Acute Serous Serous Otitis in Children

Serous otitis in children and its treatment

Acute serous otitis is an ENT disease characterized by the accumulation of serous fluid in the ear cavity. Part of the inflammatory process is accompanied by a decrease in the severity of hearing and a sense of ear congestion, especially during swallowing. In the treatment of serous otitis media and medicines are prescribed in children and adults, and in some cases, surgical intervention is indicated.

Symptoms of serous otitis media

This inflammatory process, like otitis media, can have several forms of flow and manifestation. In the case when a serous fluid accumulates in the ear cavity, but no signs of an acute inflammatory process appear, specialists diagnose serous otitis. In other words, serous otitis is a weakly pronounced course of the inflammatory process.

When serous otitis in the ear cavity accumulates exudate - a serous fluid, which has a non-purulent character. A pathogenic secret is accumulated in the tympanum.

Recognize the acute average serous otitis in children and adults can be on such grounds:

• a feeling of stuffiness in the ear;
• hearing loss;
• feeling of pressure.

Often there is a stuffy ear when swallowing, otalgia can develop.

However, these symptoms are often not enough for accurate diagnosis, because such manifestations usually indicate other types of otitis. To determine the correct diagnosis, the otolaryngologists perform an examination of the tympanic membrane. With the development of serous otitis, its color is yellowish or grayish. To confirm the development of the inflammatory process, tympanometry is often used.

Older children and adults complain of ear pain and hearing loss. At an early stage of the disease, the tympanic membrane swells and, due to this, partially loses its mobility. At a later stage of serous otitis, the membrane retracts, becomes thickened, loses its former coloration, often on it a specialist can notice white spots on examination. In addition, with tympanometry, the otolaryngologist behind the membrane can see the level of fluid and air bubbles, while observing that the light reflex is broken or completely absent.

Causes of serous otitis media

Among the reasons that cause the development of this pathology, experts call such factors:

• violation of the functionality of the Eustachian tube;
• penetration of viruses;
• exposure to bacteria;
• the action of viruses and bacteria simultaneously.

Even the shortest dysfunction of the Eustachian tube in most cases becomes the cause of the development of the initial stage of serous otitis in children. This connecting body performs such functions as ventilation, protective, drainage. That is why the development of otitis media depends to a large extent on the condition of the auditory tube. The small and short Eustachian tube, as well as its almost horizontal position, lead to frequent recurrences of otitis in children.

Children attending pre-school or school educational establishments are in contact with a large number of people, so they are prone to frequent respiratory viral infections. It is known that the cold provokes the development of serous otitis, especially with a protracted runny nose.

Another common factor affecting the condition of the hearing organ in a child is allergic diseases of the respiratory system. As medical practice shows, otitis is more common in children suffering from year-round or seasonal allergic rhinitis. Also, you should not exclude food allergy, in children up to two years, most often there is such a reaction to milk.

Acute form of serous otitis

Despite the fact that serous otitis is characterized by a mild course, an acute form of the disease can occur. In this case, when performing tympanometry in the tympanum, a liquid of amber-yellow color is visible. Usually, such otitis occurs asymptomatically or with few symptoms, so diagnosis is very difficult. Often a disease is found in the late stages of its development, which is very dangerous for a person. The main symptom of an acute form of serous otitis may be a decrease in hearing, but the patient gradually becomes accustomed to this and does not notice the changes occurring.

Treatment of serous otitis in children and adults

Early diagnosis and identification of the causes of the disease is the key to successful treatment of acute serous otitis in children and adults. With the timely detection of the pathological process in the ear cavity, the chances of eliminating unpleasant and dangerous otitis symptoms by the method of conservative treatment are increased.

Such therapeutic measures should consist of such actions:

1. Do not feed infants in the "lying" position;
2. In case of allergic origin of serous otitis, it is necessary to exclude the contact of the sick person with the allergen;
3. During bathing, put on the head a special cap;
4. Regularly moisten the air in the room where the patient is.

In the treatment of acute serous otitis caused by an allergic reaction of the body, in parallel with symptomatic therapy, the administration of H-1 blockers is prescribed internally. Also, you need to take vasoconstrictive drugs, they will help to remove puffiness in the ear cavity and nasopharynx.

To remove puffiness in allergic rhinitis, otolaryngologists appoint cromolyn and corticosteroids to their patients. After such treatment of serous otitis, the functionality of the auditory tube is often restored.

