Ear pain in children: symptoms and treatment of otitis. Otitis media, otitis media and childhood ear infections. Symptoms and treatment

Perhaps every parent remembers how capricious and weak a baby becomes when his ears suddenly hurt. In such a situation, even the most calm mom she will be confused and will chaotically go through in her head all the methods known to her for getting rid of otitis media. After all, it is this disease that first comes to parents’ minds when a child complains of ear pain.

Otitis is traditionally a childhood disease that occurs in children from newborn to 3 years of age. There may be several reasons for this - from anatomical features the structure of the auditory tube to the child’s fragile immunity. Even if your two-year-old child has never had otitis media, it would be a good idea to play it safe and find out how to behave in such cases and what treatment to use.

Causes of childhood otitis media

First of all, otitis media in a baby can manifest itself as one of the complications after suffering from influenza or acute respiratory infections. The same consequences cannot be excluded due to a prolonged cold, chronic inflammation of the adenoids, or penetration of a pneumococcal or staphylococcal infection into the body.

Another reason explaining why ear inflammation more often attacks infants than older children is the special structure of the auditory canal. The ear tube in newborns is almost 2 times shorter than normal parameters, and in addition to this, it is also very wide.

These anomalies in the structure allow various microorganisms to freely move into the auditory tube from the nasopharynx along with mucus and other secretions.

The next factor that provokes childhood otitis media is the way the baby is fed. If you feed your baby in a lying position, then food particles will certainly enter the nasopharynx, and from there into the Eustachian tube. For this reason, it is recommended to feed infants strictly vertically, and also to carry them in a column more often when unwell.

Over time, the auditory tube begins to change and acquires its normal sizes. Its position relative to the nasopharynx also changes. It becomes not so easy for bacteria to penetrate the Eustachian tube, which is located at a large angle towards the pharynx.

However, older children also often complain of ear pain. The reason for this may be a weak immune system, unable to protect the body from pathogenic bacteria that have entered it.

Another risk factor for catching otitis media is any frequent illnesses nasal passages and upper pharynx. This includes all kinds of rhinitis, sinusitis, adenoiditis and others. pathological conditions, in which it is difficult for a child to breathe through his nose.

Only a qualified otolaryngologist can determine more accurately. Remember that further treatment depends on understanding the nature of the disease and the factors that provoked it.

Symptoms of ear inflammation in a child

The onset of the disease is usually unexpected and quite abrupt. The baby's body temperature may suddenly rise to critical levels.

Children also often refuse food and cannot sleep, because any movements of the head and jaw cause discomfort to the baby. Acute pain in the ear can occur when sneezing or blowing your nose, because the auditory tube increases because of this.

Newborns and infants cannot yet explain to their parents what exactly is bothering them. The baby simply feels unbearable pain and as a result begins to cry, be capricious, refuses to lie alone and cannot sleep for a long time. Often newborns even stop taking the breast due to discomfort when sucking.

Only in aggregate indirect signs pretty hard. A more reliable method is to apply pressure on the child's ear tragus. If at the same time the baby begins to behave restlessly, inflammation in the ear is undoubtedly present.

Starting at four months, a child can give signals to his parents that something is wrong with his ears. For example, the baby begins to frequently twist and wave his head in different directions, tries to touch with his hand or fiddles with sore ear, rubs it against various objects.

In case of particularly severe otitis media, the baby may have the following number of signs:

1. Protrusion or retraction of the fontanelle;
2. Nausea and vomiting;
3. Uncontrolled head movements;
4. Disorder of the gastrointestinal tract.

Note! Such conditions should prompt parents to show their child to the doctor as soon as possible, because treatment should begin immediately!

Despite the difficulty self-diagnosis otitis, symptoms in a 2-year-old child appear more pronounced, and the disease itself becomes easier to recognize. As a rule, older children can already inform their parents about ear problems.

The child experiences acute throbbing pain, spreading to all parts of the skull. Pain may radiate to the temple, jaw or crown. The child often says that he has begun to hear worse, and his ears seem to be bursting from the inside or there is a feeling of severe congestion in them.

Older children, like toddlers, experience fever and chills, signs of intoxication, and disorders gastrointestinal tract. The child loses appetite and sleep, consciousness is confused, and possible loss of coordination of movements.

Such a symptom as abundant purulent discharge from the ears indicates that a rupture has occurred eardrum. As a rule, the child’s condition returns to normal after this.

Periods of exacerbation of chronic disease are characterized by the same symptoms as its acute initial stage.

Medication and folk treatment

Otitis media in childhood can be treated with medications and folk remedies. But before you self-medicate, you need to consult a specialist.

Treatment of otitis media with medications

The therapeutic course for childhood otitis includes the appointment antibacterial drugs in the form of tablets or intramuscular injections for a period of at least 5 days.

Antibiotics are necessary for children in order to prevent the occurrence of parallel diseases, as well as to prevent possible complications. At the same time, it is necessary to constantly monitor the condition of the Eustachian tube in order to eliminate the resulting obstruction in a timely manner.

For this purpose, the child is prescribed vasoconstrictor drops for the nose and local treatment procedures:

1. During an acute ear infection, applying dry heat to the area of ​​the sore ear helps very well. Such manipulations normalize blood circulation and contribute to the production of additional protective bodies. Dry heating includes exposure to the affected ear with a blue or red lamp, therapeutic ear turundas, warm bags of salt and alcohol-containing compresses.
2. The purulent stage of otitis media requires regular manipulation to clear pus from the ears. You can do this at home using antiseptic solutions(such as hydrogen peroxide), and then remove the remaining pus with a cotton swab. In case of complications, the doctor may prescribe the child to inject antibacterial solutions directly into the middle ear.

For a child under 2 years of age, it is mandatory to take antibiotics, including ceftriaxone, amoxiclav and cefuroxime. The course of treatment lasts from 5 days to a week. The dosage of the drug is calculated individually, based on the baby’s weight. Any of the above antibiotics is administered intramuscularly into the body.

It's also possible intravenous administration if the baby rapidly develops complications. Older children are prescribed an antibiotic only if the child experiences unbearable pain in the ear, feels unwell, and his body temperature does not fall below 38 °C.

Children over 1 year of age are already allowed to use some vasoconstrictor medications, but before doing this, the child’s nose must be carefully cleared of mucus. Nasal drops should be used no more than 2 times a day - shortly before bedtime and before one of the feedings.

The most popular drug of this plan is Nazivin - vasoconstrictor drops for children. It is necessary to instill 2-3 drops of the product into each nasal passage.

If you have any doubts whether ear drops can be used for a newborn, be sure to consult a specialist. As a rule, doctors do not recommend instilling any products into the ears or nose of babies under one year of age.

Despite the fact that many drugs are approved from birth, individual intolerance or an allergic reaction in a child to any drug cannot be ruled out.

It is also important to know what you can do to bring down a baby’s high fever before the doctor arrives. Children are allowed to be given drugs such as: Panadol for children, Efferalgan, Panadol for baby, as well as other drugs whose instructions do not contain any contraindications for children. Aspirin and analgin are prohibited for use in pediatrics.

Local preparations and traditional treatment

In addition to basic medical treatment, your doctor may also recommend a course of warm compresses on the affected ear. They are prescribed only if the eardrum is intact and no suspicious discharge is observed from the ear.

Treatment with alcohol or vodka compresses has long been famous for its effectiveness. The process itself is not complicated and consists of just a few sequential steps:

• In a sterile cloth or gauze, folded 4 times, you need to make a hole for the ear;
• The size of the napkin should extend beyond the edges of the auricle by about 2 cm;
• The resulting napkin is moistened in a previously prepared warming solution and applied to the area of ​​the affected ear;
• The outer auricle should remain outside;
• A plastic film, 2–2.5 cm in size, must be tightly placed over the gauze. more than the first layer;
• Another layer is applied on top of the polyethylene - cotton wool, which protrudes beyond the edges of the film or wax paper;
• The resulting structure should be secured with a scarf or other warm material, tying it around the baby’s head;
• Keep the compress for at least 3 hours. However, leaving it on for 4 hours or more doesn’t make much sense, because thermal effect the structure will already be exhausted by that time.

Another effective remedy for the treatment of otitis in a 2-year-old child - these are special drops for the ears. However, you also need to know how to bury them at home correctly. With an unprofessional eye, it is almost impossible to determine what nature of the inflammatory process is occurring in the ear, whether the tympanic membrane is damaged, etc.

