OTITIS SYNDROME IN CHILDREN

Introduction

            Conjunctivitis has been recently associated with acute otitis media. Besides that, there are some reports in which most of the patients having conjunctivitis also exhibited some instances of concomitant while others developed AOM. Conjunctivitis is closely associated with a nontypable organism referred to as Haemophilus influenza. Other organisms, although they are less frequent, are Staphylococcus aureus. Making the determination to look for medical attention and advice for children during the upper respiratory infections is founded on the assumptions of the parents that the symptoms of the child are related to the acute otitis media. However, researchers consider the symptoms about Conjunctivitis and otitis media nonspecific thus raising the need for further research.

Pathophysiology of Conjunctivitis - Otitis Syndrome in Children

            Conjunctivitis (Otitis Media in children) is systematically characterized by the nonpurulent effusion of the middle ear. The middle ear may either be mucoid or serous. Some notable symptoms of conjunctivitis may include loss of hearing or aural fullness. However, these typical symptoms of conjunctivitis do not involve feeling of pain or fever. In children, conjunctivitis causes generally mild hearing loss. This mild hearing loss in children can easily be detected using an audiogram. Serous conjunctivitis is a certain type of conjunctivitis mainly caused by the transudate formation resulting from the rapid decrease in the pressure of the middle ear about the atmospheric pressure. In aforementioned case, the fluid is clear and watery (Casselbrany, Mandel, & Fall, 1999).

            There is a need to comprehensively understand the difference between conjunctivitis and effusion and other forms of the infections of the middle ear. Conjunctivitis is a generic term comprehensively defined as an inflammation of the middle ear without referring to a specific etiology or pathogenesis. All pneumatized spaces of the temporal bone of the ear are easily contiguous. Therefore, the inflammation of the middle ear may also involve some inflammations in the other three spaces which are (Kvaerner, Harris, Tambs, & Magnus, 1997):

        i.            The mastoid

      ii.            Petrous apex

    iii.            Perilabyrinthine air cells

            The pathologic changes witnessed in conjunctivitis condition occur on a continuum. The condition progresses from acute and subacute stages to the chronic stage. In this stage the irreversible damage to the tissue. The earliest morphological changes when a person gets conjunctivitis involve the lamina propria of the middle ear mucosa. The changes include permeability of the capillary, leukocytic infiltration, and edema. During the occurrence of the late acute to subacute phases, the mucosa also tends an increase in the numbers of the ciliated and secretory epithelial cells. The inflammatory process now enters the chronic stage. At this stage, the infiltrating leukocytes shift in their population towards the increase in the number of the mononuclear cells which secrete substances capable of facilitating fibrosis and tissue destruction.

            The granulation tissue also develops and granulates. This is intimately involved in the process in which bone erode. As the granulation tissue becomes matured, it also becomes less vascular and denser. This process leads to a permanent fibrosis as well as the formation of adhesions capable of significantly compromising the function of the middle ear. There are other pathologic entities which are occasionally linked to chronic conjunctivitis among which includes:

        i.            Cholesteatoma

      ii.            Cholesterol cysts

    iii.            Tympanosclerosis

    iv.            Granuloma

The above pathologetic entities have immense capability of contributing to irreversible alterations of the structure of the middle ear.

Incidence of Conjunctivitis - Otitis Syndrome in Children

            Otitis syndrome in children is diagnosed in the children with acute onset which is the presence of the middle ear effusion, the physical evidence of the inflammation of the middle ear, and other symptoms such as pain, fever, or irritability. Otitis syndrome in children is a complication of the dysfunction of the Eustachian tube that happens during a viral infection of the upper respiratory tract.  The most common organisms isolated from the fluid in the middle ear are the Moraxella catarrhalis, Haemophilus influenza, and Streptococcus pneumonia. The Management of Otitis syndrome in children should begin with sufficient analgesia. The antibiotic therapy can be easily deferred in the children who are two years older and having mild symptoms (Fielding, Banks, & Doyle, 2003).

            Most people choose the high-dose amoxicillin (80 to 90 mg per kg per day) as the antibiotic of choice for treating Otitis syndrome in children who are not allergic to penicillin. Children who have previously shown persistent symptoms despite being under 48 to 72 hours of therapy should be carefully reexamined and should, if suitable a second-line agent like the amoxicillin (clavulanate). Otitis syndrome in children is a middle ear effusion when the acute symptoms are not there. The antibiotics, nasal steroids, or decongestants have not the capability of hastening the clearance of middle ear fluid and should not be recommended. Children, whose anatomy has been damaged, have a hearing loss or delay in language should be immediately getting referred to the otolaryngologist. Otitis syndrome in children is one of the most common issues faced by the doctors facing for the children. It is approximated that more than 80% of the children will have an episode of otitis and the rest between 80% and 90% will have at least an episode of otitis with effusion before they attain the age of going to school (Stangerup & Tos, 1986).