A short course can be prescribed corticosteroids and vasoconstrictive agents for topical application. Corticosteroids, as a rule, are not used for systemic use. If serous otitis was caused by a bacterial or viral infection, antiviral and antibacterial agents are indicated for use.

Children are prescribed antibiotics such as:

• amoxicillin;
• ampicillin;
• erythromycin;
• cefaclor.

If there is a frequent reoccurrence of serous otitis - three times in six months, it is recommended to drink a course of antibiotics for preventive purposes.

In some cases, surgical treatment of serous otitis media is indicated. The operation becomes necessary with enlarged adenoids, when the overgrown tissue covers the opening of the auditory tube. Then an adenotomy is performed - an operation to remove adenoids. When the serous fluid is not itself removed from the tympanum, surgical intervention will also be required.

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How to treat serous otitis media of the middle ear?

Serous otitis media of the middle ear is a serious disease that requires timely treatment. When otitis occurs an inflammatory process, it is caused by viral infections. The eardrum swells, reddens, in about 70% of cases, bacteria are found in the crop. In the cavity of the middle ear accumulates fluid, there are all the signs of acute inflammation. Approximately 50% of cases show the growth of bacterial colonies, viruses are detected in only 30% of crops.

The average secretory serous otitis at the initial stage resembles the form of purulent otitis, the main problem being the dysfunction of the Eustachian tube. Most of the cases become infected during the first year of life, while the children are affected by the syncytial virus. The development of the disease is facilitated by parainfluenza, influenza. Children with cleft palate are much more often exposed to otitis media.

Various methods are used to treat serous otitis, but after the examination by a doctor, the sanitation of the nose and pharynx is usually first. Through a special catheter, the doctor enters into the existing lumen of the auditory tube such tools as:

• chymotrypsin;
• hydrocortisone;
• proteolytic enzymes;
• various antibiotics;
• lidase;
• vitamins;
• restorative medications;
• immunocorrectors.

Vasoconstrictive drugs may be administered in the nose, but they can be used only up to 2 weeks. If the otitis occurs on the background of allergic reactions, then antihistamines are prescribed. The patient is constantly under the supervision of doctors.

If the functions of the auditory tube are not fully restored within the first 14 days, then surgical treatment is prescribed. It is usually performed by a surgeon bypass, this operation leads to recovery.

In some cases, cavity drainage is used, since the inflammatory process can affect other areas.

Symptoms and possible consequences of serous otitis media

At the first stage of the disease, symptoms such as:

• failure of the ventilation function;
• eustachiitis;
• catarrhal inflammation of the mucosa.

In the region of the tympanic membrane, a vacuum builds up. If this condition is expressed clinically, then the membrane is stretched, the injection of the vessels is detected along the malleolus. With further flow there is the formation of easy autophony. The patient's hearing loss may not be noticed. This stage lasts for about 30 days.

The next stage is called secretory, since slime begins to accumulate in the tympanic cavity. In the middle ear, the number of goblet cells and mucus increases. If you take subjective manifestations, then in the ear, the patient experiences pressure, noises, a feeling of overflow, conductive hearing loss.

There may be a feeling of overflow of liquid, splashing, especially when changing the position of the head. How can we explain such a state? When tilting or changing the position of the head, the fluid in the eardrum is displaced. One niche in the labyrinth of the ear is released, with not only improved hearing, but also sound reproduction. The secretory stage is long, it can last about a year. Each case is individual.

In the third stage, the contents of the tympanic cavity acquires a viscosity, so this stage is called mucosal.

The deafness is more pronounced, the duration of such a stage is about 1-2 years. The fourth stage is called fibrous, at this time there are degenerative processes that occur in the mucosa. The drum cavity is subject to changes, the processes can become irreversible. At the fourth stage, there is a decrease in the formation of mucus, the mucosa itself undergoes a fibrous transformation. Many parts of the hearing aid are now involved in this process, including the auditory ossicles. Hearing loss is intense in the patient.

What is the treatment prescribed?

Acute or chronic otitis media should be treated immediately, once it has been diagnosed. Most often, conservative therapy is prescribed, which is sufficient for a complete cure without consequences for the hearing.

Common measures for the treatment of otitis media:

1. A special regime is appointed, not necessarily bed rest, but presupposing peace, in the room you must constantly moisten the air.
2. If you have allergic complications, you must always remove contact with the allergen so that there is no deterioration.
3. For children, bottle feeding is not recommended to prevent fluid from entering the middle ear area.

