Acute Otitis Media

Acute Otitis Media
Symptoms The signs and symptoms of acute otitis media may range from very mild to severe:
The fluid in the middle ear may push on the eardrum, causing ear
pain. An older child may complain of an earache, but a younger
child may tug at the ear or simply act irritable and cry more than
usual.
Lying down, chewing, and sucking can also cause painful pressure
changes in the middle ear, so a child may eat less than the normal
amount or have trouble sleeping.
If the pressure from the fluid buildup is high enough, it can
cause the eardrum to rupture, resulting in drainage of fluid from
the ear. This releases the pressure behind the eardrum, usually
bringing on relief from the pain.
Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing difficulties. A child may:
not respond to soft sounds
turn up the television or radio
talk louder
appear to be inattentive at school
Other symptoms of acute otitis media may also include:
fever
nausea
vomiting
dizziness
However, otitis media with effusion often has no symptoms at all. In some children, the fluid that?s in the middle ear may create a sensation of ear fullness or ?popping.? As with acute otitis media, the fluid behind the eardrum can block sound, so mild temporary hearing loss can happen, but it may not be obvious. Ear infections are also frequently associated with upper respiratory tract infections and, therefore, with their common signs and symptoms, such as a runny or stuffy nose or a cough. Causes Causes: Anatomic and immunologic factors in the presence of acute infection are the main causes of acute otitis media.
Pneumococcus species, Haemophilus influenzae (untypeable), and
Moraxella species are the bacteria most commonly involved in
otitis media.
Less common causes are other bacteria, Mycoplasma species, and
viruses.
Sterile effusions occur in approximately 20% of cases studied.
Risk factors for otitis media have been identified.
Daycare leads to an increased incidence of URIs.
Bottle-feeding increases the incidence compared with
breastfeeding.
Smoking in the household clearly increases the incidence of all
forms of respiratory problems in childhood.
Male sex is a minor determinant of infection.
A family history of middle ear disease increases the incidence.
Acute otitis media in the first year of life is a risk factor
for recurrent acute otitis media.
Kids more likely than adults ? Why Do Kids Get Middle Ear Infections? Children develop ear infections more frequently in the first 2 to 4 years of life for several reasons:
Their eustachian tubes are shorter and more horizontal than those
of adults, which allows bacteria and viruses to find their way
into the middle ear more easily. Their tubes are also narrower and
less stiff, which makes them more prone to blockage.
The adenoids, which are gland-like structures located in the back
of the upper throat near the eustachian tubes, are large in
children and can interfere with the opening of the eustachian
tubes.
Children?s immune systems aren?t fully developed until the age of
7. Therefore, they have more trouble fighting infections.
There are also a number of other factors that contribute to children getting ear infections. The more common ones are exposure to cigarette smoke, bottle-feeding, and day-care attendance. Ear infections also occur more commonly in boys than girls, in children whose families have a history of ear infections, and more often in the winter season when upper respiratory tract infections or colds are most frequent. Breast fed less likely breastfeeding infants for at least 6 months, which helps to prevent the development of early episodes of ear infections. If a child is bottle-fed, holding the infant at an angle rather than allowing the child to lie down with the bottle is best. Potential complications Although quite rare, unresolved ear infections (those that don?t go away) or severe repeated middle ear infections can lead to complications, including spread of the infection to nearby bones. Therefore, children with an earache or a sense of fullness in the ear, especially when combined with fever, should be evaluated by their doctors if they aren?t improving. Other conditions can also result in earaches, such as teething, a foreign object in the ear, or hard earwax. Your child?s doctor can likely diagnose the cause of the discomfort and offer specific advice. Treatment If you suspect that your child has an ear infection, he or she will need to visit the doctor, who should be able to make a diagnosis by taking a medical history and doing a physical exam. To examine the ear, doctors use an otoscope, a small instrument similar to a flashlight, through which they can see the eardrum. There?s no single best approach for treating all middle ear infections. In deciding how to manage your child?s ear infection, a doctor will consider many factors, including:
the type and severity of the ear infection
how often your child has ear infections
how long this infection has lasted
how old your child is
risk factors your child may have
whether the infection affects your child?s hearing
The parents? wishes are also factored in to this decision, so an open line of communication between you and the doctor is very important. The fact that most ear infections can clear on their own has led a number of physician associations to recommend a ?wait-and-see? approach, which involves giving the child pain relief without antibiotics for a few days. There are other important reasons to consider this type of approach. Antibiotics:
won?t help an infection caused by a virus
won?t eliminate middle ear fluid
may cause side effects
typically do not relieve pain in the first 24 hours and they have
only a minimal effect on pain after that
Also, frequent use of antibiotics can lead to the development of antibiotic-resistant bacteria, which can be much more difficult to treat. However, children who get a lot of ear infections may be prescribed daily antibiotics by their doctor to help prevent future infections. And younger children or those with more severe illness may require antibiotics right from the start. The ?wait-and-see? approach also might not apply to children with other concerns, such as cleft palate, genetic conditions such as Down syndrome, underlying illnesses such as immune system disorders, or a history of recurrent acute otitis media. Children with persistent otitis media with effusion (lasting longer than 3 months) should be reexamined periodically (every 3 to 6 months) by their doctors. Often, though, even these children won?t require treatment. Whether or not the choice is made to treat with antibiotics, you can help to reduce the discomfort from your child?s ear infection by using acetaminophen or ibuprofen (which you can buy over the counter at your local pharmacy or grocery store) for pain and fever as needed. Your child?s doctor may also recommend using pain-relieving eardrops, as long as the eardrum hasn?t ruptured. But certain children, such as those with persistent hearing loss or speech delay, may require ear tube surgery. In some cases, an ear, nose, and throat doctor will suggest surgically inserting tubes (called