If there are perforations in the eardrum, ear drops entering its cavity can lead to unpredictable consequences, including malfunction auditory ossicles and further hearing loss.

In order not to harm the baby with your actions, it is necessary to bury the sore ear in a special way. A turunda is twisted from a piece of cotton wool or a cotton pad and placed shallowly in the ear canal. The medicine should be dripped onto the turunda, but not directly into the ear itself. To achieve the best results, the ear drops should be slightly warmed in your hands before use.

As a rule, children are prescribed safe and fast-acting medications, which include such a popular drug as Otipax. If there are no special drops at hand, they can be replaced with folk recipes. For example, soak a cotton pad in onion juice or boric acid, and then put it in the child’s ear.

It is important! The above recipes are not a guide to action. Only an otolaryngologist can assess all the risks from using a particular product.

No matter how strong the concern for the baby, parents should remember that starting any treatment without first consulting a doctor is strictly prohibited. Pediatric otitis requires medical intervention even in to a greater extent than an adult.

The fact is that not a single mother who is not an otolaryngologist can predict how this or that drug will affect her child.

TO dangerous consequences can lead not only to self-medication, but also to complete inaction in the event of the onset of an inflammatory process in the ear. Therapy not started on time is a guarantee of complications such as chronic otitis media, hearing loss, and even inflammation of the meninges.

• Which doctors should you contact if you have Acute Otitis Media in Children?

What is Acute otitis media in children

Acute otitis media- inflammation of the middle ear (tympanic cavity, auditory tube and air cell system mastoid process).

Prevalence. This is one of the most common diseases in pediatric practice, accounts for about a quarter of all ear diseases. Before the age of 1 year, every 2nd child develops acute otitis media; Before 3 years of age, 90% of children have suffered acute inflammation of the middle ear at least once.

Many children develop acute otitis media more than once; during the course of a year of life, 20% of children experienced the inflammatory process three times.

What causes Acute otitis media in children

Acute otitis media can be of bacterial origin. Correct orientation in the rather diverse microbial landscape of the contents of the middle ear has a very important. When prescribing therapy, you should know the activity of various antibacterial drugs against the most common pathogens. Frequent seeding of antibiotic-resistant strains must be considered. The microflora in acute otitis media is quite diverse, but the coccal flora predominates. Typical picture of microflora in acute otitis media: Streptococcus pneumoniae - 32%, Haemophilus influenzae- 22%, Moraxella catarhalis - 16%, Streptococcus heamoliticus - 2%, sterile culture (non-pathogenic microorganisms) - 25%.

A certain role is assigned to viral, especially adenoviral infection. The virus is most often detected when acute otitis media occurs in a child during an epidemic outbreak of influenza.

Otitis media can also be caused by a fungal infection.

Several years ago, when children were vaccinated with an oral vaccine against tuberculosis, peculiar BCG otitises with a characteristic sluggish course, normal temperature and the formation of granulations in the ear were quite often observed.

Pathogenesis (what happens?) during Acute otitis media in children

The disease occurs more often in childhood, or rather infancy and early childhood, due to the influence of local and general factors.

General factors: childhood infectious diseases (ARVI, scarlet fever, diphtheria, measles), including adenoviral and fungal diseases; failure natural immunity; the occurrence of otitis during childbirth, in the early period of the newborn and even in utero, when infection occurs due to an inflammatory disease in the mother (pyelonephritis, endometritis, mastitis), the development of otitis contributes long labor, anhydrous period of more than 6 hours, fetal asphyxia; nutrition factor (with artificial feeding, a child’s risk of getting sick is 2.5 times higher); allergy, exudative diathesis. About a quarter of children with acute otitis media have a positive allergy history, with food allergies predominating; hereditary factor; pathology of the bronchopulmonary system.

Local factors. Myxoid tissue in the middle ear at birth provides a very good breeding ground for microorganisms and, as a result, is easily subject to inflammation. Sometimes myxoid tissue covers the tympanic opening of the auditory tube, preventing the outflow of pus and worsening the course of acute otitis media.

Features of the child's auditory tube. It is much shorter and wider than that of an adult. There are usually no bends. The position of the tube in relation to the nasopharynx is horizontal; it can constantly gape. The function of the ciliated epithelium during inflammation is quickly disrupted. Through the auditory tube, infection penetrates from the nasopharynx into the tympanic cavity much more often and more easily than in adults.

The condition and anatomical and topographical relationships of the nasopharynx in children have their own characteristics. First of all, in children there is hypertrophy of the nasopharyngeal tonsil (adenoids) and tubal ridges. Hypertrophied adenoids, which can appear already in newborns, although they reach maximum development by 3-5 years, serve as the main source of infection at the onset of the disease and contribute to protracted process due to deterioration of outflow from the tympanic cavity.

Microcirculation in the mucous membrane of the nasopharynx is disrupted due to the constant position on the back of children infancy.

Often there are acute inflammatory diseases of the nasal cavity and paranasal sinuses, sore throats and pharyngitis.

Pathways for infection to enter the middle ear. Pathogens most often enter the tympanic cavity from the nasopharynx through the auditory tube. Features of the auditory tube in childhood are described above. Frequent rhinopharyngitis, adenoid vegetations, hypertrophy of the tubal tonsils, dysfunction of the auditory tube, enlargement of the posterior ends of the nasal concha, choanal atresia temporarily or permanently make it difficult nasal breathing, as a result of which children often suffer from acute otitis media.

Infection from the external auditory canal is less common; this is only possible with injury or perforation of the eardrum. Prevention of acute otitis media by covering the ears with cotton wool or a warm hat is essentially meaningless, just like the expression “the ear is blown.”

The hematogenous route is rarely used, mainly in severe viral diseases or sepsis.

Symptoms of Acute otitis media in children

In the classic course of acute inflammation of the middle ear, 3 stages are distinguished: I - initial development of the process, II - after the onset of perforation of the eardrum, and III - recovery. Each of them lasts approximately 1 week.

At stage I, pain, high body temperature, decreased hearing appear, and otoscopy reveals hyperemia of the eardrum. General intoxication and a reaction of the mastoid periosteum are noted.

At stage II, after the onset of perforation of the eardrum, the symptoms change: spontaneous pain decreases, temperature and intoxication decrease, discharge from the ear appears, perforation of the eardrum is determined by otoscopy, and hearing loss persists.

On Stage III the temperature returns to normal, intoxication disappears, there is no pain, discharge stops, the perforation closes and scars, and hearing is restored.

Rapidly occurring acute otitis media is not uncommon, when within several hours, against the background of severe pain, high body temperature and severe intoxication, exudate quickly forms with the onset of perforation of the eardrum and suppuration.

Sometimes in these cases it seems that stage I is completely absent; the child immediately develops pus from the ear. This course is usually associated with high virulence of the pathogen. The rapid course of the process stops with the prescription of large doses of antibiotics, preferably broad-spectrum (amoxicillin).

The disease is usually severe, accompanied by severe pain, high fever, and intoxication.

Often acute otitis media in a child begins suddenly at night; parents contact the nearest nursery medical institution; Pediatricians are forced to provide primary diagnosis and first aid.

Diagnosis of Acute otitis media in children

Correct diagnosis and rational treatment literally in the first hours are extremely important for the further course of the disease; they can interrupt the rapid course, prevent hearing loss and even severe, in particular intracranial, complications.

Symptoms are extremely varied and largely depend on the age of the child. Starting from school age, symptoms are practically no different from those in adults. The course of the disease in newborns and infants, in the early and preschool age very different. In this regard, we provide their separate description.

Decisive for diagnosis is the appearance of discharge (otorrhea) upon the occurrence of perforation of the eardrum or during its paracentesis (incision). The absence of discharge after paracentesis does not definitively indicate the absence of an inflammatory process in the tympanic cavity, since sometimes exudate has not yet had time to form by this time.

Features of the diagnosis of acute otitis media in newborns, infants and children early age. A very important role for diagnosis at this age is played by the anamnesis collected from the mother.

When interviewing, you should pay attention to the course of pregnancy and childbirth (protracted, birth injury), full term. Find out information about admission medicines, alcohol, smoking, ear disease in the mother, administration of ototoxic drugs, previous viral diseases, at what stage of pregnancy, what was feeding; the question should be asked about what caused the child’s condition to worsen. Ear disease is often preceded by acute rhinitis with heavy discharge from the nose, respiratory infections, gastrointestinal disorders, sometimes trauma (falling out of bed), allergic diseases. The leading symptom of acute inflammation of the middle ear is severe, often sudden spontaneous pain. It is associated with the rapid accumulation of exudate in the tympanic cavity and pressure on the endings of the trigeminal nerve, which innervates the mucous membrane.

