Ear Infection in Children

 One of the common causes for a parent to rush a child to a medical emergency is ear pain.

Once we recollect our knowledge of the anatomy of the ear it is easy to understand that ear infection in children which causes ear pain could be affecting either the external ear or the middle ear. 

EXTERNAL EAR INFECTION (OTITIS EXTERNA)

Anyone who has experienced ear pain knows how excruciating it can be- this is because the external ear, as well as the eardrum, are richly supplied by sensory nerves. 

Causes

1. Furuncle (boil) in the external ear canal- usually caused on account of misguided attempts to clean the ear with earbuds or fingernails, etc. This is a simple bacterial infection that is very painful. The ear is painful to touch. Treatment is usually with ear packing to reduce pain and swelling, local antibacterial cream, analgesics, and if not responding an antibiotic may be needed.

2. Swimmer's ear - usually after swimming in non-treated waters like lakes and ponds. It is caused by a fungus that accumulates in the external ear and causes itching and sometimes a lot of pain. Treatment is by cleaning the ear and applying antifungal drops.

3. Impacted wax- Dry hard impacted wax, especially when secondarily infected, can cause ear infection and pain.

MIDDLE EAR INFECTION (OTITIS MEDIA)

Children's immune systems are developing and in this period they are more prone to getting colds, sore throats - both leading to an infection of the middle.

Two changes happen to a child at 2 years of age

- they start attending playschool - thus exposing themselves to infections for the first time

- maternal antibodies through breast milk have gone down.

The commonest time a child gets a serious ear infection is from 2 years onwards.

The child develops a sore throat/ Tonsillitis or a bad cold/ Rhinitis. The infection passes on via the Eustachian Tube (which is shorter and wider in children) to the Middle Ear.

There is a gradual buildup of mucus in the middle ear which gets secondarily infected by bacteria - a condition called Acute Suppurative Otitis Media.

This may resolve spontaneously or else the suppuration may increase in which case the increased pressure of the pus in the middle ear causes the eardrum to rupture and pus is seen in the external ear canal. This leads to an immediate cessation of pain since the eardrum is not being stretched anymore.

The treatment of a middle ear infection is usually with mucolytics, pan medication, intranasal steroids, steam inhalation, etc.

Rarely an antibiotic may be needed but there are protocols for that. Do not start on your own.

Watchful waiting is the current management philosophy.

Pearls and Pitfalls

  • Do not try to clean the child's ears with earbuds etc
  • Do not instill oil in a child's ear hoping the pain will go away
  • Swimming pool water is safer than river/ lake water.
  • Do not start an antibiotic for a suspected ear infection on your own. Symptomatic relief medication with analgesics is ok.

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