Acute middle catarrhal otitis on the left in children. Symptoms of catarrhal otitis and a description of the disease. When an operation is needed

This is an inflammation of the middle ear. It is the most common childhood illness after infections of the upper respiratory tract. This is given preferably in young children. The middle ear is part of the sound transmission chain and contains the eardrum and the so-called “bones” of the ear.

The middle ear is located between the outer ear and inner ear. The middle ear communicates with the pharynx through a canal called the Eustachian tube. The Eustach tube facilitates aeration of the ear and the emptying of secrets that, under normal conditions, occur in the middle ear. In addition, the good functioning of the Eustachian tube protects the discharge of the middle ear, which occurs in the area of ​​the nose and pharynx.

There are several types of otitis media. Acute otitis media: acute inflammatory process usually of infectious origin, which is usually a complication acute infection  upper respiratory tract. It is relatively common in young children and always requires a continuation by a pediatrician, and sometimes by an otolaryngologist. In this chapter, we will refer to acute otitis media.

The presence of nasal secretions can interfere with the Eustachian tube, accumulating secretions of the middle ear and, subsequently, become infected. This is facilitated by previous tube obstructions, for example, associated with the presence of adenoid hypertrophy. How to recognize acute otitis media?

Than less childhowever, the local symptoms are less effective and the common symptoms are more common. As the child grows, the local symptoms begin to predominate compared with the general symptoms. The most common form of presentation is small child  is the emergence in the context of the catarrhal process of fever or irritability. This secretion appears when the eardrum is perforated, and the secretion accumulated in the middle ear spills out. Usually, when the ear leaks, the sensation of pain softens significantly.

In an older child, earache prevails, which can be very intense and, less commonly, hearing loss. This usually affects one of the two ears. How to confirm the diagnosis? No need to perform any additional tests for diagnosis. This is based on a physical examination of the patient.

They will be used in the usual doses recommended by the pediatrician for febrile processes. To facilitate this, it is necessary that the nostrils are clean. This is achieved in small children who do nasal flushing with saline, and in older ones - “blowing” the nose.

In addition, if necessary, an antibiotic, a pediatrician will indicate the most appropriate. Avoid a baby bath: do not wet your ears for several days. What should we not do?

• Manage ear drops.
• Do not force the child to eat.
• In most cases, it only makes the child angry and tearing food.
• If the child does not ask for something else, suggest a soft diet.
• Do not enter the antibiotic without consulting your pediatrician.

Resistant headache  and vomiting, especially if you have heat. In this case, it is recommended to consult quickly. Bulging, redness, or pain in the back of the ear. This may indicate that the infection has spread to areas near the ear, and also requires a quick consultation.

The pediatrician will judge the convenience of the child requiring assessment by an otolaryngologist. How to prevent acute otitis media? To do this, we can resort to nasal washes with saline. Infants, however, are particularly at risk for a serious form of the disease. The diagnosis of pertussis is difficult to make due to atypical clinical manifestations and analytical results that are difficult to interpret. This article discusses the causes of changes in the epidemiology of pertussis, clinical manifestations by age, diagnostic methods, treatment and prevention strategies.

Patient with abdominal pain

Universal vaccination is likely to include in the future adolescents and young people to protect not only immunized persons, but also, indirectly, infants too young to be fully vaccinated. A young, 14-year-old patient who is in good health in the morning represents a child emergency with multiple abdominal pains for several hours. These pains, when viewed, prevail to the right with protection in the right hypochondrium and right iliac fossa.

A month ago, a patient complained about persistent coughdiagnosed as bronchitis, for which she received amoxicillin-clavulanic acid treatment for ten days, and the symptom that was at the time of the consultation was practically resolved. While waiting for the surgeons to confirm the diagnosis of appendicitis, the child had an x-ray of the abdomen, which was read as normal, and then an abdominal ultrasound scan, which canceled the suspicion of appendicitis. By the way, he stressed the cause of abdominal pain, several rib fractures.