A child's reaction to pain is expressed differently and depends on his age. Until 5-6 months, the child cannot yet determine the location of the pain and the affected side. He reacts to pain with a cry, a pendulum-like shaking of his head, reminiscent of prayer movements.

Rocking in the arms does not help; the child refuses breastfeeding, because when sucking there is movement in the joint lower jaw easily transmitted to the walls of the external auditory canal and the tympanic cavity. Sometimes the baby prefers to take the breast opposite the sore ear. When the sore ear is at the bottom, the pain subsides slightly.

The preferred position of the head in bed on the painful side is also associated with this; apparently, the warmth from the pillow also somewhat reduces pain.

A very common and popular method among pediatricians for studying a child’s reaction when pressing on the tragus should be treated very critically due to the large number of false-positive reactions.

It is recommended to conduct the study on a sleeping child. The same applies to the child’s reaction when pressing on the area behind the ear, since at this age the system of air cells of the mastoid process has not yet been formed. However, if the child’s reaction is persistent and repeated, one can think about the development of periostitis.

An important general symptom is body temperature. On the 2-3rd day of the disease, it usually rises sharply, sometimes to 39-40 ° C, although there is a variant of the course of the disease (the so-called latent otitis), in which the temperature is subfebrile.

An increase in body temperature is accompanied by severe intoxication. It is more often expressed by excitement: the child does not sleep, screams, the condition worsens at night, sometimes, on the contrary, a depressed state occurs, apathy, vomiting, regurgitation, and increased bowel movements. The child refuses to eat.

After clarifying the anamnesis and common symptoms proceed to inspection. Pay attention to the child’s posture, the condition of the skin, lymph nodes, abdominal wall etc., since acute otitis media can be a consequence of infectious, allergic and gastrointestinal diseases.

When examining children of this age, special attention is paid to neurological symptoms, which can develop as a result of severe intoxication, symptoms of irritation of the meninges (meningismus). The development of menschism is explained by a good network of anastomoses (circulatory and lymphatic) between the middle ear and the cranial cavity.

It is necessary to check the basic meningeal reflexes (Kernig, Brudzinsky). The same applies to eye symptoms: limitation of gaze and mobility of the eyeball, the appearance of nystagmus.

Before moving on to endoscopy and palpation, during an external examination, pay attention to the condition of the facial muscles (paresis facial nerve); protrusion of the ears, severity of the postauricular transitional fold; condition of the mastoid area, temperature, color, swelling or infiltration of the skin over it; enlargement and tenderness of the anterior and posterior auricular lymph nodes; the condition of the sternocleidomastoid muscles and their anterior edge, where the jugular vein passes.

After a detailed examination, an otoscopy is performed. Examination of the eardrum in infants, and even more so in newborns, is very difficult due to the narrowness of the external auditory canal and the almost horizontal position of the eardrum. At this age, the external auditory canal is often filled with vernix and epidermal scales, which should be carefully removed using a probe and cotton wool before inserting even the narrowest funnel.

Usually you can only inspect upper sections eardrum, which are injected at the beginning of the disease and then become hyperemic.

Rest identification marks, as a rule, cannot be distinguished. The light reflex appears in a child at least 1.5 months old.

There are a number of other factors that distort the typical otoscopic picture for otitis media in adults. Insertion of the funnel and toilet of the external auditory canal can themselves cause hyperemia of the eardrum, as well as anxiety in the child. The epidermal layer of the tympanic membrane in a newborn and infant relatively thickened and not always hyperemic even with an inflammatory process in the tympanic cavity. All this significantly reduces the value of the otoscopic picture, significantly complicating diagnosis, which is based more on general symptoms.

Modern pneumatic otoscopes make the examination somewhat easier, which, in addition to magnifying the elements of the eardrum, make it possible to determine its mobility.

The same applies to the study of auditory function, which is only possible with the help of complex objective methods.

Some data can be obtained by x-ray examination temporal bones, in which a decrease in the airiness of the cavities of the middle ear is detected.

The hemogram does not have characteristic changes, because, like any inflammatory process, acute otitis media is accompanied by leukocytosis with a shift in the blood count to the left, increased ESR etc.

Thus, the diagnosis of acute inflammation of the middle ear in infants and newborns in the initial period is very difficult. However, at this time, an urgent determination of treatment tactics for the child is required.

Treatment of Acute Otitis Media in Children

Common Methods local treatment are aimed at improving the outflow of exudate from the tympanic cavity or at its resorption. For this purpose, vasoconstrictor nasal drops are used to improve the patency of the auditory tubes, warm compresses are applied to the ear area, physiotherapeutic procedures, and sometimes an incision of the eardrum using a paracentesis needle (paracentesis); Various alcohol drops in the ear are also widely used.

However, the mainstay is the prescription of antibiotics. The indication is primarily the severity of the condition associated with acute inflammation middle ear, intoxication, high fever and pain.

In case of illness moderate severity during the first day you can limit yourself symptomatic treatment, but in the absence of positive dynamics within 24 hours, antibiotic therapy is necessary.

Children under 2 years of age almost always require antibiotics.

Antibiotics are prescribed taking into account data on the prevalence of clinically significant pathogens. Unreasonable prescription contributes to the development of antibiotic resistance and adverse reactions.

For the first time acute otitis media occurs, as well as in children who have not received antibiotics during the previous 1 - 2 months, amoxicillin is the drug of choice. In case of an allergic reaction to this drug, modern macrolides are recommended.

If acute otitis media has developed in a child who has received antibiotics over the past 2 months, as well as if amoxicillin is ineffective within 3 days, combined “protected” antibiotics, in particular amoxicillin-clavulanate, become the drugs of choice. Clavulanic acid, which is part of, for example, augmentin or amoxiclav, binds beta-lactamase (an enzyme secreted by a microorganism that destroys the lactome ring of the antibiotic), thereby overcoming the resistance of the pathogen. Alternative drugs for acute otitis media are cephalosporins and macrolides.

For uncomplicated forms of acute otitis media, drugs are prescribed orally; The duration of the course is at least 5-7 days.

According to statistics, about 90% of children under the age of 5 have suffered from otitis media at least once in their lives. Thus, we can say with confidence that otitis media is the most common disease in children. Moreover, it is children who are most susceptible to this disease due to certain structural features of the ears and physiologically reduced immunity.

The first place among the sick remains with children under 5 years of age. The second place is occupied by elderly people, and the third place is taken by teenagers under 14 years of age. Unfortunately, the prevalence of otitis in children, as well as the relative ease of treatment, misleads many parents about the seriousness of this disease.

In fact, the disease is quite serious, capable of causing very unpleasant, even terrible complications, including deafness or meningitis. Therefore, knowledge of the symptoms and treatment methods for otitis in a child is an important part education of each parent.

What is otitis media

Otitis is any inflammatory process in the ear. Since the human ear is anatomically divided into three sections, otitis media is divided into external, middle and internal. The most common otitis media occurs in children, and the most severe, of course, is internal otitis. Inflammation of the middle ear is divided into catarrhal and purulent.

As a rule, the causative agents of otitis are various pathogenic bacteria, such as staphylococci or streptococci. Unlike other inflammatory processes, otitis media is almost never caused by viruses, and especially by fungi.

Reasons for the development of otitis media

To understand what the causes of otitis media are and why children get sick more often, you need to first look at the structure of the ear. Usually we call the ear the pinna when its largest and most important part is located inside the skull. The auricle simply picks up sounds and sends them through the auditory canal to the eardrum, which separates the outer and middle ears. The function of the eardrum is that it captures sound from outside and resonates, transmitting it further, like skin stretched over a ringing drum.

The middle ear is a small cavity in the temporal bone. This cavity houses a complex and very small bone structure that transmits sound to the inner ear. The inner ear is most similar to the cochlea, and the cochlea contains nerve endings that transmit signals to the brain.

In order for the eardrum to function properly, it is very important to balance the atmospheric pressure in the middle ear. To do this, the middle ear cavity is connected to the nasopharynx by a passage called the auditory or eustachian tube.

This is where the reason for frequent otitis media in children lies. The fact is that, like many other systems, The ear is not fully formed after birth. In children under 5 years of age, the Eustachian tube is much shorter and wider than in adults, in addition, it is located in the horizontal plane. All this facilitates the penetration of various liquids from the nasopharynx into the middle ear cavity. Most often, this happens when mucus accumulates in the nose during a common runny nose.

