Ailmemts & Remedies Pediatric

Oh, that earache!

Ear infections frequently develop in children and is one of the commonest infections in childhood. A staggering 75 per cent of children have at least one episode of ear pain and infection by the time they reach the age of three.

Most ear infections occur when the weather changes or if there is an infection going around in school.
Most ear infections are acute and are accompanied by excruciating pain, and occur when the weather changes or if there is an infection “going around” in school. Although the child may not to be able to accurately express or localise the discomfort, most parents suspect there is an earache because the child has fever and pulls or tugs at the ear. Sometimes, however, it manifests itself only with unexplained irritability or continuous nerve-wracking screaming. Hapless parents cannot localise the symptoms and are forced to seek emergency medical care.

Most ear infections start innocuously as a viral infection with fever, a runny nose and irritability. There is a three-pronged connection among the nose, throat and the middle ear. As long as all the connections are open, there is very little chance of an ear infection despite an upper respiratory infection. If any connection is blocked, pressure and secretions build up behind the ear drum, causing pain. Later, these secretions can remain stagnant in the middle ear and lead to an infection.

Ear infections often settle by themselves with symptomatic treatment. Frequent (two-hourly) administration of saline nose drops unblocks the nose. Paracetamol administered as dispersible tablets, drops or suspension (10-15mg/kg/dose) every four to six hours reduces the pain and fever. A mild anti-histamine syrup dries up the secretions. Sometimes, anaesthetic (not antibiotic) eardrops may be required to ease the pain. But the technique of administration is very important for the drops to be effective. The child should be placed on a flat surface, not on a pillow or on the lap. The affected ear should face upwards. The outer ear should then be gently pulled upwards and the drops administered. This will not help with the infection but will definitely ease the pain.

About 80 per cent of the antibiotics used worldwide are prescribed for “colds, coughs and ear infections”. They do not work against viral infections, nor do they shorten the course of the disease or prevent progress to a bacterial infection. A wait and watch policy for viral ear infections helps avoid the unnecessary use of antibiotics.

It is advisable, however, to consult a paediatrician immediately if the child is less than six months old, or has some other complicating illness.

If the pain and fever persist even after 72 hours, a secondary bacterial infection may have occurred. This needs appropriate antibiotics in the correct dose and duration. The medication should not be stopped just because the child looks better. Nor should the same antibiotic be purchased OTC (over the counter) and be self administered for a subsequent infection.

Children are more likely to develop recurrent ear infection

* If the early feeding is improper. Breast milk protects from infection, especially during the first six months of life.

* If the head is not raised while feeding. A prone position or placing a bottle of milk in a sleeping baby’s mouth may lead to an ear infection.

* If solids are force fed to an uncooperative child while lying down.

There is also a marked increase in the number of ear infections in children exposed to cigarette smoke. Most ear infections subside with no sequalae.

Certain cases of acute infection require urgent attention —

* When there is a suspicion of short-term mild hearing loss. This can persist if the fluid in the ear does not clear.

* If the infection becomes chronic, leading to damage to the bones and other structures in the middle ear. This can lead to permanent hearing loss.

* If the infection spreads to the mastoid, a bone behind the ear.

* Eventually, pus may extend into the brain and cause abscesses.

Surgery may have to be considered if the infection becomes chronic, with persistent effusions from both ears for three months or from one ear for six months. There are two procedures — myringectomy or tympanostomy, whereby a tube may have to be inserted into the ear drum.

A hole in the ear drum may need to be closed with a skin patch. Eventually, the tonsils and adenoids may need to be removed.

Two of the common bacteria causing ear infections belong to the Pneumococcal and H Influenzae groups. The Hib and pneumococcal vaccines, if administered to children, reduce the incidence of ear infections.

This is because the vaccine incidentally lends immunity against 55 per cent of the organisms that cause an ear infection. These vaccines also have a multiplier effect — they increase herd immunity, that is, they protect other children and elders in the community against bronchitis, pneumonia and ear infections caused by these common organisms.

From: Dr Gita Mathai’s writing (Telegraph ,Kolkata,India)

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