Pediatria pre prax 3/2006

ACUTE INFLAMMATION OF THE MIDDLE EAR

Acute inflammation of the middle ear (otitis media acuta – OMA) is one of the most frequent diseases in childhood. It is an inflammation of mucosa of Eustachian tube, middle ear cavity and other parts of pneumatic system of a temporal bone. Factors taking part in the cause of the acute otitis media are: 1. dysfunction of Eustachian tube 2. penetrating infection 3. insufficient immune defence. Acute otitis media can be divided clinically in 4 phases: phase of tubular occlusion, exudation, suppuration, and reparation. The most frequent etiological agents are respiratory viruses, Streptococcus pneumoniae, Haemophillus pneumoniae and Moraxella catarhalis. Major local signs and symptoms are ear pain, decrease of hearing, changes of tympanic membrane, and secretion from the external ear canal. Fever, restlessness and insomnia are usually observed. Diagnosis is based on ear-nose-throat examination and mainly on otology examination with arthroscopy. Treatment: with pain both local and systemic analgesic therapy is indicated. In case of tympanic membrane bulging paracenthesis is indicated. Antipyretic medications are indicated if the temperature is above 38 grades of Celsius. Restlessness can be softened by usual tranquillizers; it is advantageous to use medications with antihistamine effect. The secretion from the ear canal has to be removed by repetitive cleaning with cotton swabs moistened with boric water solution. Antibiotics are indicated in acute otitis media in cases of a developed inflammation with a concomitant involvement of airways and high fever. An antibiotic is indicated also if an incipient complication is suspected and in recurrent middle era infections. The Czech national consensus in the treatment of acute otitis media recommends a penicillin type antibiotic as the first choice, eventually an augmented one. The second choice are cephalosporins, and modern macrolides. In recurrent otitis we underline a necessity to treat a focal infection (adenoid tissue, sinusitis) and introduction of a pressure equalizing tube.

Keywords: otitis media acuta, otoscopy, paracenthesis, antibiotic.