However, if the rules of feeding newborns are not followed, Breast milk or formula may enter the middle ear cavity. During feeding, the baby often swallows a large amount of air, and after feeding, this air must be released while holding the baby upright. Along with the air, a small amount of milk or formula often leaves the stomach. If regurgitation occurs while the baby is lying down, food can enter the nasopharynx and then the middle ear cavity through the Eustachian tube. Immediately after birth, amniotic fluid may remain in the cavity.

Unlike nasal mucus, milk and amniotic fluid themselves do not contain pathogenic flora, but they are nutrient medium for the development and reproduction of bacteria. However, most often otitis media develops against the background of various colds, influenza, scarlet fever, diphtheria or other childhood diseases. At this time, two risk factors are combined: the presence of pathogenic flora and a decrease in the child’s immunity.

Another cause of otitis media is allergic reaction. Allergies can also cause rhinitis, rapid formation of nasal mucus and its flow into the auditory tube.

Otitis inner ear rarely develops on its own. In the vast majority of cases, it only accompanies inflammation of the middle ear if it was not recognized and treated in time.

The simplest situation is with external otitis media. It is also called traumatic, since it develops as a result of infection in microcracks in the skin of the auricle and ear canal. Injure delicate skin This can happen due to careless cleaning of the ear canal or when foreign objects get into it.

Symptoms

It is easiest to recognize external or traumatic otitis media, since the source of inflammation is located outside. Typically, otitis externa begins with a sharp skin redness auricle or ear canal. Then it begins tissue swelling , and the opening of the ear canal sharply narrows. Usually this condition goes away quickly on its own. The eardrum seals off the entrance to the middle ear and prevents infection from spreading further.

Obviously, the belief of some parents that otitis media can be acquired externally is completely unfounded. Inflammation of the middle and inner ear develops only as a result of infection from the inside. However, one of the factors leading to the development of otitis may be hypothermia.

Every parent should know the symptoms of otitis media in children: sudden increase in temperature up to 38–40 degrees, weakness, and, most importantly, pain in the ear. It can be pulsating, shooting, pulling, aching. One thing in common: the pain is very strong, growing, sometimes even unbearable. Due to pain, the child may become irritable and restless. Possible sleep disturbance.

It’s good if the baby can already speak and can complain of ear pain. And if not? How, then, to recognize the symptoms of otitis media in children under one year of age? It is very important to carefully monitor your baby's behavior. The child will try to lie on the sore ear, rubbing it against your hand or pillow. In general, when lying down, a child with otitis media usually feels worse, which is due to pressure on the source of inflammation from the nasopharynx.

Most likely the baby will be refuse food . The fact is that during sucking, an area of ​​negative pressure is formed in the nasopharynx and, accordingly, in the middle ear. Because of this, the pain in the ear also intensifies, so the child may, barely sucking on the breast or bottle, immediately spit it out screaming. In order to make sure that painful sensations connected specifically to the ear, you can press on the tragus - this is a small triangular-shaped cartilage that covers the entrance to the ear canal. If, when pressed, the child begins to worry and screams, then, most likely, we are talking about otitis media.

At the first signs of otitis in children, it is necessary to see an ENT specialist or at least a pediatrician. No matter how obvious the diagnosis is for the baby’s parents, it is impossible to be completely sure that the child is suffering from otitis media. In addition, otitis media can be very diverse, and treatment directly depends on its type.

It is noteworthy that allergic otitis media does not cause fever. The more difficult it is to recognize it. Without signs of intoxication, only symptoms associated with sensations in the child’s ear remain. If the baby cannot voice them, you can guess the existence of a problem only by behavior and then only thanks to an exceptionally attentive attitude towards your baby.

The only case when there is no doubt about the diagnosis is with purulent otitis media. The eardrum ruptures and pus begins to leak from the ear . By the way, during this period, the child usually experiences a sharp relief of his condition, as the pressure in the middle ear cavity drops, the pain decreases, and the temperature often decreases. Please note that such relief is not a reason to refuse to see a doctor. The baby still needs treatment. Otherwise, acute otitis may smoothly turn into chronic. Then you will encounter the same problems again and again. Treatment of chronic inflammation in children is a much more complex process than getting rid of acute otitis media.

First aid for otitis media

Unfortunately, in the realities of our country, it is sometimes simply impossible to get to a doctor at the first symptoms of otitis media in a child: appointments are booked for weeks in advance. In this case, you should call a doctor at home and take all possible measures to alleviate the baby’s condition. But you shouldn’t start treatment on your own; you can harm your child with the wrong selection of drugs for the treatment of otitis media.

At all, self-treatment Moreover, treatment of otitis in children with folk remedies can cause serious complications. Not all of the methods that our grandmothers suggest using are truly effective and safe.

Therefore, the tasks of parents include only alleviate the condition child. If he has a high temperature, above 38–39 degrees, it must be brought down. For this, standard drugs are used: Paracetamol or Ibuprofen. They are also good because they have an analgesic effect. It is better for infants to choose drugs in the form of rectal suppositories, since intoxication can cause them to vomit.

It is widely known that dry heat helps with otitis media. However, it is important to remember that no warming compresses can be applied during the period of fever. This can only make the condition worse.

If the child’s high temperature does not bother him, then the ears can be warmed up. For example, using an ultraviolet lamp or semi-alcohol compresses.

Very important provide the child with free breathing . To do this, you need to clear your nose of excess mucus using a special bulb or aspirator. However, this must be done correctly and very carefully, without causing pain. You should not force your child to blow his nose by pinching both nasal passages. You need to clean them one by one.

Boric alcohol has long been an integral part of the treatment of otitis media in children. Until now, many grandmothers or friends can advise putting it in a child’s ear. However, you shouldn't do this. Alcohol irritates the delicate skin in the ear canal and can even cause burns. Today boric alcohol is in medical practice does not apply. When purulent otitis and a ruptured eardrum, dripping alcohol solutions into the ear is completely prohibited, since alcohol can damage the delicate apparatus inside the middle ear.

Treatment

So how and how to treat otitis media in a child? Much depends on the type and stage of development of the disease. So, catarrhal otitis in mild form does not always require therapy antibiotics , which really surprises the parents. Treatment of otitis in children with antibiotics seems mandatory to many. But if the baby’s immune system is normal, pus does not form and the little patient’s condition is clearly not serious, then the body is able to cope on its own provided there is adequate outside help in the form of compresses, nose cleansing and pain relief.

Unfortunately, this situation is extremely rare. In most cases, even catarrhal otitis in a child requires treatment with antibiotics. They can be prescribed in tablets, suspension or drops for local application. If drops were prescribed in your case, remember that direct instillation into the ears is contraindicated for small children. It is better to use cotton pads. The turunda is inserted into the ear, and drops warmed in warm water or hands are dripped onto it. Gradually, the cotton wool will become saturated with the medicine and it will reach its destination without damaging the skin in the ear canal.

The doctor will most likely prescribe vasoconstrictor drops for the nose to make breathing easier and free the nasal passages from excess mucus.

Taking antibiotics is usually accompanied by taking antihistamines and drugs for dysbacteriosis . This is due to the fact that antibiotics kill not only pathogenic flora, but also all other microorganisms, including those that are vital to our body. It is usually the beneficial bacteria in the gastrointestinal tract that are most affected.

As a rule, treatment of otitis in children takes place at home. However, in particularly severe cases, hospitalization may be required. The most difficult thing to treat is purulent otitis media in a child. The eardrum in children is thicker than in adults. As a result, with purulent otitis media it may not rupture. As a result, pus accumulates in the middle ear cavity, pressing on the membrane and on the walls of the cavity, causing severe pain. In addition, in this case, pus can penetrate into other cavities of the skull, causing various complications.

For this reason, doctors may insist on hospitalization and puncture of the eardrum. There is no need to be afraid of this, since, firstly, the procedure takes place under local anesthesia, secondly, after recovery, the eardrum grows together without loss of hearing acuity.

Hospitalization may also be required if there are signs of any complications.

Possible complications

Since almost all systems in the head are connected in one way or another, any inflammation, including otitis media, can spread to neighboring organs and tissues. The middle ear cavity is directly adjacent to the inner ear, sinuses in the bones of the skull, eye sockets and, of course, the nasopharynx.

Incorrect or untimely treatment of otitis media can provoke transition of acute otitis to chronic form . This means that the child will experience ear inflammation much more often, since pathogenic flora will be constantly present in his body. Chronic otitis is much more sluggish than acute, but it is more difficult to cure and often causes complications.

