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December 21, 2023 at 3:51 pm #3858
Anonymous
InactiveACUTE OTITS MEDIA IN CHILDREN.
Otitis media is a very common problem in general practice.It is a term which describes two conditions which form part of a continuum of disease: acute otitis media (AOM) and otitis media with effusion (OME). Both occur mainly in childhood and may be caused by bacterial or viral infection.
Most children will have a self-limiting illness and many will not present to a doctor. A few will have recurrent or chronic problems and may require referral.
As children grow bigger, the angle between the Eustachian tube and the pharynx becomes more acute and so coughing or sneezing tends to push it shut. In small children, the less acute angle facilitates infected material being transmitted down the tube to the middle ear.
Epidemiology
More than two-thirds of children experience one or more attacks of AOM by the age of 3 and about half experience more than three episodes.
The peak age of incidence is 6 to 24 months and decreases with age. It is less common at school age.
Otitis media occurs more in the winter than summer months, as it is usually associated with a cold.
It can occur in adults but this is most unusual.Risk factors
Boys are slightly more likely than girls to develop AOM.
Children with older siblings at school or nursery are exposed to infections that may be brought home.
Use of a dummy increases risk. Presumably the sucking and swallowing opens the Eustachian tube and puts the middle ear at risk.
Children who suffer with many colds or respiratory infections are more likely to develop OME.
Parental smoking is thought to be associated with an increase in both acute and chronic otitis media.Presentation
Symptoms
AOM is a condition in which there is inflammation of the middle ear, frequently in association with an upper respiratory tract infection (URTI). It commonly presents with:
• Pain
• Malaise
• Irritability
• Fever
• Vomiting
The fever is often very high and may be associated with febrile convulsions.Signs
Examination may reveal:
Fever may be very high.
Red and possibly bulging eardrums.
Sometimes the outer ear glows red.
Hearing loss being present but not usually noticed in an acutely unwell child.
A well-recognised complication is that a child who is screaming and in a great deal of pain finally settles and the ear starts to discharge green pus. The eardrum has burst, releasing the pressure and relieving the pain.Differential diagnosis.
Otitis externa (OE).
Post-auricular adenitis.
Referred pain (especially from teeth).
Herpetic infection of the ear..
Foreign body in the external canal.
Temporomandibular joint pain.
Trauma.
Often children who are unwell have a slightly red eardrum but in AOM it is very red.See below for Management,Complications,need for Hospital admission etc.
G Mohan.
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