Ear Infection and Antibiotic in Children

Ear Infection in Children

Otitis media is the second most common reason after the common cold for visits to doctor and the most frequent reason for prescribing antibiotics to children.

About 90% of children have OME (Otitis Media with effusion) at some time before school age and 75% of children have at least one episode of AOM (Acute Otitis Media) by the age of 2 years which usually resolves spontaneously

Appropriate treatment of children with “ear infection” requires distinguishing AOM from OME by careful history and pneumatic otoscopic examination (single most important tool).

Some definitions:

Acute otitis media (AOM): an acute bacterial infection of the middle ear of less than 6 weeks duration.

Chronic suppurative otitis media (CSOM): If ear drum infection persists for more than 3 months and is associated with a chronic perforation of the tympanic membrane.

Otitis media with effusion (OME): Fluid in the middle ear without signs or symptoms of inflammation. It can occur just prior to AOM or persist after AOM for a few days or up to many weeks.

So How Do We Diagnose Ear Infection? Distinguishing OME and AOM

Child with OME

Symptoms:

  • No ear pain

  • No draining ear.

  • Slight hearing impairment/ear blockade.

  • History of frequent URTI & mouth breathing

Examination of Ear by ENT specialist:with otoscope- TM pulled, air bubbles may be seen.

Tympanometry test may show c or B (Read More)

Child with AOM

  • Usually healthy child

  • Sudden onset ear pain, blocked ear feeling

  • Fever, h/o common cold /stuffy nose

  • Pus from ear if ear drum ruptures.

Ear Examination by ENT Specialist

Congested, dull drum with / w/o discharge

Hole in the ear drum may be seen

Audiometry: mild to moderate conductive hearing loss.

Tympanogram may show type “B” curve

How to Treat Ear Infection in Children (AOM and OME)?

Treatment for children with OME

Usually resolves without treatment for 3 months it is just wait and watch

Hearing testing is done.

If the effusion persists for more than 3 months and/or hearing loss exceeds 20 dB surgery is required, tympanostomy tube (Grommet) (Read More) insertion is done.

Adenoidectomy is done if indication for surgery is present.

Treatment for Children with acute otitis media-(Antibiotic use in ear infection in children):

As per The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) guidelines:

Uncomplicated AOM in an otherwise healthy child above 2 years of age are given analgesics for pain, nasal drops and antihitamines.

If there is no response within 2-3 days antibiotic is to be started.

Antibiotics should be prescribed if child is:

  • Less than 6 month of age

  • Has Cleft palate

  • Downs syndrome

  • Immunodeficiency

  • Cochlear implant

Ear drops (Ototopical formulations) antibiotic with or without steroid are prescribed if ear drum is ruptured.

Tympanic membrane perforation in children usually heals spontaneously in 1-2 months. During this time water entry in the ears should be avoided and all possible preventive measure to reduce chances of catching common cold are to be taken.

Surgical management of otitis media is indicated for recurrent AOM, AOM with complications, chronic suppurative otitis media (CSOM) and otitis media with effusion where chances of hearing and speech problem are predicted. Read More


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