Ear Infections
involves the middle ear (the space behind the ear drum). The infection often follows a cold and the infection comes up the Eustachian tube into the space that usually contains air. The infection increases until the body's defences overcome the infection or the pressure builds behind the drum and the drum perforates with discharge of pus from the ear. The pressure of the pus in a contained space is responsible for the exquisite pain, malaise and temperature. [The other common type of ear infection is following swimming and is an external ear infection of the skin of the ear canal. Again there is pain but the external ear is also very tender to move.]
Middle ear infections (otitis media) will affect 75% of children by 3 years of age. Many are mild, self limiting and require no treatment but follow up needs to be offered if needed. Antibiotics are not routinely prescribed as analgesics (painkillers) alone will usually manage the pain and the condition is initially usually viral. More persistent infection which is not improving and recurrent infections do benefit from antibiotic treatment. The once feared complications such as meningitis are now rare but ear infections which are not improving need to be reviewed.
Children with recurrent infections need a general review as some have low immunity or allergies (eg milk). Some may have adenoid infection with a snotty nose. In some children the ears are normal between infections and in some there is persistent fluid (glue ear). In this group hearing loss and speech delay may be an additional concern.
Some children with recurrent infections benefit from a period on preventative antibiotics. Infection while on antibiotics or shortly after the course are a bad prognostic sign. These children may come to surgery with adenoidectomy and ventilation tube placement if appropriate. At the time of surgery we can check for subtle types of immune deficiency and allergy.
Flying and ears (fitness to fly with ear infections)
http://www.entnet.org/healthinfo/ears/earache.cfm
www.homehealth-uk.com/medical/earinfections.htm
http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/otitis_media.html
