Otitis

There are two very different types of otitis, both of which children can suffer from: external otitis and middle ear infection.

External otitis affects the auditory canal and is above all related to exposure to swimming pool, bath and fresh water in general. It is most common in summer.

Middle ear infection is related to infections in the upper respiratory tracts, and can be self-limiting (it resolves itself in most cases) or purulent requiring antibiotic treatment It is most common in winter.

Description

Symptoms

a) External otitis: pain in the ear, particularly on touching the external ear; sometimes with purulent secretion, but originating in the ear canal itself.
b) Middle ear infection: there is usually a history of catarrh in the respiratory tract, suddenly accompanied by pain (in small children this can manifest as intense crying), with or without fever. It does not hurt when the external ear is touched or moved. Sometimes the ear drum may be perforated due to inflammation and pressure, which may result in a purulent secretion, generally associated with the pain (and crying) disappearing.

Who is affected by the condition?

a) External otitis: children who swim in a pool or other fresh water environment and use cotton buds to "clean" (remove wax) from the ear canal. It is more common in older children and teenagers.
b) Middle ear infection: mainly in breastfeeding babies and small children who have a cold, which is viral, but can occasionally cause a middle ear bacterial infection due to a complication.

Diagnosis

In both cases, diagnosis is clinical: medical history, assessing symptomatology and exploration using an otoscope.

Typical treatment

a) External otitis: avoid exposure to fresh water and dry using fresh air (hair-dryer) after bathing or swimming. Antiseptic or antibiotic ear drops against Pseudomonas aeruginosa (the normal bacterial cause). In some cases, careful cleaning of the ear canal may be required for topical treatment (drops) to work effectively.
b) Middle ear infection: in mild cases, with no signs of being purulent, pain relief is sufficient. If acute purulent middle ear infection is diagnosed in a child, it should be treated with systemic antibiotics (orally) active against the bacteria normally responsible for this type of condition (pneumococcus, group A streptococcus, non-encapsulated Haemophilus influenza).

Typical tests

Otoscope exam. Occasionally, if there is suppuration, cultivation of the pus.

Prevention

a) External otitis: proper drying (using air) of the ear canal after bathing and swimming. In cases of repeated episodes, it is a good idea to use 1-2% acetic acid drops before bathing or swimming, as well as drying afterwards.
b) Middle ear infection: breastfeeding, typical vaccinations following the official schedule and avoiding exposure to tobacco smoke are the main preventive measures.