As medicines are used:

• blockers if allergic reactions are diagnosed;
• vasoconstrictor drugs, corticosteroids;
• Cromolyn is prescribed only with mucosal edema (to restore all functions of the auditory tube);
• antimicrobial drugs in the form of injections (drugs can be different, it all depends on the features of the course of the disease).

If you can not avoid contact with any allergens, then measures for desensitization are carried out. It is recommended for the elderly, they are contraindicated for young children.

Surgical intervention

Treatment of otitis serous can take more serious forms, in some cases conservative measures no longer bring their result - it is necessary to perform surgical intervention.

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Measures can be different:

1. With the appearance of adenoids, the patient is diagnosed with a disturbance in the regulation of pressure in the ear drum cavity. It should be noted at once that this violation of the patency of all auditory tubes occurs rarely. Improvement of the condition after adenotomy is temporary, since the residues after surgery can again be hypertrophied.
2. Catheterization of the auditory tube allows to stabilize the level of pressure in the ear drum cavity. The operation significantly improves hearing, well normalizes the functions of the middle ear. But there are minuses here too. There may be scarring, atrophy of the entire ear drum eardrum. It is much less often that the perforation of the membrane is diagnosed, but only if the drainage tube is removed.

The tactic of surgical treatment is determined only by the observing physician, depending on the general condition of the patient. It is necessary immediately to find out how the disease is proceeding, whether there was a hearing impairment, even if this process was minimal. Particular attention should be given if the disease is diagnosed in young children.

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The following forecasts are possible:

1. At the senior school age, the prognosis of treatment is favorable, even if the form of the disease is chronic, surgical treatment is rarely prescribed.
2. Children of primary school age should immediately be prescribed treatment, including surgical, if there is such a need. If treatment is delayed, then hearing loss can take irreversible consequences.
3. Otitis in young children usually proceeds quickly, ends with recovery. If the disease progresses and the treatment is not prescribed, the changes will be irreversible. Serous otitis media of the middle ear should be treated at any age, once the problem has been diagnosed.

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Acute otitis media in children

Acute otitis media in children (acute otitis media, acute middle ear Qatar) is an acute inflammatory disease of the middle ear.

It should be remembered that at present, different terminology is used in the literature in describing chronic catarrhal otitis media. The nature of the contents in this disease is sometimes very peculiar and has a high content of blood elements, protein (or its absence), etc. Can be found such names as exudative, transudative, serous, hemorrhagic, mucous otitis media, "sticky" ear, etc. However, the principles of treatment do not change from this.

ICD-10 code

Diseases of the middle ear and mastoid process (H65-H75).

• H65 Pulmonary otitis media.
• H65.0 Acute middle serous otitis media.
• H65.1 Other acute non-nasal averages otitis.
• H65.9 Pulmonary otitis media, unspecified.
• H66 Purulent and unspecified otitis media.
• H66.0 Acute suppurative otitis media.
• Purulent otitis media, unspecified.
• H66.9 Average otitis, unspecified.
• H70 Mastoiditis and related conditions.
• H70.0 Acute mastoiditis.
• H70.2 Petrosit.
• H70.8 Other mastoiditis and related conditions.
• H70.9 Mastoiditis, unspecified.

Code for ICD-10 H66.0 Acute purulent otitis media H65 Pulmonary otitis media H66 Purulent and unspecified otitis media H66.4 Purulent otitis media, unspecified H66.9 Otitis media, unspecified H65.9 Pulmonary otitis media, unspecified

Epidemiology of acute otitis media in children

Acute otitis media - one of the most frequent ear diseases in children (approaching 65-70%) is 25-40% of cases. Chronic catarrhal otitis media can be an independent disease or a stage of transition to acute purulent inflammation of the middle ear.

The frequency of acute otitis media is associated with certain general and local conditions that contribute to its occurrence in the child. The disease is more common in infancy and early childhood with a peak incidence of 6-18 months. Subsequently, the risk is slightly reduced, but at the end of childhood, almost all children in the anamnesis described at least one episode of the disease. In the first year of life, 44% of children suffer acute otitis media 1-2 times, 7.8% - 3 times or more. By 3.5 and 7 years, acute otitis media is transferred by 83.91 and 93% of children, respectively.

Causes of acute otitis media in children

The most frequent pathogens -Streptococcus pneumoniae(pneumococcus) andHaemophilus influenzae(haemophilus influenzae). A certain role is also played by viruses, primarily respiratory syncytial andChlamydia pneumoniae.

