Local therapy of acute otitis media in children

Abstract

Acute otitis media (AOM), one of the most common infectious and inflammatory diseases in infants, toddlers and young children, is defined as an infectious inflammation of the middle ear, usually bacterial, often with earache, fever, and possibly otorrhea. Almost all children suffer from otitis media, 80–90% – at preschool age. The frequency of acute otitis media in children in a megapolis is more than 4 000 cases per 100 000 population, however, given the large proportion of asymptomatic variants against the background of acute respiratory infections, insufficient equipment of pediatricians with otoscopes, registration of acute otitis media almost exclusively by ENT doctors, the frequency of acute otitis media may be significantly higher. The clinical picture may be nonspecific. Ear pain and otoscopy are decisive for the diagnosis. The severity of inflammation correlates well with the scale of visual assessment of pain according to the child’s facial expressions. The aims of treatment are to relieve pain using topical or systemic analgesics, decide together with an ENT specialist on the need for antibiotic therapy, avoid not indicated antibiotic therapy, prevent complications (tympanic membrane perforation, acute mastoiditis, meningitis). With unexpressed otitis media, it is advisable to use symptomatic therapy and drops. A complex of compounds (lidocaine, phenazone) provides a quick therapeutic effect. Topical anaesthetics block the transmission of the pain signal from the receptor to the central nervous system through the inhibition of voltage-gated sodium channels. The symptomatic treatment (analgesics, antipyretics, topical therapy) results in improvement in 60% of patients within the next 24 hours, and in 80% within the next 3 days.For prophylaxis of otitis, it is necessary to prevent acute respiratory infections, do vaccination against influenza and pneumococcal infections, avoid exposure to tobacco smoke, and keep babies breastfeeding.