Otitis media can spread to the inner ear, eyes, or sinuses in the bones of the skull. The consequence of this may be complete or partial hearing loss, blurred vision, severe headaches . In addition, the bony sinuses are separated from the brain by only a thin membrane. If the sinuses are filled with pus, the membrane may burst, and then the infection spreads to the cerebral cortex, which leads to the development meningitis .

Fortunately, modern medicine has effective methods for treating otitis media, and if parents promptly consult doctors and strictly follow all their recommendations, complications of otitis media develop extremely rarely. This is why it is so important that parents are well aware of the symptoms of otitis media in children.

Prevention

Prevention of otitis media consists, first of all, in maintaining the child’s immunity, as well as timely treatment of respiratory diseases. Preferably as soon as possible breastfeed your baby longer, since breast milk for newborns is a source of maternal antibodies. It is this that helps to form protection during the period when one’s own immune system is not yet functioning properly. full force. Be sure to follow all feeding recommendations and allow your baby to burp correctly.

Promotes the development of immunity and frequent walks on fresh air . Ideally, you need to regularly get out of town with your child, but walks within the city will only benefit him. In addition, it is necessary to regularly ventilate the room in which the child is most often located, since stagnant air provokes the development of colds.

An important part of the developing immune system are vitamins. The lack of many of them makes the human body vulnerable to a variety of infections. Therefore, it is very important to ensure that there is a sufficient amount of vitamins in the child’s diet. In the summer, you can buy him more fruits and vegetables, since natural vitamins better absorbed by the body. In the off-season, it would be a good idea to take courses of vitamin complexes, since it is at this time that children most often get colds.

If it was not possible to prevent ARV, which still happens to almost everyone from time to time, it is important to treat the disease as early as possible. Make sure that mucus does not stagnate in the nose so that it does not flow into the Eustachian tube. In addition, it is very important to closely monitor the child’s condition and promptly notice the symptoms of otitis media if it was not possible to prevent its development.

On the one hand, almost every child has suffered from otitis media at least once in their life, and most of those who have been ill hear perfectly well and have not developed inflammation of the cerebral cortex; on the other hand, this is not a reason to relax and leave such a serious disease unattended. A sick child definitely needs health care, adequate and timely.

We recommend viewing: Doctor Komarovsky about otitis media in children

Replies

Otitis caused by blockage of the eustachian tube and stagnation of fluid in the middle ear. Often the cause is the penetration of microorganisms (mainly bacteria) from the pharynx into the Eustachian tube and middle ear. Otitis media occurs most often in infants and children. The reason for this is that the Eustachian tube in young children lies in a horizontal plane between the middle ear and the nasopharynx. As a result, microorganisms from the pharynx easily penetrate into the middle ear. In older children, the position of the Eustachian tubes shifts to the vertical, which makes it difficult for microorganisms to penetrate into the middle ear.

Large mucus production in children with allergies increases the risk of otitis media, since swollen adenoids (one of the pairs of tonsils located behind the nose) often block the Eustachian tubes. Children at risk of upper respiratory tract infection, such as those who live with smokers, have high probability get otitis media.

High pressure in the middle ear can cause the eardrum to rupture. The rupture leads to subsequent scarring, and if the ruptures and scarring are repeated, chronic hearing loss can occur.

Causes of otitis media in children

Otitis can rightfully be called one of the most common and most unpleasant diseases for a child in childhood. They occur in children of all ages. But if a child older than one and a half to two years can already explain to his parents that his ear hurts, then a six-month-old baby will not tell you anything.

And otitis media in childhood is very dangerous. What should parents do, how to suspect a child has an illness, what is the right thing to do - what should be done and what should not be done under any circumstances.

It is quite difficult to suspect otitis media in a child; it usually first manifests itself as a common cold: snot, high fever, and the child may cough.

There is still an opinion among parents that the infection enters the ear from the outside, through the external auditory canal. Also groundless are such precautions as constantly wearing a hat (and at home, when there are 2 heaters in the room and batteries at full power - the child is red as a lobster, sweating like a stream - but in a hat) or, for example, plugging the ears with cotton wool or tying them with a scarf. “Getting infected with otitis media” from a neighbor’s boy is also unrealistic, so there is no point in isolating other children from the sick one.

Acute otitis media is characterized by sudden and acute pain in the ears, irritability, decreased hearing, and restless sleep. Pus-like discharge from the ear is also common.

What types of otitis occur in children?

There are external and medial otitis, the latter can be catarrhal and purulent.
Inflammation of the outer ear. Occurs if the skin of the external auditory canal (when cleaning the ears or if a child picks in the ear) foreign object) gets infected. In this case, the skin around the ear canal itself turns red, and the passage narrows slit-like due to swelling. Often a translucent discharge appears there.

Therefore, children’s ears need to be cleaned carefully. After bathing, roll up a roll of cotton wool (not grab cotton swab), saturate it boiled water, turn the baby's head to the side and wipe the outer ear, wiping all the folds of the auricle. Use a separate cotton swab for each ear. Do not penetrate beyond the vestibule of the ear canal, as you may push the wax into the tympanic septum and cause a plug!

Inflammation of the middle ear (acute otitis media)- Almost every child in one form or another has suffered from otitis media at least once. This is due to a number of anatomical and physiological characteristics babies' bodies. In most cases, otitis media occurs as a complication of acute respiratory disease (ARI) - when parents begin to self-medicate, sometimes using unnecessary or contraindicated drugs. Please note - most common reason the development of otitis media is a banal, improperly treated runny nose. The child's weak immunity, tendency to allergic reactions, the presence of adenoids in the nasopharynx, inability to blow your nose, etc. lead to the fact that infected mucus from the nasal cavity and nasopharynx penetrates through the auditory tube into the middle ear.

It must be taken into account that children prone to allergies have allergic otitis media. Following improper feeding, the child develops skin rashes, the tympanic cavity opens and fluid leaks from the ear. Allergic otitis media may not be accompanied by fever.

The most difficult in terms of diagnosis and treatment are otitis media in the smallest children.

Acute otitis media in newborns, infants and children from 1 year to three years has its own characteristics of course, diagnosis and treatment. Acute otitis media in children very often develops if the baby is cold (especially the legs), if his mother wrapped him up and he overheated, with improper feeding, after viral diseases and childhood infectious diseases; In addition, the anatomical and physiological features of the structure of the middle ear in children, as well as a decrease in the child’s immune defense, play a role in the occurrence of acute otitis media. What are the main reasons that newborns and infants suffer from acute otitis media especially often? Several main groups of reasons can be distinguished.

Anatomical features of the ear in children that contribute to the development of otitis media:

In babies (especially those under one year old), the auditory tube, also known as the Eustachian tube, is shorter, wider and located more horizontally than in adults. In the middle ear of newborns and infants, instead of a smooth, thin mucous membrane and air, there is a special (myxoid) tissue - loose, gelatinous connective tissue with a small amount blood vessels, which is a favorable environment for the development of microorganisms. In newborns, in addition, amniotic fluid may remain in the tympanic cavity for some time.

The eardrum in children is thicker than in adults. The child has weaker body resistance (lack of acquired immunity).

Infants are almost constantly in a horizontal position, i.e. lie down, so when regurgitated, milk enters the tympanic cavity through the auditory tube. In infants, the cause of otitis may be the entry of formula or breast milk from the nasopharynx into the middle ear.

Otitis often occurs against the background of acute respiratory viral infections in children with weakened immune systems, premature babies, as well as in babies who are bottle-fed. In the vast majority of cases, the infection enters the middle ear from the inflamed nasopharynx through the auditory tube. There are also other factors. Drafts, a cap that comes untied while walking, and active nose blowing also often become causes of otitis media. As experts note, difficult nasal breathing causes pain in the baby. Since the ear and nose are interconnected, problems in one organ immediately affect the other. With a prolonged runny nose, the Eustachian tube can become clogged with nasal discharge - in this case, treatment for otitis media will not work. Therefore, you need to clean and bury the little one’s nose. medicines, which will be recommended by the attending physician.

Children are more susceptible to common infectious diseases such as measles, scarlet fever, diphtheria, which can be complicated by acute otitis media. In this case, the infection spreads through the lymph and blood. This path in medicine is called hematogenous. The influenza virus can provoke an inflammatory process in the baby’s ear. It leads to the formation of herpetic-type bubbles in the ear canal on the eardrum and causes pain.

