On the Coast – Families Issue 101 I August/September 2019 | Page 32

Spotlight
on
ENT
BY DR SAMANTHA PETHEN
Otitis Media
ENT is the branch of medicine that
applies to all conditions related to the
ears, nose and throat. In the first of this
three-part series, we will focus on the
ears, in particular, otitis media. This is
a very common reason for kids to come
and see their doctor and, sadly, a leading
cause of hearing loss, particularly in
developing countries.
What is otitis media?
Otitis media is the, short lived,
inflammation and infection of the middle
ear, which can be caused by a virus or
bacteria.
This is the part of the ear that sits
behind the tympanic membrane (or
eardrum). It contains the three tiny
‘hearing bones’ that transmit sound from
the eardrum to the inner ear, and
connects to the eustachian tube ending
in the pharynx.
Some children develop glue ear (or
otitis media with effusion), often after an
episode of otitis media. This tends to last
a bit longer, sometimes several weeks,
in which time a thick, glue like material
collects behind the ear drum. It is so
thick, it can struggle to drain through the
eustachian tube.
Around 75% of children in Australia
will have had an episode of otitis media
before they start school. It becomes less
common as we get older because, in a
growing ear, the angle between the
eustachian tube and wall of the pharynx
changes and coughing and sneezing
causes the passage to close, making it
harder for infected mucus to move into
the middle ear. Also, as the eustachian
tube grows, it is easier for mucus to drain
back out again.
It is no surprise it happens more in
winter, and, interestingly, affects boys
more than girls.
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ON T H E C OA S T – FAM ILIES
How do I know if my child
might have it?
If your child has developed an acute otitis
media, you may notice they are tired,
they may become irritable, with poor
feeding, they could have a temperature,
or complain of pain, younger children
may pull at their ear. If a doctor examines
your child’s ear, we might see a
discoloured eardrum that may be
bulging, and even have an air-fluid level
visible, like a spirit-level!
Other things that may cause pain in
the ear include, infection of the ear canal,
referred pain from teeth, trauma or the
presence of a foreign body, for example a
tiny piece of LEGO!
What should I do?
If you think your child has an ear
infection, take them to a GP. Some
children may be sick enough to need to
go straight to hospital.
All babies, under the age of 3 months,
with a temperature of 38˚C or more, need
to be seen in hospital immediately.
Generally, however, most children will
be fine with paracetamol and ibuprofen to
manage their fever and pain, plenty of
drinks and lots of rest. A warm washer
over the ear can also help to ease the pain.
In most cases, antibiotics are unlikely
to make any difference to symptoms but
may cause side effects and contribute
to antibiotic resistance. If antibiotics
are prescribed, be sure to complete
the full course as advised, to prevent
complications such as mastoiditis.
It has been shown that 60% of
children will improve in 24 hours, and
80% will improve within three days.
If your child has had more than three
episodes in six months, or more than four
episodes in a year, it may be time to ask
your GP to consider a referral to an ENT
specialist. Similarly, if your child has
speech, language or developmental
problems, with recurrent infections, or
glue ear, a specialist may consider inserting
gromets (tiny tubes) into the ear drum.
These help drain fluid from the middle ear.
Surgery aside, repeat episodes can be
reduced by avoiding exposure to cigarette
smoke, by trying to avoid the use of
dummies, and by feeding your baby in a
tilted position, rather than flat.
Very importantly, we all need to
make sure, if possible, our children are
up to date with their immunisations.
The introduction of the pneumococcal
vaccine has helped to dramatically
reduce the incidence of otitis media and
its complications.
So…in summary
ƒ ƒ Otitis media is a common condition in
young children, with 75% of children
having an episode before school age
ƒ ƒ If you are concerned your child may
have an ear infection, take them to
their GP
ƒ ƒ 60% of cases will improve within 24
hours
ƒ ƒ In most cases antibiotics will make no
difference to how bad the symptoms
are, or how long the condition persists
ƒ ƒ You must get your child checked again
if their symptoms get worse, if their
symptoms continue for more than a
few days or if you are worried
ƒ ƒ Ask about seeing a specialist if your
child has had 3 or more symptoms in 6
months, 4 or more episodes in 12
months, or if your child has recurrent
infections or persisting glue ear and
speech, language or behavioural issues.
Dr Pethen is a GP at your Family Doctors at Erina, a doctors surgery that aims to deliver high quality
care with a personal touch, find them at www.yourfamilydovtors.com.au or phone [phone]