tympanostomy tubes) in the tympanic membrane. This allows fluid to drain from the middle ear and helps equalize the pressure in the ear because the eustachian tube is unable to. Conjunctivitis Symptoms One of the most common symptoms is discomfort or pain in the eye, which may feel like having sand in the eye. Many children have redness of the eye and inner eyelid as well; this redness led people to call conjunctivitis by its other common name, pinkeye. The child may also have swollen eyelids and be sensitive to bright light. Itchiness and tearing are common with allergic conjunctivitis. Discharge from the eyes may accompany the other symptoms. In bacterial conjunctivitis, the discharge will be somewhat thick and colored white, yellow, or green. Sometimes the discharge will cause the eyelids to stick together when the child awakens in the morning. In viral or allergic conjunctivitis, the discharge may be thinner and may be clear. Ear infections can occur in some children who are diagnosed with bacterial conjunctivitis because similar bacteria can cause both infections. A red, sore throat and runny nose often accompany conjunctivitis caused by viruses. Causes Infectious conjunctivitis is usually caused by either bacteria or viruses. Many different bacteria can cause conjunctivitis but the most common are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus Allergic conjunctivitis occurs more frequently among children with allergic conditions such as hay fever. It is often seen only at certain times of the year, especially when caused by allergens such as grass or ragweed pollen. Other allergy-causing substances like animal dander or dust mites can cause year-round symptoms of conjunctivitis. Although other forms of conjunctivitis often start in one eye, allergic conjunctivitis typically affects both eyes at the same time. Irritant conjunctivitis can be caused by chemicals such as those in chlorine and soaps or air pollutants such as smoke and fumes. Kids more septible Small children may be susceptible to infective conjunctivitis and they may develop severe forms of the condition because of poor immune defences. This type of conjunctivitis (ophthalmia neonatorum) may be due to an infection that has been contracted during the passage through the birth canal and may include gonococcal or chlamydial infection. Small babies may develop conjunctivitis from other types of infection but swabs should always be taken in order that appropriate treatment can be given. Small babies often have poorly developed tear drainage passages (a condition known as nasolacrimal duct obstruction). These children are susceptible to watering eyes and they may intermittently become sticky, but this is usually not serious. Potential complications Even if left untreated, most forms of conjunctivitis will gradually get better on their own in a few weeks. With appropriate treatment the eyes are usually more comfortable within a few days, although cases of adenoviral infection may cause problems for some weeks. Chemical conjunctivitis may be a medical emergency, depending on the chemical involved. If your child has gotten a chemical in her eyes, flush the area gently with cool, running water for at least 15 minutes. Then call your doctor or, if the irritation looks severe, take your child to the nearest hospital emergency department. Since most products containing dangerous chemicals are required to have emergency first-aid instructions on their labels, check the product?s package for first-aid information, or call your local poison control center. For other forms of conjunctivitis, call your doctor if your child has any of the following symptoms: eyes that are unusually red, itchy, or watery; eyes that look puffy or swollen; a thick, sticky, yellowish discharge from the eyes; or eyelids that look crusty or stick together when your child awakens. Doctors can often determine the type of conjunctivitis by taking a careful history of when and how the child?s eye symptoms began and by examining the child?s eyes to look for specific signs, such as swelling or discharge. Some cases of chemical conjunctivitis can be medical emergencies that require immediate action to prevent eye damage. If a chemical has gotten into your child?s eye, flush the eye gently with cool, running water for at least 15 minutes. After covering the injured eye with a clean pad, take the child to the nearest hospital emergency department immediately. For some chemicals, flushing the eye alone may be sufficient to prevent eye damage, but it is important to follow up with your doctor. If your child has allergic conjunctivitis, your doctor may treat her irritated eyes with decongestants or with eyedrops containing antihistamines. Cold compresses may also help relieve irritation. In some cases, your child may need to be referred to an ophthalmologist (eye doctor), who may prescribe stronger eye medications. Bacterial conjunctivitis is treated with antibiotics, usually given as either eyedrops or as an ointment. With certain types of bacteria, oral antibiotics may be given. If you are caring for a child with bacterial conjunctivitis, it is important to give these medications for as many days as your doctor has prescribed, even if eye symptoms clear several days before the end of the treatment. This will prevent your child?s conjunctivitis from coming back. If your child?s eyelids are very sticky with yellowish discharge, you can use a clean cotton ball soaked in warm water to gently wipe the eyelids. Ask your doctor when your child can return to school. Viral conjunctivitis cannot be treated with antibiotics effectively, but it usually clears on its own after a few days. As with bacterial conjunctivitis, viral conjunctivitis is contagious, so follow your doctor?s advice about when your child can return to school. Prevention To prevent infectious conjunctivitis, teach your child to wash his or her hands often with warm water and soap. Children also should not share eyedrops, tissues, eye makeup, washcloths, towels, or pillowcases with other people. If your child already has conjunctivitis, ask your child to wash his or her hands after touching the eyes. Your child also should not touch the infected eye and then touch the other eye without first washing his or her hands. Be sure to wash your own hands thoroughly after touching your child?s eyes, and throw away items like gauze or cotton balls after they have been used. Wash towels and other linens that your child has used in hot water separately from the rest of the family?s laundry to avoid contamination. If you know your child is prone to allergic conjunctivitis, keep windows and doors closed on days when the pollen is heavy, and dust and vacuum frequently to limit allergy triggers in the home. Irritant conjunctivitis can only be prevented by avoiding the irritating causes. Many cases of neonatal conjunctivitis are prevented by screening and treating pregnant women for sexually transmitted diseases. The mother-to-be may have bacteria in her birth canal even if she shows no symptoms, which is why prenatal screening is important.

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