1. Definition: what is otitis?
otitis is an inflammation of the ear, most often of infectious origin. It can concern the auditory canal, in which case we speak of otitis externa; this attack does not affect the eardrum. In other cases, otitis affects the bone cavity located just behind the eardrum (the eardrum), this is called otitis media.
Acute otitis media is one of the most common infections in children. It often occurs after an episode of nasopharyngitis. In infants, it is bilateral in nearly 40% of cases. Its evolution is spontaneously favorable in the majority of cases.
There are several forms of acute otitis media. We speak of congestive otitis when there is no effusion in the eardrum. If there is purulent effusion, otitis is called purulent. At this point, it is either collected or perforated; when perforated, the eardrum lets out the yellowish secretions through the external auditory canal of the ear.
From an epidemiological point of view, the frequency of acute otitis media is highest in children between 6 months and 2 years old, and affects boys more than girls. It most often occurs in winter, since this period corresponds to a maximum circulation of viruses and bacteria responsible for infections of the upper airways, which make the bed of acute otitis media.
In general, the situation improves with age; if a child often has episodes of otitis before the age of 3, he will have fewer and fewer, then much more rarely after six years. However, although much rarer, acute otitis media can occur in adults.
2. Fever, ear pain… what are the symptoms of ear infection?
Acute otitis media is manifested by an earache (pain in the ear) more or less intense as well as a feeling of clogged ears with loss of hearing and buzzing. These symptoms are usually accompanied bya fever above 38°C.
Sometimes the patient may have otorrhea, that is, a discharge of yellowish secretions from the ear canal, often observed in the morning upon rising.
Depending on the type of otitis, the local clinical signs observed will be different. Normally, the eardrum is translucent, pearl gray in color, with a bright antero-inferior triangle. In case of congestive otitis, it becomes bright red and we no longer perceive the luminous triangle or the reliefs. If the otitis is suppurative and collected, then the eardrum is purplish-red and bulging at the level of its posterior part. Finally, in the case of suppurative otitis with spontaneous otorrhea, the auditory canal is frankly filled with pus; after aspiration of the latter, a perforation can be observed from which pus comes out in a pulsating manner.
3. What are the causes of otitis and its risk factors?
Several factors can favor the occurrence of ear infections.
The first of these is age. Indeed, after the loss of maternal immune protection acquired during pregnancy, toddlers become vulnerable because their own immune system is not yet mature. They are therefore, during this period of immune adaptation, more often subject to nasopharyngitis. These cause hypertrophy of the tonsils and adenoids, which then become the reservoir of infectious germs that can penetrate to the ear, through a conduit called the Eustachian tube.
In addition, community life and the winter period are contextual elements that facilitate the transmission of viruses and bacteria. Children are more prone to the development of ENT infections and present anatomophysiological peculiarities (Eustachian tube shorter and less functional in infants than in adults).
Sometimes, anatomical abnormalities in the Eustachian tube, cleft palate or a genetic predisposition (history of recurrent otitis in close family) are associated with a greater frequency of occurrence of otitis. Trisomy 21 has also been identified as a risk factor.
The vast majority of acute ear infections are caused by the occurrence of bacteria (60 to 70% of cases). They are generally monomicrobial (due to a single germ). In recent years, we have observed the emergence of resistant strains, which induce difficulties in therapeutic management.
In France, there are two predominant bacteria responsible for ear infections: Haemophilus influenzae and pneumococcus. Haemophilus influenzae is the most frequently found germ (30 to 40% of acute otitis media), especially in children. Other germs can be incriminated, especially in newborns and infants under 3 months, such as Staphylococcus aureus (staphylococcus aureus), Pseudomonas aeruginosa or enterobacteria.
Sometimes, viruses are the cause of the attack: respiratory syncytial virus, parainfluenza virus, rhinovirus, among others.
In rarer cases, the origin of otitis can be mycotic (due to a fungus).
