Otitis

The common cause of otitis is dysfunction of the Eustachian tube. This is usually due to inflammation of the mucous membranes in the nasopharynx, which can be caused by a viral upper respiratory tract infection (URTI), strep throat, or possibly by allergies.

By reflux or aspiration of unwanted secretions from the nasopharynx into the normally sterile middle-ear space, the fluid may then become infected — usually with bacteria. The virus that caused the initial upper respiratory infection can itself be identified as the pathogen causing the infection.
Discharge from the ear can be caused by acute otitis with perforation of the eardrum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).

The primary symptom of acute otitis is ear pain; other possible symptoms include fever, reduced hearing during periods of illness, tenderness to touch of the skin above the ear, purulent discharge from the ears, irritability, and diarrhea (in infants). Since an episode of otitis is usually precipitated by an upper respiratory tract infection (URTI), there are often accompanying symptoms like a cough and nasal discharge. One might also experience a feeling of fullness in the ear.

The following tips may reduce the risk of developing ear infections:

• Prevent common colds and other illnesses. Teach your children to wash their hands frequently. Try to keep your child home from child care or school when ill.
• Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free environments.
• Breastfeed your baby. If possible, breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections.
• If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby’s mouth while he or she is lying down. Don’t put bottles in the crib with your baby.
• Talk to your doctor about vaccinations. Ask your doctor which vaccinations are appropriate for your child. Seasonal flu shots, pneumococcal and other bacterial vaccines may help prevent ear infections.

Ear inflammation often goes away by itself within a few days, without treatment. Children between one and twelve years who have an uncomplicated ear inflammation need no antibiotic treatment – the inflammation usually heals by itself. 

With bacterial otitis however, antibiotics should be used. And a cracked eardrum should always be treated with antibiotics, often in combination with ear drops. Antibiotics are most useful in children under two years of age with bilateral AOM, or with both AOM and otorrhoea. For most other children with mild cases, an expectant observational approach is sufficient.

Both children and adults who have problems with recurrent ear inflammation or fluid in the ear can get a tube in their eardrum. The tube allows any liquid that collects behind the eardrum to run out.

When you have ear pain you should avoid bathing.

There are also painkillers that can relieve symptoms. Always consult a healthcare professional before giving prescription drugs to young children.

Important contraindication: Children and adolescents under the age of 18 should not use acetylsalicylic acid drugs without a doctor’s recommendation. This is because there is a risk of suffering from Reyes syndrome – a serious but unusual condition that affects children and teenagers who have been treated with acetylsalicylic acid during a virus with a fever. Shortly after recovery, they may experience inflammation of the brain and liver. Symptoms include convulsions, abdominal pain, vomiting and even unconsciousness. Sometimes Reye’s syndrome has a fatal outcome.

If your child has an ear pain which persists for more than a day or if there is discharge from the ear, you should see a doctor. If an eardrum breaks, you should seek immediate assistance.

Seek emergency care if you or your child have:

• ear pain with a stiff neck and tiredness/weakness
• ear pain with high fever 
• dizziness and difficulty with balance

You can contact APPOTEK for help with ear inflammation. A nurse or physician will make an individual assessment based on your symptoms, after which you may be prescribed treatment or referred for further examination. Please note that a physical examination is usually required to correctly diagnose and treat ear inflammation. If your child has a problem, they should see a doctor.