A friend presented the other day complaining of a fuzzy head, intermittent
balance problems, noises in the ear and a ‘sniffly’ nose. By the time he had
stopped talking I had the auriscope in my hand and 30 seconds later we had the
diagnosis - a middle ear infection, or Otitis Media.
A friend’s child was also brought along with a painful ear,
and as she has had a cough and cold recently, there were enough factors to
satisfy all clinical diagnoses. Once again, the auriscope was the appropriate
instrument and a very brief inspection of the offending ear drum showed the
scarlet flare that results from infection behind the drum, in the middle ear.
Ear infections are actually very common in small children,
much more than in adults, and most ear infections involve the middle ear. By the
way, we usually examine the “good” ear first, as the child is not apprehensive
with the doctor examining that one, as there is no pain in it. An old trick
learned from many years of practice.
Babies and young children suffer more middle-ear infections
than older children because the tubes connecting the middle ear to the throat
(called the Eustachian tubes) are shorter and when the Eustachian tube is
blocked, fluid does not drain very well from the middle ear to the throat, and
air does not get up into the middle ear space as well as it should, providing an
ideal breeding ground for all kinds of bugs.
Babies and toddlers will usually suffer intense ear pain and
generally have a fever. There may also be vomiting, loss of appetite, decrease
in energy and some loss of hearing. In some cases, the pus will break through
the eardrum. This results in a thick yellow discharge from the ear. However, the
child feels better when the ear discharges as the painful pressure is gone. The
burst eardrum usually heals on its own, without any need for ear drum repair.
Going straight to the cause with these two patients was not a
case of brilliant diagnosis (though the plaudits of the crowd are always
accepted) but purely the result of many years of experience. In any young child
with those symptoms, one must always suspect and exclude the middle ear
problems. Children, in particular, will pull at the offending ear, there will be
no doubts about which side has the infection.
I mentioned vomiting, as one of the symptoms. Why do they
vomit with Otitis Media? Probably for the same reason that people get sea sick -
disruption of the normal fluid workings of the inner ear. The inner ear is
intimately involved with balance, which is why the adult gave balance problems
as part of his symptoms. Whatever, it is always worth asking your vomiting,
febrile child if he or she “hurts” anywhere. If they point to or pull at the ear
then you are most likely on the right track.
Remember that the middle ear infection does not necessarily
produce an ear discharge as an initial symptom. For that to happen, it means the
pus and goo trapped in the middle ear has ruptured through the ear drum. This is
what we call a perforation, generally shortened to “perf”.
The treatment is a swiftly administered appropriate
antibiotic. If the ear is discharging, then a culture can be taken and the
exactly appropriate antibiotic chosen. If not, then most doctors fly by the seat
of their pants and prescribe a penicillin derivative or one of the newer drugs.
Some paracetamol to ease any pain and lower the temperature completes the
package and expect junior to be better in a couple of days.
With the adults you have to also treat any ongoing or chronic
sinus infections, and if the patient is a smoker, cessation is the best thing
they can ever do for their sinuses.
If your child gets recurrent middle ear infections, then you
really should get this investigated - including an audiogram (hearing test) to
ensure there is no lasting damage.
So just remember, Mums of the world, a temperature and
vomiting may not necessarily mean an intra-abdominal problem. It could all be in
the ears!