The patient, re-interviewed, confirmed that her cough was predominantly mainly in the fifth, and that these episodes were sometimes painful on the chest level. Bordt identified whooping cough in a child; he could not isolate him until six years later, when a new culture medium was developed for this fragile embryo.

Whooping cough is a disease. respiratory diseases  a person who is very contagious. It is estimated that up to 80% of non-immune individuals in the same household become infected with the disease. It is transmitted from an infected person to a susceptible person through aerosol drops of respiratory secretions or through direct contact with these respiratory secretions. Patients are contagious during the catarrhal phase and the first two weeks of coughing. Factors that reduce the duration of infection are: patient's age, vaccination status and appropriate antibiotic therapy.

This information is important because it may have implications for the prevention strategies described below. Whooping cough usually begins with symptoms of the upper respiratory tract, which is called the "catarrhal phase." It lasts from a few days to a week in general and includes rhinorrhea, moderate dry cough and clear discharge of the eyes. Then comes the “paroxysmal phase”, which lasts from two to six weeks and includes the most typical form of whooping cough: paroxysmal cough, accompanied by a unique inspiration, resembling a rooster or barking cough. due to inspiration through vertigo, reduced in diameter inflammation and secretions.

When paroxysmal cough is often accompanied by vomiting, especially in young children. These coughing episodes can occur dozens of times a day and usually have a predominance at night. Fever is usually absent or low. If the child is exhausted by these coughing episodes, he may appear in good general condition between the fifths. Subsequently, symptoms gradually improve after a few weeks or even months: this is the “recovery phase.” A pertussis episode usually lasts six to ten weeks. Incubation period  estimated at six to twenty-one days, an average of seven to ten days, although some clinical manifestations are less clearly identified, especially in infants and adults.

Complications of whooping cough

It is estimated that the risk of death is approximately 1% in infants less than two months old and 0.5% in children between the ages of two and eleven months. Other complications described especially in adolescents and adults include syncope, urinary incontinence, back pain, rib fractures and hernia. 1, 24.

A clinical diagnosis is often difficult to ask, as mentioned earlier. Table 2 suggests prognostic factors for the diagnosis of pertussis. Direct immunofluorescent tests for secretion of the nasopharynx also have variable sensitivity, reduce specificity, and require qualified personnel. This requires nasopharyngeal secretions using a thin swab Dacron, which is then quickly transported. in the laboratory for analysis. Unfortunately, this diagnostic method can also have many false positives.

The sensitivity and specificity of the test depend on the primers and laboratory used. 26. Serological pertussis diseases are not commonly used, but sometimes allow the seroconversion of specific antibodies between a sample taken during the acute phase of the disease, compared with that taken during the convalescent phase. however, it is considered the gold standard due to interpersonal differences between laboratories. The threshold for the diagnosis of pertussis on one sample has also been discussed for a long time.

Pertussis antibiotic treatment is mentioned in table 29. The therapeutic problem mainly arises from the fact that during the catarrhal phase it is often difficult to make a diagnosis, since the characteristic cough is not predominant, whereas during paroxysmal treatment, there is almost no greater benefit for the development of the disease. . The interest in antibiotic therapy at this stage is to reduce the infectiousness and, therefore, transfer to vulnerable populations. on the convalescent phase, they should not be treated, even if they are still coughing.

It is important to note that prophylactic antibiotic therapy is recommended for the close environment of a patient with whooping cough, to prevent embryo transmission and, possibly, disease in the family nucleus29. The infant does not always produce protective antibodies after his illness and may soon be reinfected with his surroundings, putting him at risk again. Children under seven years of age who did not receive four doses of pertussis vaccine and who were in close contact with the patient should, in addition, continue to vaccinate as soon as possible.

Protection: natural immunity

Numerous clinical and epidemiological studies have shown that infectious immunity does not last a lifetime. There are two types of pertussis vaccines: the whole cell vaccine and the so-called acellular vaccine. The omnidirectional vaccine consists of purified and inactivated bacterial suspensions. Despite its good efficacy, this vaccine has the disadvantages of complex and variable production depending on the manufacturer and poor tolerance to the vaccine with local and systemic reactions in the case of booster doses.