Otitis media in children

Dr Nguyễn Thị Minh Tâm. – Photo courtesy of Family Medical Practice

Dr Nguyễn Thị Minh Tâm*

Otitis media is the name for a group of inflammatory diseases affecting the middle ear which are mainly caused by bacterial or viral pathogens - in young children it is mainly caused by viral pathogens.

Another common cause of otitis media is rhinitis. This is where the nasal passages get inflamed which causes congestion, sneezing and a runny nose.

Otitis media is one of the most common diseases among preschool children and usually occurs in the winter-spring time. Most ear infections will clear up on their own within three days although symptoms can sometimes last up to a week. In cases where symptoms are not improving or a child is suffering from recurring infections, medical care should be sought to prevent severe complications and/or hearing loss. 

There is a strong association between rhinitis and otitis media because of the Eustachian tube which connects the ear and the nose.

This tube has three functions, namely to balance middle ear pressure from the outside world, to clear mucus secretions from the ear into the throat and lastly to protect the middle ear against infections, sounds, and secretions from the back of the nose.

Otitis media in children is often caused when there is dysfunction to the Eustachian tube. The Eustachian tube in children is shorter and more horizontal than that of adults and does not function as well, therefore any infections in the nose, throat or especially the adenoids can disrupt the function of the tube and lead to otitis media.

There are additional causes of otitis media and children who are at increased risk are those who suffer from allergies, are diagnosed with congenital malformations and/or congenital malnutrition, have a poor diet, were born prematurely and those exposed to polluted environments or cold and humid weather.

Understanding the cause and mechanism of otitis media will help parents understand how to best take care of their child’s health. Parents are understandably worried by ear pain or discharge however less worried about runny noses, sniffing and common nose symptoms- however, these can be the main causes for ongoing ear infections.

Otitis media is a general term for middle ear inflammation and the severity can vary. Most people assume an ear infection is when there is significant pain, discharge or perforation of the eardrum however there are cases of otitis media where there are very few presenting symptoms or a child has difficulty in communicating the symptoms that they are experiencing. This can often be the case when there is fluid retention in the ear. It is important to observe children closely and seek medical support if any symptoms present. Some common symptoms are:

• Body: high fever, fussy crying, anorexia, diarrhoea
• Ear pain: infants who do not know how to speak will often pull their ears, rub their ears, hold their ears, shake their heads. Ear pain increases when sleeping so children often cry during sleep without rest
• Older children may have poor hearing, tinnitus, dizziness and poor balance. Children who do not know how to speak will change their character: they may appear irritable, distracted and or have impaired communication, irritability, impaired communication
• On clinical inspection, the eardrum may be punctured and there may be fluid in the ear canal
• There may be other severe complications that your ENT specialist will explain to you which can affect other areas of the body such as the head/heart.

Treatment

The treatment of otitis media follows four principles: treatment of the causes, symptomatic relief, treatment of the complications (if any) and lifestyle advice to prevent recurring infections.

• Treating the cause: if there is evidence of infection based on blood tests, bacterial cultures then antibiotics must be used. In addition, if the child has rhinitis, it is imperative to treat the nose and throat, clear the nasopharynx, such as using anti-congestion remedies and antihistamines to minimise the chances of the nose becoming inflamed and congested.
• Symptomatic treatment: pain relief and medication to reduce the temperature for the child. If the eardrum is swollen the doctor may recommend some further treatments and if multiple ear infections are occurring in a small time frame then catheter insertion or curettage techniques may be used. These methods are very effective and a combination of treatments may be required in cases that do not resolve with one treatment. 
• Complications treatment: surgery is sometimes required for more severe cases
• Preventing recurring infection: consider drugs, vitamins, diet, exercise and pollution to prevent further infection.

To prevent otitis media, keeping your child free of rhinitis is very important. Try to keep the living environment clean, smoke-free, coal-smoke-free, dust-free, keep children warm during weather changes and ensure compliance with the recommended vaccination schedule. If your child already has rhinitis, it should be treated immediately. If your child has an ear infection with a perforation of the eardrum, avoid swimming in dirty water which may lead to an ear infection. It is important to seek medical help if your child shows any changes to their communication or behaviour to ensure that hearing loss does not go undetected as this can have greater impacts on your child's ability to learn and develop further. 

In summary, otitis media is a common disease in children and early treatment with good results avoids complications. Otitis and rhinitis are closely related, so it is best practice to help to prevent runny noses and nasal symptoms to prevent further complications involving the ear. If infections or symptoms are present it is best to treat both nasal and ear concerns together to reduce the risk of recurrent symptoms of more complicated infections. – Family Medical Practice

*Dr Tâm holds a bachelor’s degree in general medical practice and a master’s in ENT from Hanoi Medical University. She has completed many training courses with Australian experts focusing on Audiology, and taken part in many courses in other ENT-related fields. She has worked in ENT for more than 20 years.