Sometimes the disease occurs through contact. This is possible when the child’s eardrum is damaged (for example, due to a foreign body, being hit by a ball, carelessly cleaning the ears with a sharp object). As a result, the infection penetrates into the middle ear, which leads to otitis media. No matter how the inflammatory process in the ear occurs, it undoubtedly requires immediate treatment.

Hypertrophy of the pharyngeal tonsil (adenoids), often present in children, acute tonsillitis and adenoiditis contribute to the occurrence and protracted course of acute otitis.

There is also whole line risk factors that contribute to the occurrence of otitis media. These are gender characteristics (boys get this disease more often), White race(it turns out that children of the Negroid race are less likely to have otitis media), artificial feeding (in infants, caries sometimes becomes a companion), cases of middle ear disease in the family, the winter season, Down's disease and even passive smoking.

Symptoms and course of otitis media in children

Otitis usually begins acutely, suddenly. The temperature sometimes rises to 39-40 degrees. In newborns they predominate general reactions body: the child is worried, cries a lot, sleeps poorly and sucks poorly. The inflammatory process in their middle ear, as a rule, is bilateral, non-perforative (there is no rupture of the eardrum and no suppuration, since the membrane in children is thicker than in adults).

Otitis caused by infection usually develops following damage to the nasal cavity, that is, a runny nose and respiratory symptoms from the upper and lower respiratory tract. The mother may note that after ARVI, the child’s temperature sharply increased again, he became more restless, and refuses to eat. The baby develops a pendulum-like movement of the head, and some children even try to look at the sore ear with their eyes. The first signs of otitis can most often be recognized at the moment breastfeeding. When a baby attaches to the breast, negative pressure is created in the nasopharynx, and this increases pain. As a result, the baby's attempt to eat becomes very painful, and the baby bursts into loud crying. He kicks his legs, screams, and his mother gets the feeling that this intestinal colic. If the baby lies down on his sore ear, he suddenly begins to suck better. In this position, with the sore ear pressed, it’s easier for him, it doesn’t hurt so much. And when turned the other way, the baby will still refuse the breast with a cry.

From the age of four months, the child tries to reach his sore ear with his hand, or rubs it on the pillow, sometimes grinds his teeth, and cannot sleep. With a one-sided lesion, the baby tends to take a forced position, lying on the sore ear, sometimes reaches for it with his hand, refuses food, since sucking and swallowing increase the pain.

In severe cases of otitis in infants, symptoms of meningism may occur: vomiting, tilting of the head, tension in the arms and legs, protrusion of the fontanelles. Sometimes gastrointestinal disorders in the form of vomiting and diarrhea may occur.

In children, acute catarrhal otitis media can very quickly (already in the first day after the onset of the disease) turn into purulent. The rapid development of the disease leads to the formation of pus in the middle ear cavity, which ruptures the eardrum and begins to flow from the ear canal. The catarrhal form of otitis is replaced by a purulent one. Sometimes, especially in infants, this happens very quickly. With the appearance of suppuration, pain in the ear, as a rule, decreases or stops completely, the temperature decreases, and the child’s well-being improves.

This condition is an indication for emergency medical care.

How can a mother recognize the signs of otitis media? When the child is sleeping, you can gently press the tragus - the parts of the ear lobe protruding above the earlobe. If a child winces and moves his head away, this may be considered one of the symptoms of middle ear disease.

Any otitis occurs either in catarrhal or in purulent form(when the eardrum is opened). The mother can determine whether purulent discharge has appeared from the ear herself by cleaning her ears every day. In addition, oddly enough, when the eardrum is perforated (ruptured), a visible improvement in the child’s condition occurs. The membrane is torn, which means that the pressure decreases, immediately after this the temperature drops, and the baby’s appetite returns. All symptoms disappear except one - purulent or bloody discharge.

Complications of otitis media

Otitis media is dangerous due to its complications. The fact is that recognizing otitis media is sometimes not entirely simple. For example, it is not always accompanied by severe pain in the ear. Symptoms of the disease often include disturbances in the functioning of the gastrointestinal tract. This is due to the fact that the middle ear and abdomen innervated by one nerve. Therefore, when the ear gets sick, intestinal symptoms may predominate in young children: bloating, regurgitation, vomiting, stool retention. That is, external manifestations may resemble, say, appendicitis or colic. Often infants with similar symptoms end up not in the ENT department of the hospital, but in the surgical department. But surgeons are literate people, so they begin examining such children with an invitation from an ENT doctor. Only after excluding the diagnosis of “acute otitis media” do they engage in further diagnostics.

If a mother undertakes self-treatment of a gastrointestinal disorder, ignoring other symptoms, then otitis media can develop into such formidable complication, like otoanthritis. The infection from the middle ear spreads to the area behind the ear and affects another air cavity of the middle ear. Protrusion of the auricle, redness, swelling appears, and an increase in temperature is noted again. The timing in which this process can develop is unpredictable - it occurs both immediately after acute otitis media and a month later. If the mother does not notice these symptoms, then the child will most likely be admitted to the hospital in 2-3 months, but with meningitis: the structure of the child’s ear is such that an infection from the tympanic cavity can directly come into contact with meninges. So parents should be more vigilant and monitor the course of any, even the mildest viral disease.

Other complications of acute otitis include facial nerve paresis, chronic otitis media, hearing loss, defeat vestibular apparatus and meningitis. Fortunately, they are quite rare in children.
Meningeal syndrome - irritation of the membranes of the brain, occurs due to underdevelopment of the structures of the middle ear, when nothing restrains the spread of inflammation beyond its boundaries, as well as due to the abundant vascular network and connection with the cranial cavity. This causes convulsions, vomiting, confusion and decreased motor activity. To alleviate his condition, the child reflexively throws back his head.

Diagnosis of otitis

In children under 2-3 years of age, and especially in newborns, it is quite difficult to place correct diagnosis, therefore, when similar symptoms It is imperative to show the child to an ENT doctor.

The diagnosis of otitis media is established ONLY after examining the ear by a doctor.

Indirect indications of otitis may be that the disease begins, as a rule, acutely, often at night, after the child has been put to bed. The main symptom is ear pain, which can be very severe. Usually the temperature rises and worsens at the same time general health. In infants, the disease manifests itself as severe anxiety and crying. The child reaches out with his hand to his sore ear and refuses the pacifier. Sleep and appetite are disturbed, and loose stools often appear.

Treatment of otitis media

Otitis media cannot be cured in a few days (sometimes therapy is extended for 1-2 weeks). However, remove pain syndrome in case of illness, it is not only possible, but also necessary.

It is necessary to provide the child with free nasal breathing. To do this, as necessary, it is necessary to free the nasal passages from mucus using a special suction bulb or flagella twisted from cotton wool and soaked in baby oil. You should put a scarf or cap on your baby's head to keep his ears warm during the day. It is not recommended to bathe a child during illness, but you can dry him. Walking with the baby is allowed after the ear pain disappears and the temperature returns to normal. At the same time, when walking, the baby must wear a hat.

In some cases, with otitis - especially when complications occur - it is necessary to resort to surgical treatment in the hospital.

Drug treatment of otitis.

Therapy includes a course of antibiotics in tablet form or by injection (for purulent otitis media) for at least 5-7 days, especially for children under 2 years of age. This is done to prevent the development of complications. In addition, it is necessary to regularly use drugs to narrow blood vessels (vasoconstrictor drops in the nose), which maintains the patency of the auditory tube and - local treatment:

a) for acute catarrhal otitis media, dry thermal procedures in the ear area, since heat activates blood and lymph circulation in the area of ​​inflammation, as well as additional production of protective blood cells. For example, warming with a blue lamp (reflector), semi-alcoholic (1 part alcohol and 2 parts warm water) or vodka compresses, as well as dry heat, warming compresses, turundas with ear drops.
b) in case of acute purulent otitis media, careful and systematic removal of pus with cotton swabs is required, ear toilet disinfectant solutions(for example, 3% hydrogen peroxide solution), antibiotics.
In addition to the main treatment, thermal physiotherapy may be prescribed: ultraviolet irradiation (UVR), UHF therapy, laser radiation, mud therapy.

Treatment of acute catarrhal otitis media takes an average of a week, and acute purulent otitis media – more than 2 weeks.

Treatment in children under one year of age and in cases of moderate to severe and severe course carried out in a children's ENT hospital. There the child is actively monitored.

