Otitis at children – inflammatory defeat external (external otitis), an average (average otitis) or an inner ear (labirintit). Otitis at children is followed by an acute pain and a congestion in an ear, decrease in hearing, the pus expiration, concern of the child, high temperature of a body. Diagnosis of otitises at children is carried out by the children's otolaryngologist on the basis of an otoskopiya, bacteriological crops from an ear. Treatment of otitis at children can include antibacterial therapy (local and the general), physical therapy, washing of a middle ear, if necessary – an eardrum, shunting of a drum cavity.
Otitis at children
Inflammatory diseases of an ear (otitises at children) – the most frequent pathology in pediatrics and children's otolaryngology. At early children's age about 80% of children, and to 7 years – 90-95% have otitis. Children can have various current and an outcome of otitis; quite often the disease gets a recidivous current, and in hard cases leads to dangerous otogenny complications (to an otoantrit, paralysis of a facial nerve, extra-and subduralny abscesses, meningitis, encephalitis, sepsis, etc.). The otitis transferred the child at children's age serves as the reason of development of relative deafness in adults in a quarter of cases.
Classification of otitis at children
Depending on the level of an inflammation distinguish external otitis, average otitis and internal otitis (labirintit) at children. Quite often, having begun in an external ear, inflammatory process extends to deeper departments, i.e. external otitis passes into average, and average – in internal.
At external otitis at children the auricle and external acoustical pass is surprised. External otitis at children can proceed in two forms – limited (a furuncle of external acoustical pass) and diffusion (an inflammation of an external ear throughout).
Children can have a sharp course of average otitis, recidivous and chronic. On character of the formed inflammatory exudate children can have a catarrhal sharp average otitis or purulent. Sharp average otitis at children passes 5 stages: sharp evstakhiit, acute catarrhal inflammation, doperforativny stage of a purulent inflammation, post-perforative stage of a purulent inflammation and reparative stage.
Labirintit can proceed sharply or chronically; in the form of a serous, purulent or necrotic inflammation; to have limited or diffusion character.
The otitis reasons at children
Infection of hair follicles of cartilaginous department of external acoustical pass is the reason of external otitis at children. Grazes and scratches of an external ear, diabetes, the gnoyetecheniye accompanying average otitis at children contribute to development of an infection. As causative agents of external otitis at children most often serve the sinegnoyny stick, colibacillus, proteas, staphylococcus; in 20% cases – fungi.
Average otitis usually acts as a SARS complication at children (an adenoviral infection, flu), children's infections (measles, scarlet fever, diphtheria). Quite often average otitis is the satellite of other LOR-pathology of children's age: adenoides and adenoidit, rhinitises, sinusitis, quinsies, tonsillitis, pharyngitises, foreign matters of an ear, atresia Joán etc. From external acoustical pass introduction of an infection in a middle ear is possible at an eardrum injury. Average otitis can develop even at newborn children at infection from mother sick with mastitis, pyelonephritis, an endometritis, etc. At a microbiological research separated from an ear more often the pneumococcus, a hemophilic stick, a moraksella, a hemolytic streptococcus, fungal activators is sowed.
Internal otitis at children most often arises as a complication of a purulent inflammation of a middle ear or other bacterial infections – antritis, meningitis and so forth.
Frequent developing of otitises at children is promoted by immaturity of natural immunity, prematurity, a hypotrophy, ekssudativny diathesis, allergies, bronchopulmonary pathology, avitaminosis, rickets. A special role is played by local anatomic factors: the acoustical pipe at children shorter and wide, than at adults, has practically no bends, is located horizontally in relation to a nasopharynx.
Otitis symptoms at children
The furuncle of an ear and diffusion external otitis at children is shown by temperature increase of a body and severe local pain which amplifies at a conversation, a food chewing, when pressing on a trestle. At survey reddening of acoustical pass which at the expense of hypostasis becomes shchelevidno narrowed, regionarny lymphadenitis is found.
The beginning of sharp average otitis at children is followed by sharp ear pain, high temperature of a body (to 38-40 °C), decrease in hearing, the general intoxication. Babies become uneasy, continuously cry, swing the head, nestle a sore ear on a pillow, rub an ear a hand. Often kids refuse food as sucking and swallowing strengthen pain. The concern periods at the child can be replaced by depression; children of younger age often have a diarrhea, vomiting and vomiting.
After perforation of an eardrum pain decreases, temperature falls down, intoxication decreases, but the hearing impairment remains. At this stage of average otitis children have purulent allocations from an ear (). After the termination of an ekssudation all symptoms of sharp average otitis at children disappear, there is a scarring of perforation and restoration of hearing. Sharp average otitis at children lasts about 2-3 weeks. At children's age violently proceeding and latent average otitises quite often meet.
