Acute otitis media in children

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What is it about ?

Acute otitis media is an infection of the middle ear that occurs suddenly and is short-lived.

The ear is made up of the outer ear (ear canal and pinna), the middle ear (ossicles) and the inner ear (cochlea and vestibular organ). The eardrum separates the outer ear from the middle ear.

With ear infections, fluid collects behind the eardrum. Often the increased pressure pushes the eardrum. If the pressure is too strong, a hole forms in the eardrum, this is called a perforation of the eardrum. Inflammatory fluid can then escape from the middle ear, and pus drains from the ear; this is called otorrhea. Perforation and otorrhea are often accompanied by a decrease in fever and rapid disappearance of pain.

How does ear infection develop?

Acute ear infection is almost always a complication of a cold. The mucous membranes of the nasopharynx swell, which clogs the eustachian tube. The nasopharynx is the upper part of the throat extending from the back of the nose to the soft palate. The Eustachian tube connects the middle ear to the nasopharynx. If it is blocked, fluid can build up in the middle ear, which promotes the growth of viruses and bacteria.

The bacteria generally responsible for otitis media are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. The viruses usually responsible are those of colds, such as rhinoviruses. Respiratory syncytial virus (RSV) can also cause ear infections.

The presence of fluid behind the eardrum is often the result of persistent ear infection. After an acute infection, it may last a few more weeks, this is normal. This does not necessarily indicate the development of a new ear infection.

Fluid can also collect behind the eardrum without infection, usually due to functional and / or structural problems with the eustachian tube.

What are the risk factors?

Acute ear infection usually occurs with an infection of the upper respiratory tract. In young children, the development of the Eustachian tube (the connection between the middle ear and the nasopharynx) is not yet complete. They are therefore more likely to develop otitis media than adults.

A hereditary predisposition may also play a role. The risk is also higher if the parents smoke. Contact with other children at the nursery or at home with siblings increases the risk of infections. Other risk factors include pacifier use and not being breastfed or only breastfed for a limited time.

Where and how often?

About 4 in 10 children aged one year and about 7 in 10 children aged two years have one or more acute ear infections. Ear infections are found mainly between the age of six months and the age of 2 years, the highest frequency being observed at the age of one year.

How to recognize it?

The child is in pain because of the pressure that the fluid accumulated in the middle ear puts on the eardrum. The child may also have a fever, be more irritable, have difficulty sleeping at night, have stomach ache, eat and drink little, vomit or have diarrhea.

When you touch his ear, the child will often put his hand on it or start to cry. The pain is stronger when the child is lying down, and he can hear less well. Hearing spontaneously returns to normal after a few weeks or months.

What can you do ?

In the event of otorrhea, it is important to ensure good ear hygiene: dab the liquid on the pinna regularly to keep the ear dry, then wash your hands. Do not put a cotton swab in the ear. Also clean off anything that has come in contact with the pus that has leaked from the ear. The ear can be covered with a large bandage to prevent contamination of other people. Make sure not to create a humid space: ventilate the ear regularly. As long as the ear is running, it is better not to go swimming.

What can the pharmacist do?

Acute otitis media usually heals on its own within a few days. A pain reliever with paracetamol will relieve the pain and lower the fever. If this is not effective enough, you can switch to ibuprofen, unless your child has asthma, a kidney problem, or there is a risk of dehydration.

Ibuprofen-type painkillers can cause gastrointestinal symptoms: give them to your child with or after a meal, and stop immediately if your child has an upset stomach. Respect the dose, wait at least 4 hours (for paracetamol) to 6 hours (for ibuprofen) between two doses, and tell the pharmacist if your child is taking other medicines such as anticoagulants for example.

If the ear infection was triggered by an upper respiratory infection, you can rinse the nose with saline. Children over 6 years old can use nasal spray or nasal drops for a short time (maximum 5 days). For young children (between 2 and 6 years old), a decongestant nasal spray is only recommended if absolutely necessary and after doctor’s advice.

Pain reliever (eg lidocaine) in ear drops is not recommended.

If after 2-3 days of painkillers the pain and fever have not gone away, you need to see a doctor.

How is the diagnosis made?

The diagnosis of acute otitis media is made using an otoscope (a medical device that a doctor uses to examine the inside of the ear).

What can the doctor do?

In most cases, acute otitis media heals on its own, without antibiotics, within 2 or 3 days. Paracetamol or ibuprofen can relieve pain and lower fever.

In determining whether antibiotics are indicated, the doctor will take into account the severity of the disease, the possible side effects of the antibiotics (for example, diarrhea), and a possible increase in the resistance of bacteria to the antibiotics.

Antibiotic treatment is recommended in the following cases:

  • otitis of both ears in children under 2 years old;
  • children with a discharge from the ear (due to a hole in the eardrum) for more than 7 days;
  • children under 6 months;
  • if the child is very ill;
  • if, after 3 days of treatment with paracetamol, the fever has still not gone down or the pain has not yet been relieved;
  • children who have the Down syndrome, a cleft palate or cleft lip ;
  • immunocompromised children.

The course of antibiotics usually lasts 5 days. If there is no improvement 48 hours after starting treatment, the doctor may prescribe a stronger antibiotic or send the child to a specialist.

Sometimes the doctor gives parents a delayed prescription for antibiotics. This will allow them, if there is no spontaneous improvement after 3 days, to get these antibiotics at the pharmacy without having to return to the doctor. But if the parents are worried about their child’s health or if the symptoms change, it is better to see the doctor again.

Perforating the eardrum has no effect on healing. In very rare cases, it is necessary to reduce pain due to pressure on the eardrum, to find the causative organism or because the child is very sick.

How do we follow up?

It is normal for there to be fluid behind the eardrum for some time after an acute middle ear infection. It can even last for several weeks. But the liquid cannot persist for too long. Therefore, a follow-up examination is usually scheduled. The liquid is not dangerous in itself, but it causes hearing loss, which returns to normal as soon as the liquid is gone. The timing of the follow-up examination depends on the child’s age, speech development, and the underlying disease.

The doctor will refer the child to a doctor specializing in the ears, nose and throat (ENT, for otolaryngologist) in the following cases:

  • suspected complications,
  • child under 3 months,
  • child often having ear infections (more than 3 infections in 6 months or more than 4 infections in 1 year),
  • in case of hearing loss,
  • the fluid accumulation did not disappear after three months.

How to prevent it?

It is important to avoid or limit the risk factors. Above all, do not smoke in an environment where children are growing up.

Transtympanic drains (diabolos) can reduce the number of acute ear infections to some extent, but they do not improve quality of life. They can be considered in children who have had at least 3 ear infections in 6 months.

The removal (ablation) of the tonsils has no effect on the prevention of acute otitis media.

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