Recurrent otitis media in children

Recurrent otitis media is an inflammation of the middle ear, repeating several times during the year after full recovery (normalization OTO-picture, closure of perforation and hearing).
Prevalence. Occurs in children aged 2 to 5 years.

Causes of relapses (sometimes up to 5-6 times per year) may be local and General.
Common causes include recurrent pneumonia, exudative diathesis, disorders of digestion and nutrition, allergies and low immunity. Local causes are enlarged adenoid vegetations, polyps in the nasal cavity, sinusitis, hypertrophy of the turbinates and tonsils etc.
Important in the event of relapse is the nature of the infection. Along with Pneumococcus, Staphylococcus aureus epidermidis et quite often sown Chlamydia, Mycoplasma, about 20 Haemophilus influenzae. Also playing a role of viral and adenoviral infection.

The clinical course is usually easier. The disease may be accompanied by perforation of the eardrum. When the perforation of the eardrum dull, only slightly flushed, as if thickened perforation is usually small, often located in beredning-it quadrant - mucous or Muco-purulent, quite profuse, odorless, whitish color.
In the absence of perforation of the first symptom is a slight pain and a feeling of fullness in the ear.

Complications. The risk of recurrent otitis media is persistent hearing loss in children of early age, which greatly affects the overall intellectual development and the formation of speech.
If you suspect a persistent hearing loss, especially bilateral, at an early age the child should be examined by a specialist because there are all the possibilities for accurate audiological diagnostics, for example by means of acoustic impedance.
Recurrent otitis media may lead eventually to permanent perforation of the tympanic membrane, i.e. to the development of chronic otitis media with all the adverse effects.

The diagnosis of recurrent otitis media with perforation to install easily.
Recurrent otitis media without perforation, unfortunately, is often not diagnosed because children do not always complain of hearing loss, especially when unilateral process, the reaction temperature is missing, intoxication, as a rule, no.
Essential for the diagnosis in this period has an objective study of auditory function, especially in small children with the help of acoustic impedance.

Treatment of recurrent otitis media performed in two stages.

At the first stage of treatment is aimed at eliminating the current exacerbation:

• produce toilet ear, carefully remove mucus or pus from the ear, use alcohol drops-
• good effect is observed when the active aspiration of pus and injection of solutions of drugs (antibiotics, hormones, proteolytic enzymes) into the tympanic cavity through a large perforation with a syringe-
• simultaneously conducted conservative treatment related inflammatory diseases of the nasal cavity, paranasal sinuses and nasopharynx-
• after rehabilitation of the upper respiratory tract is shown blowing ears for the purpose of removal of exudate, improve the patency of the auditory tube and restore hearing
• oral antibiotics at this stage is rarely used.

The main is the second stage (in remission), aimed at prevention of relapse. Treatment at this stage must necessarily be comprehensive and conducted in conjunction with the pediatrician.

The importance of identifying common causes. For example, in infants sometimes just a change in diet of the mother lead to the cessation of relapses ear.

In children with recurrent otitis media proved immune insolvency, which is expressed in the reduction of General and local immunity, the number of T-lymphocytes, secretory and humoral complexes of immunoglobulins G, A, E. in this regard, In the treatment administered gamma globulin, plasma transfusions, methyluracil, ascorbic acid, Dibazol (interferon inducer), lysozyme, etc.

In the period of remission is also active in local conservative and surgical treatment. Produce pneumatic and vibrating massage of the eardrum, blowing off the Eustachian tubes. Rely on the testimony of vasoconstrictor drops, sugarless chewing gum, if required, carry out puncture for the treatment of sinusitis, adeno - and tonsillotomy. In some cases, one adenoidectomy does not restore the patency of the Eustachian tube, it should be combined in future with exercises for development of muscles, the electro-reflex therapy, vibration and pneumomassage eardrums. A rather persistent effect in combination with other methods give extracorporeal ultraviolet irradiation of blood the effects of helium-neon laser.

In some cases, despite the reduced function of the auditory tube, targeted antibiotic therapy and the use of all measures of the overall impact on the child's body, recurrent otitis media continue. Most often this is due to destructive bone changes in the mastoid. In such cases it is necessary to resort to surgical treatment. It can be minimal (myringotomy, tympanotomy in the absence of perforation, Antreprenor), but sometimes you have to break open the cells of the mastoid process (antromastoidotomy).

ENT