Otitis media: Diagnosis and Treatment

Otitis media: Diagnosis and Treatment

Diagnostic examination

In many cases, an accurate diagnosis of otitis media is difficult. If the doctor when viewed in the ear otoscope (device inspected ears) finds all the typical features, it will put an accurate diagnosis. If the symptoms are vague or not fully present, the diagnosis is imprecise and may take time to refine it. In this case, the doctor will discuss with you which treatment is more suitable. Most accumulation of earwax difficult viewing, and its removal is required for an accurate examination of the eardrum.

Suspicion of otitis media in children requires a call to the home of children's doctor. Although the examination of the ears is usually a painless procedure, most children do not like it. In order to facilitate the examination, put the child on her knees and hug him hand and foot, making it impossible to move.

Objectives of the survey:

  • Determine the presence or absence of inflammation in the tympanic cavity
  • Determine the type of pathogen (bacteria, virus) and its sensitivity to antibiotics.
  • Detect step process and the need for antibiotics.
  • Rule out or confirm the presence of complications — perforation of the tympanic membrane, purulent process of hearing loss.

Consultation with specialists

ENT consultation is mandatory for children:

  • suspected of need for surgical treatment
  • with frequent recurrent otitis
  • with suspected hearing loss.

In other cases, the doctor may treat otitis pediatrician.

Analyses:

Blood and urine samples, with no complications are not required.

Diagnostic procedures:

Tympanometry— An additional test on the mobility of the eardrum, the doctor may need in some cases to confirm the diagnosis of otitis media. Performed immediately after the examination the ear with a special device in the ENT's office, with no prior training.
Audiometry — A study of hearing, it is necessary for suspected its decline.
Computer or magnetic resonance imaging (CT or MRI) are necessary in the case of suspected purulent, intraosseous or intracranial complications — mastoiditis, purulent abscess, meningitis. Imaging also reveals the cholesteatoma. MRI is more informative than CT for the detection of clusters of fluid and pus.
Timpanotsentez— Piercing the eardrum to extract liquid and diagnostic purposes. It is a standard for clinical trials of otitis media, but in practice is rarely used. Requires all children with severe disease, children receiving chemotherapy or hormonal treatment of steroids, as well as carriers of HIV. Exudation and the subsequent determination of micro-organisms in it helps to accurately select an antibiotic that is appropriate for this type of infection.

Treatment

The vast majority of cases of otitis media treated at home. Hospitalization is required only in cases of suspected severe septic complications — mastoiditis, meningitis, etc.

Drug therapy:

  • Antibiotics (pills or injections)
  • Antipyretics and analgesics
  • Watchful waiting and watching
  • The combination of all the above

"The best treatment" depends on many factors: age, medical history, as well as the associated diseases.

Antibiotics — The need for their use in otitis media in children being actively discussed by doctors in the past ten years. The reason for that — the high resistance of bacteria that cause inflammation of the ear, penicillin and similar drugs. Many older children acute otitis goes without antimicrobial therapy. Therefore, many physicians tend to possible use of expectant management, limited only by analgesics and antipyretics, such as paracetamol.
Watchful waiting is suitable if:

  • A child older than two years
  • Sore only one ear
  • Symptoms are mildly
  • Diagnosis requires clarification

In this case, the physician may prescribe any child antipyretic, e.g. acetaminophen or ibuprofen, or a combination thereof, and assign reception repeated on the next day or two days later. If re-examination confirmed the diagnosis of otitis media, or if the child's condition deteriorates during the observation period, the doctor will prescribe a type of antibiotics.