If necessary, a myringotomy is performed - an incision of the eardrum. Myringotomy is performed by a doctor using special instruments using a microscope and under general anesthesia. The purpose of this procedure is to ensure the free outflow of pus (or fluid) from the middle ear cavity, because It is rare for the eardrum to rupture on its own. Immediately after this procedure, the child’s condition improves, the temperature drops, and infants are more willing to breastfeed.

In children under two years of age, antibiotics must be used - Amoxiclav, Cefuroxime, Ceftriaxone for 5 days. The dose of antibiotic is calculated individually, taking into account the child’s weight. All antibiotics are prescribed parenterally, i.e. intramuscularly, in severe cases and in the presence of complications - intravenously. In children over two years of age, antibiotics are used when the child’s condition is severe, there is severe pain in the ear and the body temperature is above 38 degrees.

Vasoconstrictor nasal drops are not prescribed for newborns and infants (children under 1 year of age). Before meals and before bed, suck out the mucus from the nose with a rubber bulb with a soft tip (preferably 90 ml). If necessary, thin the mucus by instilling 2-3 drops into each nostril. saline solution(aquamaris, salin, aqualor and others), and then after 2 minutes they are sucked off with a rubber bulb.

In children from 1 to 3 years of age, treatment is the same as in infants, but careful nose blowing is allowed. It is possible to use vasoconstrictor drops in the nose only before feeding and before bedtime; special children's drops are used - Nazivin 0.01% 1-2 drops of the drug solution are dripped into each nasal passage 2-3 times a day.

Ear drops are also not prescribed for up to a year (although many instructions state that, for example, Otipax is allowed from the neonatal period), but it is better to ask your doctor. In addition, some components included in the drops (chloramphenicol, boric acid), can have side effects - nausea, vomiting, diarrhea, convulsions, shock - therefore they are prohibited in pediatrics.
To reduce the temperature, drugs based on paracetamol are used: Children's Panadol, Calpol, Panadol Baby and Infant, Efferalgan and others. The use of Analgin and Aspirin in children is not allowed.

Local treatment according to the rules and treatment with folk remedies

Compresses.

So, if for the treatment of acute catarrhal otitis media the doctor prescribed semi-alcoholic or vodka compresses(in case of suppuration from the ear, these procedures are contraindicated), then they should be done as follows.

You need to take a four-layer gauze napkin, the size of which should extend beyond the auricle by 1.5-2 cm, and make a slot in the middle for the ear. The napkin must be moistened in alcohol solution or vodka, squeeze out, apply to the ear area (place the auricle in the slot). Apply compress (waxed) paper on top, slightly larger than gauze, and cover with a piece of cotton wool larger than the size of the paper. All this can be secured with a scarf tied to the child’s head. The compress should be kept until it has a thermal effect (3-4 hours).

Ear drops.

Direct instillation of ear drops is dangerous, since at home it is impossible to examine the ear in the same way as an ENT doctor and clarify the nature of the inflammation at the moment - whether the eardrum is damaged or not. If a ruptured eardrum causes droplets to enter the middle ear cavity, they can cause damage to the auditory ossicles or lead to lesions. auditory nerve which will lead to hearing loss.

Instead, you need to make a turunda out of dry cotton wool, carefully insert it into the external auditory canal and drip warm medicine onto it 3-4 times a day. A portion of drops should be heated to body temperature (36.6 degrees C). You can, for example, heat a pipette in warm water, and then draw the medicine into it, or first draw the medicine, and then heat the pipette with it in warm water. Ear drops for children with anti-inflammatory and analgesic effects, such as OTIPAX, are useful to have in your home medicine cabinet. For older children, you can use a popular folk remedy - cotton wool in the ear, lightly moistened with warm vodka or onion juice. This ensures improved blood circulation and increased temperature in the area of ​​inflammation. In case of a purulent process, such procedures are contraindicated.

The use of boric alcohol in the treatment of middle ear inflammation in children is undesirable. This substance irritates the delicate skin of the baby's ear canal, which not only increases the pain, but also leads to peeling of the skin inside the ear. And plugs are formed from exfoliated skin cells. There is evidence that boric alcohol can cause convulsions in children in the first year of life.

IN vertical position the blood flows away from the area of ​​inflammation, the pain subsides, the baby calms down, so take the baby in your arms more often.

Prevention

Prevention of otitis is the prevention and competent treatment ARVI, especially accompanied by a severe runny nose.

The child needs to be provided with breast milk for as long as possible, since it is the source of the main protective forces of the small body. When feeding, it is better to keep the baby closer to an upright position to prevent fluid from refluxing into the ear through the auditory tube. Reasonable hardening also increases the body's resistance.

When you have a cold, lying down causes congestion to form in the nasopharynx, increasing the risk of middle ear infection. Therefore, it is necessary to remove pathological contents from the nasal cavity with a bulb suction and periodically turn the baby from one side to the other.

Otitis media is caused by bacteria that settle in the middle ear and cause inflammation. And, please note, it can cause meningitis, especially in children of the first year of life. Therefore, the vaccination calendar throughout the world (and we, as always in Russia, lag behind) has been introduced compulsory vaccination against Haemophilus influenzae, and from the age of two, vaccination against pneumococcus is introduced. These vaccinations will help protect children from meningitis, especially of ear origin.

Now a number of typical mistakes or what not to do with otitis media.

At high temperatures, you should not apply a warm compress to the ear. This can seriously worsen the child's condition. If pus begins to flow from your ear, do not try to deep clean with an ear swab. At best, this will do nothing, at worst, the eardrum will be injured. Do not give an antibiotic or other medicines without talking to your doctor.

It often happens that middle ear diseases are provoked by parents themselves. For example, a child has a severe runny nose, and the mother incorrectly blows off nasal secretions. She pinches both nostrils and forces the child to blow his nose violently. This should never be done - your ears instantly become clogged. You cannot blow your nose into both nostrils at once - only one at a time. Why do otitis occur so often in young children and very rarely in adults? Because the middle ear is connected to the nasal cavity by an airway - the auditory tube. In children it is very wide, short and open. And if a child blows his nose into pinched nostrils, then all the pus from the nose is immediately thrown into the middle ear.

Often the cause of otitis media is improper feeding. The mother fed the child and immediately puts him in the crib on his side, that is, on some ear. And during feeding, children swallow a lot of air, which must be removed later, holding the baby in an upright position. If regurgitation occurs while the baby is lying horizontally, then the milk is immediately thrown into the auditory tube.

Another common mistake is improper suction of mucus from the nasal cavity using a bulb. This must be done very gently, slowly. If the mother abruptly releases the pear, then negative pressure arises in the nasal cavity, hemorrhage occurs in the tympanic cavity and peeling of the mucous membrane occurs.

Ear pain is one of the most severe pain that a person experiences in his life. Therefore, in the first 2-3 days of otitis media, be sure to give your baby painkillers and antipyretics. If the pain persists for more than two days, this is an indication for a doctor to open the eardrum.

When Small child is sick with otitis media, feeding him becomes a serious problem. To ensure that your baby can latch onto the breast, 15 minutes before feeding, place vasoconstrictor drops in his nose and anesthetic drops in his ear. Or try feeding him with a spoon.

Remember that under no circumstances should you heat sore ears before consulting a doctor. If it started in the ear purulent process, then warming compresses will only strengthen it, and it’s not far from dangerous complications. If there is no pus, then heating will have a beneficial effect on the ears.

What should you consider if your child has had otitis media?

Remember that after your baby has had otitis media, he or she may experience temporary hearing loss. Therefore, do not scold the child if it seems to you that your request did not receive the child’s attention. Make sure the baby even heard what you told him? If you are sure that hearing acuity has decreased, tell the doctor about this; when communicating with your child at home, speak louder.

If your child is involved in swimming, then after suffering from otitis media, he should stop this activity for some time, since during the recovery period it is impossible for water to get into the external auditory canal, especially if there has been a violation of the integrity of the eardrum. And of course, if your “swimmer” gets ear infections too often, consider changing the sport.

Don't forget about warm clothes and a hat for your baby in winter or in cold, windy weather. At this time, wool or fur “earmuffs” will come in handy as they cover your ears well.
One more word of caution. Scientists have proven that passive smoking contributes to the sluggish course of acute otitis media or even its transition to a chronic form. Weigh all this up if there are smokers in the family.

Latest trends in the treatment of otitis media in children:

Many children's ear infections can be successful without additional antibiotic treatment, thereby reducing unnecessary antibiotic use.

