Otitis media in the baby

introduction

Otitis media (Otitis media) is a common disease in babies and toddlers. More than half of all children experience at least one otitis media in the first few years of life. Children between 6 months and 6 years are particularly often affected. Middle ear infections occur more frequently, especially in the cold season between December and March. Middle ear infections are not necessarily dangerous, but they are often very painful and uncomfortable. Treatment is very possible and effective in most cases.

anatomy

As its name suggests, it is Middle ear (Auris media) the middle of the three components of the ear. It is limited to the outside by the eardrum. From Inner ear, more precisely the Cochlea (Cochlea), it is passed through two more membranes (the round and the oval window) delimited. There is only a direct connection between the middle ear and the outside world via the Eustachian tube (Eustachi tube, mostly simply as tube designated). There are some important structures in the middle ear itself; including the Auditory ossicles. In addition, the Facial nerve (Facial nerve), which the Flesh muscles innervated, and a Taste bud (Chorda tympani) through the Tympanic cavity.

causes

Middle ear infections are mostly caused by bacteria, but sometimes also by viruses. Pathogenic bacteria usually colonize the middle ear continuously coming through the ear trumpet. Typically this happens in the context of colds or tonsillitis, i.e. infections of the upper respiratory tract. Pathogens rarely reach the middle ear via the bloodstream. These are mostly viruses, for example measles otitis. But scarlet fever otitis, triggered by streptococci, i.e. bacteria, also develops in this way. If the eardrum is perforated before the illness, pathogens can also get into the ear from outside, for example through bath water.

Small children are generally more prone to inflammation of the middle ear than adults because their ear trumpet is still comparatively short, but has a fairly large diameter. This makes it easier for pathogens to ascend into the middle ear via the tube. In the course of the disease, the infection leads to swelling of the mucous membrane, including in the ear trumpet. This prevents the discharge of secretions and pus. In addition, a negative pressure can arise in the middle ear, which also promotes the formation of an effusion. This manifests itself in a deterioration in hearing and a noise in the ear.

Risk factors

In addition to the infectious causes of otitis media, which are difficult to influence, there are a number of risk factors in babies that promote the development of otitis media. This includes all types of immunodeficiency of the baby, but also Allergies. Size Almonds or one Cleft palate are also among the risk factors. Passive smoking and the uninterrupted use of pacifiers also increase the risk of otitis media, whereas months lasting several months decrease Breastfeeding proven the risk.

Symptoms

Since babies cannot communicate and show only very unspecific physical symptoms, an otitis media is difficult for the parents to recognize. The infectious overpressure in the middle ear can be very painful and uncomfortable because it tightens the eardrum. Because of this, the infant is very restless and cries a lot. When an otitis media starts, affected babies often touch each other ear or throw the head back and forth. If the disease is already advanced, the ear is no longer touched and touching by the parents is also not tolerated, as the pain is now very great. As with other illnesses, sick children often refuse to eat.

Other unspecific symptoms such as fever, diarrhea and Vomit are also common. Begins bloody, purulent secretion running out of the baby's ear, the eardrum is already torn (ruptured). However, since the overpressure in the middle ear can now be compensated for by the opening that has been created, the pain will decrease significantly. A Crack (Rupture) of Eardrum occurs after an otitis media that has existed for about 1 to 2 weeks.

diagnosis

Symptoms of any kind that persist for several days should always be clarified in babies. After asking the doctor about the symptoms and a subsequent orienting physical examination, the diagnosis of otitis media in babies is ultimately made, as in adults, by an otoscopy. When looking at the eardrum in this way, in addition to making the diagnosis, a good assessment of the extent of the disease is also possible. In a healthy condition, the eardrum should be pearly colored and a reflection of the examination lamp on the eardrum should be visible. In the case of otitis media, however, the eardrum appears dull and without reflection. In addition, it can be tense and visibly reddened if the eardrum is also affected by the inflammation.

