Middle Ear Infections
Middler ear infections or otitis media occurs in approximately 30% of children before the age of 7 years. This condition occurs when fluid accumulates behind the ear drum. There is a passage called the Eustachian tube, which drains fluids into the back of the throat behind the nose. Sometimes in children, this tube malfunctions and is unable to drain the fluids sufficiently. Bacteria or viruses can then invade this inner ear and cause an ear infection. This also explains why otitis media occurs shortly after a cold when the nose is blocked and congested. The child often complains of pain or discomfort and may tug or hit his affected ear repeatedly. In infants, they become cranky and irritable. Fever is a common sign or may be the only sign. In worse cases, the ear drum may rupture from the pressure of the infected fluid and there may be ear discharge.
The doctor will examine the child's ear with a special instrument called an otoscope. He will note the inflammed drum and sometimes visualise fluid behind the drum. Otitis media will usually require antibiotics for up to a total of ten days. Although the symptoms and fever with irritability may disappear within two days, the course of antibiotics must be completed to prevent unwanted complications. There may even be a recurrence. Paracetamol may be given for pain relief and fever. If there is no improvement after 48 hours, the child will need a reassessment and need intravenous antibiotics. After the full course of treatment, an assessment is necessary. This is because the most common complications are recurrence and persistence of ear infections. This will then lead to hearing loss with delayed speech development. The serious complications which are rare are meningitis and mastoiditis, where the infection has spread beyond the middle ear compartment. Fortunately, the majority of children have uncomplicated otitis media and soon outgrow this infection with no long term sequelae.