Prevalence of Conjunctivitis - Otitis Syndrome in Children

            Otitis syndrome is said to be an infection of the middle ear. Otitis syndrome makes up the list of the most common infections of the children below the age of 15 years. Otitis syndrome in children below the age of 15 years can cause in them serious symptoms like fever, otorrhea, and otalgia. All these symptoms can easily get associated with the children using considerable medical services. Otitis syndrome with effusion in children is the result of acute otitis media and can easily impair hearing and in the process affect the performance of the school-going children and the development of their speech. Generally, Otitis syndrome in children can disrupt their daily activities while having a profound negative impact on the quality of their life.

            Otitis syndrome is a disease common and prevalent with the pediatric population. It is very important to prevent and manage Otitis syndrome in children from a public health point of view. There will be no improvement of clinical care and proper allocation of the medical resources without the medical community knowing and identifying the epidemiological characteristics of Otitis syndrome in children. According to the recent United States National Health Interview Survey, there is a declining in the rates of the occurrence of Otitis syndrome in children. Other declining rates are antibiotic prescriptions, office visits for Otitis syndrome in children, and the middle ear surgery since the pneumococcal conjugate vaccines were licensed and routinely used in infants. Additionally, the panel report recommends further research on Otitis syndrome in children to reduce its incidence (Homoe, Christensen, & Bretlau, 1999).

            There is the availability of mounting data with regards to prevalence and incidence of Otitis syndrome in children in the epidemiological studies. However, it is difficult if not impossible to compare and extrapolate the epidemiological data from these studies mainly because of the dissimilarities in the study design, sampling methodology, and consistency of diagnosis. The American Academy of Pediatrics (AAP) and the American Academy of Family Practice (AAFP) have previously updated the guidelines for the management of Otitis syndrome in children. Some of their recommendations were the management of otitis syndrome in children should include the evaluation and treatment of pain.

Clinical Manifestations of Otitis Syndrome in Children

            Otitis syndrome in children is a painful type of ear infection. The infection occurred when the area behind the eardrum referred to as the middle ear becomes inflamed and infected at the same time. Otitis syndrome should be easily suspected in children with a history of the general symptoms and characteristics head-neck. Below are the common head and neck symptoms of Otitis syndrome in children:

1.      Otalgia

            The young children may show some signs of otalgia by constant pulling of the affected ear, ears, or regularly pulling on the hair. Apparently, otalgia occurs often when the child is in a state of lying down such as during the night and nap time. Otalgia may happen because of the increase in the Eustachian tube dysfunction (ETD) when the child having the otitis is in a recumbent position.

2.      Otorrhea

            There may be discharge coming from the middle ear through the tympanic membrane recently perforated. The discharge may come through a preexisting tympanostomy tube (TT) or still through another perforation. It is very important for trauma patients to exclude a basilar skull fracture which is associated with cerebrospinal fluid (CSF) otorrhea.

3.      Headache

4.      Concurrent or recent symptoms of the upper respiratory infection (URI) like coughing, sinus congestion, or rhinorrhea.

Despite the above symptoms, there are other common general symptoms which may include although are not limited to:

        i.            Up to two-thirds of the children with otitis have a history of fever. However, fever beyond 40 degrees Celsius is not common and may be indications of bacteremia or other types of complications.

      ii.            One of the early symptoms of Otitis syndrome in children may be irritability in a toddler or a young infant.

    iii.            Children suffering from otitis have a history of lethargy although it is nonspecific. However, it is a sensitive marker for the sick children and physician, and parents should not dismiss it (Horven, 1993).

Conclusion

            Otitis syndrome in children increases with age. As many as a third of younger children with conjunctivitis also have otitis. Therefore, these children should always have a thorough examination of the throat, ear, and lung. Additionally, the physician most of the time warrant tropical therapy. Additionally, tropical fluoroquinolones are known to be more potent than other types of tropical agents. The clinicians may be encouraged by cost and formulary restrictions to use the combination of polymyxin B and neomycin as the first line agents while treating Otitis syndrome in children. However, as much as it will be treated, Otitis syndrome in children should be diagnosed as early as possible.

Works Cited

Casselbrany, M. L., Mandel, E. M., & Fall, P. A. (1999). Heritability of otitis media: A twin and triplet study. JAMA, 282 (3), 2125-2130.

Fielding, U. N., Banks, J. M., & Doyle, W. J. (2003). Middle ear gas exchange in the air phase.     Acta Otolaryngol, 123 (2), 808-811.

Homoe, P., Christensen, R. B., & Bretlau, P. (1999). Acute otitis media and age at onset among   children in Greenland. Acta Otolaryngol, 119 (2), 65-71.

Horven, I. (1993). Acute conjunctivitis: a comparison of fusidic viscous eye drops and      chloramphenicol. Acta Ophthalmol, 71 (2), 165-168.

Kvaerner, K. J., Harris, J. R., Tambs, K., & Magnus, P. (1997). Distribution and hereditary of       recurrent ear infections. Ann Otol Rhinol Laryngol, 106 (2), 624-632.

Stangerup, S. E., & Tos, M. (1986). Epidemiology of acute suppurative otitis media. American     Journal of Otolaryngology, 47-54.

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in customized term papers if you need a similar paper you can place your order for article critique writing services.