BABY AND CHILDHOOD DISORDERS OF THE EARS, NOSE AND THROAT: SORE EARS (ACUTE OTITIS MEDIA)
'Peter woke up in the middle of the night and started yelling and pulling at his left ear,' Marcia said. 'He was hot and obviously in pain. I gave him some paracetamol elixir—you say this is all right for little fellows when they are in pain and running a temperature—and that seemed to help for a while. But I'm still not happy with him, and he certainly has a sore ear.'
'Sore ears can be very trying,' I commented, as I picked up my auriscope to have a look inside Peter's ears. This little instrument has a light and a magnifying glass at one end; and the light is directed into the ear canal through a silver funnel. It is possible to obtain a very clear picture of the ear canal and the drum, the noise sensitive part at the far end.
'Ouch!' wailed Peter, as I inserted the ear piece of the auriscope. 'That 'urtz!' he went on, in true Aussie colloquialism.
'Sorry, Peter,' I said. Til only be a moment, I promise.'
An instant later, I could see a very red, inflamed ear drum, fiery and painful looking. The canal was also pretty red and obviously represented an extension of the infection.
'What's the worst?' Marcia asked, as I withdrew the instrument, to have a quick look at the opposite side.
'Acute bilateral otitis media,' I announced, after I had finished.
'Sounds awfully gruesome,' Marcia said. 'What's that in simple language the rest of us can understand? Ear something or other..'
'Peter has an acute infection in both middle ears,' I replied. The middle ear is the part immediately inside the drum, and houses part of the hearing mechanism. Germs often penetrate there via the Eustachian tube, a narrow canal that leads from the back of the throat into the middle ear area.
'I'd say he recently had a mild cold or cough. Often germs are forced up the canal during coughing, or they simply find their own way there unaided.'
'Peter did have a mild cold last week,' Marcia said. T didn't think it needed any treatment. He seemed to get over it in a few days, and appeared all right in most respects after a day or two.'
'That is the common picture,' I continued. 'Anyway, the germs have become firmly entrenched, and have set up a very acute inflammation. Both sides are affected. Fortunately, he hasn't yet run foul of pain in the other side.'
T hope it can be checked before we have a repetition of last night's episode,' Marcia said.
Treatment
'Treatment is usually quite effective,' I assured her. 'Most cases are caused by bacteria which are quite sensitive to antibiotics. Would you believe it, that penicillin and its derivatives usually give a quick response. I'll write out a prescription for some arnpicillin, one of the semi-synthetic penicillins which has a very wide spectrum of activity. It comes in a reasonably flavoured syrup form. Give him a dose about an hour before each meal—that is, on an empty stomach. Ideally do not give it with food, for this may interfere with its absorption from the gut system.'
'And how long should I continue with it?' Marcia asked. 'Do I stop it as soon as the pain eases?'
'No. Ideally, continue until the entire bottle has been taken. In some cases a second course is advisable. It is essential not to stop antibiotics too early, for this can half-kill the germs, allowing the half-stunned ones to smoulder on and perhaps set up a chronic ear infection. Certain chronic ears, sometimes called "glue ear", are believed to be a consequence of antibiotics being stopped too early; as a result, a horrid, gluggy discharge persists. This can take a long time to heal up, and sometimes surgery is needed and little pipes called grommets inserted for a lengthy period of time. So you understand the importance of completing the antibiotic course of treatment?'
'I get the message,' Marcia said, with an assuring smile. I certainly think the message had penetrated.
'Mum's not dumb, you know,' Peter echoed, admist his dejection, hanging on to his sore ear.
'For sure, Pete. Mum's not dumb. Neither are you.'
'What about a pain-killer?' Marcia then queried. 'Can I keep on with something, for obviously Peter is not very happy and he is still running a fever.'
'Paracetamol elixir, 10 millilitres every three or four hours is okay,' I answered. 'I prefer paracetamol elixir for youngsters under the age of six. Over this, they may be given paracetamol tablets or even aspirin. But aspirin is not for little fellows. I've seen too many cases of gastric irritation and bleeding as a result. It's simply not a good idea.'
'Should I put some drops into the ear?' Marcia asked.
'I'd prefer no drops at this stage,' I replied. 'Some doctors like them, but personally I don't think they do any good. Incidentally, be careful not to let water get into his ears, for this can send an infection mad and may cause it to spread rather alarmingly. I have seen that happen often too,' I went on. 'Incidentally that means no swimming until the ears have completely and totally mended.'
'Supposing he gets another bad attack at midnight again,' Marcia questioned.
'I don't think it is likely once you commence medication,' I answered. 'But in case it does happen, a good emergency measure is to place a few drops of warm olive oil into the ear. I know I said not to instill drops, but for an on-the-spot measure it can often bring quite a deal of comfort. Also, a warm hot-water bag held against the head on that side may bring relief.'
'That sounds reasonable,' Marcia said.
Complications
'I must point out that doctors generally regard infected ears with a good deal of concern. Although most heal up and leave little or no adverse aftermath, a few develop complications. The ear is very close to the brain, and it is possible for germs to cross over into the brain. Meningitis or encephalitis, both severe brain infections, may result. Headaches, neck stiffness, increasing fever, maybe mental confusion, are all symptoms that require prompt medical attention. I merely mention it, for it happens to a certain number of patients every year with this problem. So, think about it...'
'I must ask one more question,' Marcia said. 'We are supposed to be flying interstate in a week's time. Would it be safe to take Peter with us? That was the plan.'
'Personally I don't think he will be fit to fly within a week. He ought to be in bed for a few days to start with. And flying itself can produce certain ear problems. Quite a lot of people, children and adults, are susceptible to the pressure differences even when flying in pressurized aircraft. During a descent, it is possible for germs to be forced into the middle ear, and intense pain and a condition as bad as or worse than Pete has now may develop.
Mucous or fluid may clog up the Eustachian tube, and this in itself can produce intense pain when there are pressure differences on either side of the drum.
'It is possible to help this by chewing when descending. Or holding the nose and forcing air up into the Eustachian tubes to keep them open. If you can postpone your trip, it would be worthwhile. In any event Peter must not fly for at least two to three weeks, in my opinion.'
'Okay, decision made,' Marcia said. 'Thanks for the advice anyhow. Now it's back home and into bed, Master Peter. Let's be on our way.'
*137\87\2*
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