In these cases, your doctor may prescribe antibiotics from day one, without a period of observation:

  • If the patient is a child under the age of 24 months
  • Symptoms including pain and temperature strongly expressed
  • In the process involves both ears
  • The diagnosis of otitis odtverzhden specialist (ENT doctor)

Antibiotics first row in the treatment of otitis media are the penicillins (amoxicillin, e.g. "Amoxiclav" "Augmentin" etc.), and cephalosporins (cefazolin, ceftriaxone tsefipim). They can be administered in the form of a syrup or tablet, or in injectable dosage forms, which are usually more effective.
First-line drugs have the least amount of complications and have the most pronounced activity against the causative agents of otitis media.
If you have previously been observed in the child is allergic to penicillin and cephalosporin antibiotics, the doctor is suspected bacterial resistance to them, or are there other reasons that prevent their appointment, the doctor may prescribe drugs second row. These are clarithromycin, azithromycin, co-trimoxazole, levofloxacin.
Antibiotics may cause side effects such as diarrhea, rashes, allergic reactions. When excessive and uncontrolled use of antibiotics in bacteria can develop resistance to them, which will require the use of heavier drugs.

Analgesics — The most safe use of paracetamol and / or ibuprofen doses of age as a syrup or tablets. Multiplicity of receiving 2 — 3 times a day. Also exert a positive effect eardrops with anesthetics ("Otipaks"), but their use should be aware of potential allergic reactions contained therein lidocaine and its analogs.

The remedies for the common cold (Vasoconstrictor, decongestants) — the use of drugs vasoconstrictor action (phenylephrine, oxymetazoline, xylometazoline, etc.) with otitis media in children in clinical trials did not reduce the duration and course of the disease, and had no effect on the incidence of complications. These funds have significant side effects, the harm of which potentially exceeds the benefit. Therefore their use is not justified and they should not be given in this disease.

Antihistamines (Suprastin, tavegil, loratadine, etc.) — as well as decongestants are not facilities for the treatment of otitis media, and the risk of their use exceeds the benefit in clinical trials. In this regard, they can not be recommended for the treatment of this disease.


Surgical treatment

Is rarely used, since the vast majority of cases of otitis media do not require surgical treatment.
Tympanotomy— Opening of the eardrum. It is used in severe cases with very severe pain. In the ENT department of the child is under anesthesia, an incision in the eardrum, which allows to take the pus and exudate (inflammatory fluid) out. The procedure greatly facilitates the child's condition, and pus may be sent to a laboratory to determine the sensitivity to antibiotics. If there are indications myringotomy may be associated with the installation of the tube in the middle ear (timpanostomiya).
Timpanostomiya — A procedure in which the cavity of the middle ear tube is installed to facilitate the outflow of pus and fluid. Performed in the case of frequent otitis repeated in the absence of a positive response to treatment with antibiotics, as well as exudative otitis.
Removal of the adenoids and tonsils — Supporting the controversial measure in the treatment and prevention of otitis media. Many children with frequent ear infections are also enlarged adenoids, frequent tonsillitis and sore throats associated with streptococcus group A. With the combination of these factors deemed appropriate operation of removal of tonsils and adenoids.

Other methods

Traditional and complementary medicinefor the treatment of otitis media offers homeopathy, naturopathy, acupuncture and other therapies actively advertised. For them, there is little clinical trials, and even less to confirm their effectiveness. In this regard, conventional methods of medicine can not be recommended as a first line treatment of otitis media.

Observation

Improvement should be expected within 24 — 48 hours, regardless of having been treated with antibiotics or not. If no improvement occurs after 48 hours, you need to re-call doctor at home. He will either prescribe antibiotics if the child did not get it, either replace the other.
If a child has become noticeably worse than it was at the first examination the doctor, call him immediately.

Prophylaxis

Risk factors— The main method of preventing otitis media in children. Risk factors include a kindergarten, tobacco smoke, sucking pacifiers, bottle-feeding.
Antibiotikoprofiaktika — Was common in the past. Currently, most experts do not recommend prophylactic antibiotics, as it contributes to the emergence of resistance in bacteria.
Surgical prophylaxis — Installation of a drainage tube into the cavity of the middle ear with frequent repeated otitis. May be recommended under certain conditions in some children. The final decision on whether this method should remain with the treating physician.
Vaccination— There is evidence that some vaccines can reduce the frequency and severity of cases of otitis media in children. These include vaccines against influenza and pneumococcus.

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