Read more about this under Recognizing hearing impairment in children - does my child hear correctly?

therapy

One of the most important and at the same time simplest means of treating otitis media is a decongestant nasal spray or nasal drops in babies and adults. This is available especially for children in lower concentrations than it is used for adults and works mainly by causing the mucous membrane of the ear trumpet to swell. This ensures ventilation of the middle ear. However, they should only be used for a limited period of time. Ear drops, on the other hand, do not help with otitis media because their active ingredient cannot get through the eardrum into the tympanic cavity. Ear drops are only useful if there is inflammation of the external ear canal. Expectorant preparations can also help speed up recovery.

Antibiotics are only indicated and helpful if the inflammation is really a bacterial infection; antibiotics have no effect on viruses. The antibiotic of first choice is usually a penicillin (e.g. amoxicillin) if there is no penicillin allergy. The pediatrician can easily determine whether the administration of an antibiotic is necessary. Homeopathic preparations can also be helpful under certain circumstances, but their effects are very controversial.

Paracetamol in the form of suppositories or juice is particularly suitable for relieving the pain. Paracetamol can be administered in the first months of life and has a good pain reliever effect. However, this pain reliever lacks an anti-inflammatory effect. In any case, the recommended maximum dose should be strictly observed, otherwise a dangerous overdose can quickly occur. Ibuprofen is approved from around 6 months of age and has both analgesic and anti-inflammatory effects.

If the baby or toddler is affected by middle ear infections several times within a year, the insertion of a ventilation tube into the eardrum should be considered. This usually has a diameter of 1 - 1.5 mm and is made of plastic. In order to enable the introduction of the tube, the eardrum is opened (paracentesis) beforehand. In children, this is usually done under general anesthesia. Since water can now enter the tympanic cavity through the ear canal, the ear canal should be closed when bathing in order to avoid infections occurring in this way. This can be done through special plugs. After about 9-12 months, the tube is rejected spontaneously or sometimes removed by the doctor.

Is the eardrum torn as a result of the otitis media (ruptured), a hearing test should be carried out immediately.

prophylaxis

Just as there are risk factors for developing otitis media in babies, there is one too prophylaxis possible. Breastfeeding (at least 4 months) and one smoke free environment are very important. Furthermore, infections of the respiratory tract always be treated; Nasal sprays are well suited for this. A pediatrician should always be consulted if the symptoms are more severe. It is also worth mentioning with regard to older children that the generally frowned upon "Pulling your nose up“Is actually healthier than blowing your nose frequently, since secretions and pathogens are ultimately swallowed and removed from the Stomach acid be decomposed. When blowing your nose, however, infectious secretions can get into the ear trumpet and ultimately into the middle ear as a result of the excess pressure that is created.

They are also highly recommended Vaccinations against Pneumococci and the Haemophilus influenzae Bacterium. These two vaccinations cover the most common subspecies of these bacteria in our latitudes. In addition to otitis media, these two groups of bacteria are also life-threatening, especially in small children Meningitis (Meningitis) and Pneumonia (Pneumonia) responsible.

Complications

Left untreated can otitis media chronic and ultimately that Inner ear damage; a Hearing loss is the consequence.In addition to direct losses in the child's later quality of life, hearing loss in infants and children can lead to complications in language development. In addition to the inner ear, other structures of the tympanic cavity can also be damaged by a long-standing otitis media. Inflammatory processes can cause the Listen very important ossicles (hammer, anvil and stirrup) calcify and scar the eardrum. In both cases, hearing loss is the result. Very rarely it can also lead to one Facial nerve paralysis or one Meningitis (meningitis) come. One is also possible, albeit rarely sepsis or one Mastoiditis (a very painful inflammation of the Temporal bone just behind the ear).

Duration

An uncomplicated one Otitis media takes about a week to heal. One goes from one to her curve-like course out. It increases over 2 to 3 days, then reaches its peak and subsides over another 2 to 3 days. However, depending on the extent and type and start of treatment, its duration varies greatly.

You can find much more information on our website: Duration of an otitis media