogram of the child becomes normal. If the otitis becomes more frequent, go to the next step.
Stage two. Take preventive measures
As mentioned above, resort to preventive measures that include breastfeeding, fighting allergens, minimizing your child's contact with sick children, feeding in an upright position, early treatment of colds and washing the nasal passages of the child. If the otitis is still repeated, go to the next step.
Stage three. Try to take a course of daily antibiotic taking to maintain a cure for
. If you are still frequent visitors to your doctor's office, go to the last step.
Stage four. Perform surgical treatment with the
tubing being tightened, can even cause complete loss of hearing. Without these preventive measures, the next step for a child with relapses of otitis can be surgically treated.
If the middle ear of pathogens and fluids are not tolerated for an extended period of time, it also allows the middle ear, and especially the Eustachian tubes, to recover after a constant inflammatory process. Usually by this time a vicious circle closes: in the Eustachian tube there are such chronic injuries that it functions poorly, thereby predisposing to repeated otitis. Often, a preventive course of treatment with antibiotics can give the child enough time without the inflammatory process, so that he finally grew stronger and grew out of the disease. In addition to cases of allergy( and this is still in question), the effectiveness of anti-edema and / or antihistamines in the treatment or prevention of otitis has not been proven. And do not forget, antibiotics only kill pathogens. They do not remove liquid from the ears. Keep the nasal passages of the child clean - that's a good preventive tool.
Surgical intervention
Sometimes preventive measures do not give the desired result, and the child still often
otitis occurs. By this time, the fluid in the middle ear has become thick, like glue, and surgical removal is required. This operation is called myringotomy, as well as tympanotomy or paracentesis;during it under easy general anesthesia lor drains the middle ear, removing sticky substance from it. In this case, the doctor inserts into the tympanic membrane a very thin plastic tube( about the diameter of the tip of the ballpoint pen).These plastic tubes remain in the ear from six months to a year, allowing the accumulated fluid to flow outward than reduce the incidence of inflammation of the middle ear and instantly improve the child's hearing. This procedure takes about thirty minutes and is sometimes performed right in the doctor's office, but more often in the hospital, and the child is discharged on the same day. These tubes eventually fall out on their own. Remained in the eardrums tiny holes heal.