Finally, there are non-infectious causes of occurrence of otitis of the middle ear, following for example a violent shock or a sudden pressure difference (frequent during air travel or scuba diving sessions).
4. In case of otitis: what to do and when to consult?
The patient should remember to consult a general practitioner or an ENT doctor in the event of otalgia persisting beyond 48 hours or repeated pain. The consultation is more urgent if the earache is accompanied by a decrease in hearing capacity and dizziness, when it is very intense, if pus flows from the ear or if the person already suffers from an ear injury.
If the pain is accompanied by a high fevera confusional state, tremors or of seizuresthe patient must alert the emergency services by calling 15 or 112.
5. Examinations and diagnosis of otitis
Diagnosis of otitis is carried out by the attending physician or by the ENT doctor. It is first based on questioning the patient and on the clinical signs he presents. The warning signs can be very polymorphic, but there are specific signs, including earache and otorrhea, sometimes accompanied by general signs such as fever or digestive disorders.
Diagnosis in a toddler may be more difficult only to be established in adults, especially if they are too small or unable to explain the symptoms experienced. He will sometimes express them in his own way, for example by rubbing or pulling the pinna of his ear when he is in pain. Other attitudes may be signs of discomfort, pain or fever, such as unexplained crying and screaming, nocturnal awakenings, irritability, hypotonia (lack of energy and tone) , a refusal to take milk or a bottle, or even digestive disorders (diarrhea, vomiting). Most often, the parents notice the change in behavior and the doctor must know how to make the diagnosis from these elements too.
After anamnesis and clinical evaluation of the patient, the key examination enabling the doctor to confirm the diagnosis is otoscopy. It requires good lighting and good examination conditions, in particular good posture for the child and an external auditory canal cleared of ceruminous debris. The use of a magnifying glass can help clarify the diagnosis. The otoscopy is done bilaterally, in each of the two ears.
In case of persistence or aggravation of the disorders or in case of tympanic anomaly, a paracentesis can be carried out, in other words a perforation of the eardrum by a small orifice which will allow its decompression and the drainage of the secretions accumulated in the middle ear. Thus, the germ can be isolated and the treatment adapted accordingly.
6. Treatments: how to treat an ear infection very quickly?
In general, the evolution of acute otitis media is spontaneously favorable within a few days. Sometimes spontaneous perforations of the eardrum occur, usually healing in less than two weeks.
However, drug management can be considered in order to relieve the symptoms and prevent the risk of complications in the event of bacterial origin.
First, symptomatic treatment can be put in place to reduce fever and pain. The analgesic and antipyretic drug of first choice is paracetamol. In case of failure or very intense pain, the relay can be taken by ibuprofen.
In children older than 1 year, the doctor may prescribe ear drops containing a local anesthetic in congestive otitis media, in the absence of tympanic perforation.
Then, if the otitis is bacterial, antibiotic therapy may be considered depending on the case. Preferably and when the context allows it, the doctor will wait 48 to 72 hours before initiating it, which will make it possible to avoid its misuse. It is important to specify that it is not systematic and, in general, not recommended in congestive otitis in children under 2 years of age.
Since 2005, Haemophilus and pneumococcus resistance has decreased significantly.
The first-line antibiotic is amoxicillin, which belongs to the beta-lactam family. The other classes of antibiotics have a less favorable risk-benefit ratio, but can be proposed in the event of a contraindication to beta-lactams (for example, in the event of an allergy). Antibiotic therapy generally does not exceed 8 to 10 days of treatment in children under 2 years old, and 5 to 6 days in children over 2 years old.
How long does an ear infection last?
How to relieve an otitis?
Serous otitis: what is it?
serous otitis, serous otitis serous otitis
Internal otitis: what is it?
internal otitis, internal otitis, internal otitis
Recurrent ear infections
Recurrent otitis , Recurrent otitis , Recurrent otitis
Sources
The Practitioner’s Review: otitis
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