Pneumococcus and hemophilic rod are characterized by high sensitivity to beta-lactams and cephalosporins. but 35% of all pneumococci and 18% of hemophilic rods are resistant to co-trimoxazole.

What causes acute otitis media?

Symptoms of acute otitis media in children

Serious differences in the clinical picture of acute otitis media in children and adults are noted.

Acute illness proceeds easily: the general condition does not change, there is no temperature reaction, in the anamnesis more often - ARVI. When the otoscopy of the tympanic membrane is almost not changed, occasionally determine the level of exudate. Complaints of patients - a decrease in hearing, a feeling of stuffiness in the ear. At children of early and preschool age complaints can be absent owing to fear of survey by the doctor, therefore a role of the pediatrist at suspicion for the deafness should be more active, and the child should be sent for examination of hearing to a specialist-otorhinolaryngologist.

Symptoms of acute otitis media

Where does it hurt?

Pain in the ears of children

What's bothering you?

Noise in ears

Classification of acute otitis media in children

Forms of acute otitis media, different in etiology, conditions of origin, clinical course, morphological character, functional disorders, consequences, complications and principles of treatment.

In addition to the typical course of the disease (detailed below), there are other options. One of them in childhood is the so-called latent course of otitis media. In this form, about a third of the diseases occur, especially in infancy.

The most characteristic for the latent flow of acute otitis media is the dulness of all the symptoms. The child has a little spontaneous pain, low temperature, hearing decreases. The otoscopic picture is atypical: only the color of the tympanic membrane changes, it becomes cloudy, as if thickened, hyperemia is limited injection of vessels, sometimes only in one, more often the upper part, protrusions are not observed, however the light reflex is scattered, the region the mastoid process does not change; there is a dissonance with the blood picture, where high leukocytosis and an increase in ESR can be observed.

The importance of the latent acute acute otitis media is often underestimated by pediatricians. That is why a child with a prolonged, unusually flowing, difficult to treat disease should necessarily be consulted by an otorhinolaryngologist.

Often meet and violently flowing acute middle otitis, while for several hours against the background of severe pain, high temperature and severe intoxication, rapid formation of exudate occurs with the onset of perforation and suppuration. Sometimes in these cases it is imagined that the first stage is completely absent, the child seems to have pus from the ear, this course is usually associated with a particular virulence of the microorganism.

Diagnosis of acute otitis media in children

Symptoms of acute otitis media are diverse and largely dependent on age, it is most difficult to establish a diagnosis in newborns and infants. An important role for diagnosis is the history. It is necessary to find out, after which there was a deterioration in the state of the child. Most often the ear infection is preceded by acute rhinitis, acute respiratory viral infection, sometimes trauma (falling from the crib), allergic diseases.

The leading symptom of acute otitis media is a strong, often sudden, spontaneous pain. It is associated with rapid accumulation of exudate in the tympanic cavity and pressure on the end of the trigeminal nerve, innervating the mucosa.

Diagnosis of acute otitis media

What it is necessary to survey?

Middle ear

How to inspect?

Ear research

Who to contact?

Otolaryngologist ENT - doctor Pediatrician

Treatment of acute otitis media in children

The main thing in the treatment of acute otitis media is the restoration of the patency of the auditory tube, which is easily achieved by the use of vasoconstrictive drops in the nose and by usual physiotherapeutic procedures. Sometimes, if this does not help, apply a simple blowing of the ears through the nose (according to Politzer). beginning with 3-4 years, and in older children with a unilateral process - catheterization of the auditory tube. Antibiotics for acute catarrhal otitis media do not apply.

Treatment of acute otitis media

In addition to treatment

Physiotherapy for otitis Antibiotics for otitis Than to treat? Tavanik Zedex Galazoline

Prevention of acute otitis media in children

Breastfeeding for 3 months significantly reduces the risk of acute otitis media during the first year. Given the relationship of acute otitis media with a seasonal surge in incidence, it is recommended that prevention of cold infections should be carried out according to generally accepted protocols.

Forecast for acute otitis media in children

In most cases, acute otitis media is favorable.

The danger of recurrent middle otitis media is, first, in a persistent hearing loss in children of early age age, this largely affects the overall intellectual development and formation of speech. If suspected of such persistent deafness, the child should be examined by a specialist, since at present there are all possibilities for an accurate audiological diagnosis. Secondly, recurrent middle otitis media can lead to the formation of a stable perforation of the tympanic membrane, that is, chronic otitis media.

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