Recurrent average otitises at children repeat several times within one year after absolute clinical recovery. Most often the new episode of a disease arises against the background of recurrent pneumonia, a viral infection, disorders of digestion, decrease in immunity. The course of recurrent otitis at children easier; is followed by slight pain, feeling of a congestion in an ear, mucous or mucopurulent allocations from an ear.
Ekssudativny average and adhesive otitis at children proceed with ill-defined symptomatology: noise in an ear and the progressing decrease in hearing.
Chronic purulent average otitis at children is characterized by existence of permanent perforation of an eardrum, a periodic or constant gnoyetecheniye and the progressing relative deafness. At an exacerbation of otitis the child has a temperature increase, emergence of symptoms of intoxication, strengthening of allocations from an ear and pain. The disease occurs at a half of the adults who often had otitis in the childhood.
Otitis complications at children
Otitis complications at children develop at late begun or wrong treatment, or in case of extremely heavy course of an infection. At the same time the inflammation of an inner ear most often develops (labirintit) which is followed by dizziness, noise in ears, decrease or total loss of hearing, balance violation, nausea and vomiting, nistagmy.
At children damages of a temporal bone (zigomatitsit, mastoidit), paralysis of a facial nerve are among complications of average otitis. At spread of an infection deep into of a skull emergence of intra cranial complications - meningitis, encephalitis, abscesses of a brain, sepsis is possible.
Against the background of the chronic course of average otitis in several years at children the resistant relative deafness connected with cicatricial processes in an eardrum and the sound perceiving device can already develop. It in turn adversely influences on formation of the speech and intellectual development of the child.
Diagnosis of otitis at children
Children with initial displays of otitis often get on reception to the pediatrician therefore it is extremely important to reveal in due time an ear infection and to redirect the child on consultation to the children's otolaryngologist.
As otitis is often accompanied by other LOR-pathology, children need full otolaryngologic inspection. Among tool methods of diagnostics the main place belongs to an otoskopiya which allows to examine an eardrum, to see its thickening, an injection, hyperaemia, protrusion or perforation and a gnoyetecheniye. At perforative average otitis at children exudate for a bacteriological research undertakes.
In case of recurrent or chronic otitis at children the particularly important becomes a research of acoustical function by means of an audiometriya or an acoustic impedansometriya, definition of passability of an acoustical pipe.
At suspicion on development of intra cranial complications children with otitis have to be examined by the children's neurologist.
Treatment of otitis at children
At external otitis at children are, as a rule, limited to conservative treatment: a careful toilet of an ear, introduction with spirit solutions, local infrared radiation. If within 2-3 days the inflammation does not abate, resort to opening of a furuncle of acoustical pass.
At average otitis to children ear drops are appointed osmotically active (phenazone + lidocaine) and antibacterial (containing rifampicin, , ciprofloxacin). For reduction of an inflammation and removal of a pain syndrome analgetics and NPVS are used. For the purpose of knocking over of an allergic component antihistaminic medicines are shown. At difficulty of nasal breath carrying out an anemization of a cavity of a nose, an instillation of vasoconstrictive drops in a nose is necessary. System antimicrobic therapy at otitises at children is most often carried out by penicillin, ftorkhinolona, tsefalosporina, macroleads.
At not perforative purulent otitis children have a need of carrying out a paratsentez of an eardrum for ensuring outflow of a purulent secret from a drum cavity outside. Maintaining otitis at children in a post-perforative stage assumes clarification of external acoustical pass from turundama pus, washing of a middle ear medicines.
After subsiding of the sharp phenomena for the purpose of improvement of function of an acoustical pipe blowing off of ears on Polittsera, pneumomassage of an eardrum is carried out. Include various physiotherapy in a complex of medical actions: UVCh, Ural federal district, microwave therapy, laser therapy, electrophoresis, .
At ekssudativny otitis at children for removal of a secret carrying out a timpanopunktion, miringotomiya, shunting of a drum cavity, an auditing timpanotomiya can be required. If conservative treatment of adhesive average otitis at children is inefficient, and relative deafness progresses, performance of a timpanoplastika with prosthetics of the destroyed acoustical stone is possible.
Prevention of otitis at children
At the typical course of sharp external and average otitis at children, and also timely complex therapy there occurs recovery with a complete recovery of acoustical function. At preservation of the contributing reasons perhaps recidivous and chronic course of otitis at children with serious consequences.
Prevention of otitis demands increase in the general resistance of an organism, an exception of a travmatization of external acoustical pass and an eardrum from children foreign objects (Q-tips, matches, hairpins and so forth), training of the child in the correct smorkaniye. At identification at the child of associated diseases of ENT organs their treatment, including planned surgical intervention (an adenotomiya, a tonzillektomiya, a nose polipotomiya etc.) is necessary.
It is not necessary to self-medicate otitis at children; at the complaints indicating an inflammation in an ear, the child has to be immediately consulted by the children's expert.