It is known that one of the most common reasons why pediatricians prescribe antibiotics to young children is ear infections (for example, acute otitis media). But recently, more and more people are avoiding unnecessary use of antibiotics due to the side effects of such treatment. There is ample evidence of children with ear infections successfully recovering without additional treatment, and based on this evidence, the practice of “watchful waiting” was developed.

The point of this approach is to carefully monitor the development of otitis without pharmaceutical treatment, if it flows easily enough. For example, the American Academy of Pediatrics and the American Academy family doctors Since 2004, it has been recommended to use "watchful waiting" in cases of moderate ear pain without a large increase in temperature and without complications for children over 2 years of age. This prescription is of particular importance in a situation where the doctor is confident that the child’s condition will worsen with intensive antibiotic treatment.

Otitis externa

Causes of external otitis. Otitis externa, as a rule, occurs as a result of infection (most often staphylococcus) in the hair follicles and sebaceous glands external auditory canal as a result of microtrauma. Inflammation of the outer ear can develop due to colds, hypothermia, or irritation of the ears due to the accumulation of wax.

Otitis externa can occur in a limited area of ​​the outer ear (furunculosis of the external auditory canal), or be diffuse (spread), when the entire external auditory canal is involved up to the eardrum.

Symptoms of external otitis. With furunculosis, sharp pain in the ear is observed, aggravated by chewing, opening the mouth, swelling of the tissues surrounding the ear, and the formation of a cone-shaped elevation with a suppurating apex. When the boil matures and the pus breaks out, significant relief is felt. With diffuse otitis media, severe itching and pain are felt in the ear canal, and hearing is reduced, although not very significantly. Pus accumulates in the ear and small crusts form. If the causative agent of otitis is yeast, when examining the ear, you may see a coating similar to wet blotting paper.

Treatment of external otitis. With boils, most often you can do without surgical intervention - the boil will mature and open on its own. Antimicrobial drugs are prescribed. For improvement general condition at elevated body temperatures, antipyretics are prescribed. For diffuse external otitis, rinsing with disinfectant solutions is useful. If otitis media is caused by fungi, antifungal therapy (ointments and oral medications) is necessary.

A common cold in a child can result in completely unpredictable consequences. For example, an infection from the nasopharynx can enter the ear canals, thereby triggering an acute inflammatory process. It is impossible to predict whether your baby will get otitis media, because it depends on many individual factors - from proper ear care to the strength of the body's immune system.

As a rule, it occurs at the age of 3-4 years, when the immune system is not yet fully formed, and auditory tube wide and short, like a newborn's. It can affect the baby either externally or purulently - this is determined by the cause or causative agent of the disease.

External childhood otitis - symptoms

In children, they are divided into two main types - limited and diffuse. Without determining an accurate diagnosis, it will be impossible to begin quality treatment.

Undoubtedly, an otolaryngologist should diagnose the disease. However, it also wouldn’t hurt for parents to remember the symptoms of a particular type of otitis in order to help competent help for your child before visiting the doctor.

Limited otitis occurs when the hair follicles in the ear become inflamed for some reason. Over time, this inflammation becomes a boil. There may be one or several suppurations. The main ones are:

• Pain during chewing movements or yawning (newborns refuse the breast);
• The child reacts by crying if you touch the tragus of his ear;
• The baby began to hear poorly (large boils often close the ear canal).

It is quite difficult to see boils in a baby’s ear on your own. Therefore, if there is the slightest suspicion of limited otitis, the child must be shown to a doctor.

The second type, diffuse, is often the result of streptococcal bacteria entering the ear canal. In this case, the entire auricle is involved in the inflammatory process, and not just any of its parts.

Symptoms diffuse otitis, as a rule, is as follows:

• Barely noticeable pain in the ear;
• The child constantly tries to scratch his ear;
• The baby's body temperature does not rise above 37˚C;
• Hearing impairment in case of damage to the eardrum;
• Selection clear liquid from a child's ear.

How to recognize otitis media in a baby

Purulent inflammation of the middle ear in young children, as a rule, manifests itself suddenly sharp deterioration child's well-being. The baby's condition can rapidly deteriorate over a short period of time.

Parents notice that the baby’s mood has changed - he began to cry more often, his sleep and appetite have worsened. main feature childhood otitis is that a child under three years of age cannot yet understand and describe to adults what he feels.

In order to suspect the disease in time and begin treatment, elders should especially carefully monitor the baby. Quite often, children themselves point out the problem area when they try to scratch it or simply touch it. In the case of otitis, the baby may turn his head for no reason or pull the outer ear with his hand.

In addition, an acute purulent process in the ear has the following symptoms:

• Sudden jumps in body temperature, up to 40˚C;
• Sleep disturbance and refusal to eat;
• The child prefers to sleep on the side of the affected ear;
• Nausea and stomach pain;
• Unbearable headache;
• Symptoms of general intoxication of the body;
• Disorders in the gastrointestinal tract;
• Difficulty in nasal breathing;
• Sore throat;
• Children over 2 years old are reluctant to play games and become inattentive;
• Vomiting;

Important to remember! The sooner parents treat their child, the faster it will be possible to select adequate treatment. Inattention to a child’s complaints is a waste of precious time and aggravation of the inflammatory process.

Pediatric otitis media - what to do?

The duration of treatment for acute otitis may take up to 7-14 days. However, you can significantly improve your baby’s well-being within the first hours after diagnosing the disease. To do this, you must adhere to certain recommendations:

1. Be sure to clear your baby's nasal passages as needed. To do this, you can use a special bulb for suctioning out mucus, as well as cotton pads dipped in water or oil.
2. The newborn's head must be covered with a cap. For children 3 years and older, you can offer a warm scarf or scarf - this will keep the child’s ears warm throughout the day.
3. During illness, you cannot bathe your baby in a bathtub or pool, but for hygiene purposes you can wipe the baby with a damp towel.
4. Walking with a child is allowed only if his ear pain has decreased and his body temperature has dropped to normal. Please note that a child should not walk outside without a hat.

An otolaryngologist will first examine the child’s ear using a special device - an otoscope, and will also prescribe a number of additional research. Based on diagnostic results little patient The following treatment may be prescribed:

1. Antiviral agents (kagocel, viferon, cycloferon, cytovir). Their main purpose is to relieve the child from the manifestations of ARVI, including a runny nose, which can aggravate otitis media.
2. Vasoconstrictors for nasal instillation (Polydex). They help get rid of swelling and improve breathing through the nose.
3. Steroid-free anti-inflammatory ear drops with anesthetic (otinum). Their use is advisable at the very beginning of the disease to calm sharp pain in the baby's ear.
4. Ear drops with a combined composition containing glucocorticoid components (prednisolone). They are prescribed to relieve inflammation, reduce swelling, as well as burning and itching in the ear canal.
5. Preparations for instillation of the ear containing an antibiotic. The doctor may prescribe antibacterial drops if the child has multiple purulent foci or otitis media of bacterial origin.
6. Antiallergic antihistamines (Lasix, Diazolin). These drugs are excellent at combating swelling in the nasopharynx and eustachian tube.

Antibacterial therapy, as a rule, is an integral part of therapeutic measures for infants.

With the help of antibiotics, it is advisable to treat any purulent processes in the ear caused by harmful bacteria.

It should be remembered that antibiotic therapy is carried out in courses that cannot be interrupted even if the baby suddenly feels well. Important factors Treatment also includes the correct active ingredient and dosage of the drug.

The doctor may extend the course of medication if necessary. As a rule, the duration of antibiotic use in two-year-old children is from 10 to 14 days. Older children may be prescribed a 7-day therapeutic course.

If the drug is chosen incorrectly, the active substance of the antibiotic will not be able to overcome all pathogens, and the acute inflammatory process will become chronic.

In standard cases, treating a child for inflammation in the middle ear is allowed at home. However, the baby must be regularly shown to an otolaryngologist and all his recommendations must be strictly followed.

If otitis media is severe or the purulent process has shifted to the skull area, hospitalization and subsequent surgical intervention may be necessary.

When appearing at 3 years of age or younger, treatment should be carried out exclusively by a pediatrician - an otolaryngologist or pediatrician. For correct diagnosis, it is necessary to determine what caused the inflammatory process.

If it is caused by pathogenic bacteria, then the baby will need a course of antibacterial therapy. In other cases, treatment may be limited to local medications and procedures in a physiotherapy room.

You should not self-medicate under any circumstances, because the consequences of such amateur activities can cause enormous harm to the child’s health. Remember that some consequences of improper therapy can accompany your child throughout the rest of his life.