middle ear infections in children [read-only]€¦ · pathophysiology viral urti et mucosal injury...
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Prevention of middle ear infections in Prevention of middle ear infections in childrenchildren
Dr Graeme CopleyDepartment of Paediatric Otorhinolaryngology
Red Cross Children’s Hospital
Acute middle ear infectionsAcute middle ear infections
• Seen mostly by primary care givers
• Rarely by ENT specialist• Rarely by ENT specialist
– We see the chronic end point
• Intervention on history provided
– If you suggest grommets that’s what will happen
Are acute middle ear infections Are acute middle ear infections in children an issue?in children an issue?
• Most common reason for prescribing antibiotics
• 1995= US$ 2 billion• 1995= US$ 2 billion
• School and work
• Incidence increasing• Despite research
• improved healthcare?
SideSide--effects of treatmenteffects of treatment
• Antibiotic resistance
• Side-effects– Diarrhoea and vomiting
– Nappy rash– Nappy rash
– Immune suppression
• Cost
Why are children susceptible?Why are children susceptible?
• Immune maturity / impairment
• Short narrow Eustachian tube
• Small nasopharynx
Adenoidal tissue• Adenoidal tissue
Children at risk for AOMChildren at risk for AOM
• Genetic factors • Male sex
• Low socio-economic status– Immune function
– Nutrition
– Hand washing
– Over crowding
– Access to health care
• Breast vs bottle feeding– Immune function
– Nutrition
• Household smokers
• Creche
Risk factorsRisk factors
• Syndromic children• Cleft palate
• Down’s syndrome
• Pacifier use?• Pacifier use?
• Sleeping position?
Prevention of AOMPrevention of AOM
• Less middle ear damage
• Less meningitis
• Less antibiotic resistance
Less burden on healthcare• Less burden on healthcare
Antibiotic use and the Antibiotic use and the incidence of resistanceincidence of resistance
Antimicrobial Drug Use and Resistance in Europe van de Sande-Bruinsma Emerg Infect Dis. 2008
November; 14(11): 1722–1730.
A good indication for A good indication for ventilation tubesventilation tubes
• Persistent middle ear effusion
• Hearing loss
Complications of grommetsComplications of grommets
• ? complication of the grommet?
• Or due to chronic disease?
• Persistent infection• Persistent infection
• Granulation tissue
• Persistent perforation
• Hearing loss
Key to middle ear health is the Key to middle ear health is the health of the nose and health of the nose and
postnasal spacepostnasal space
Protection of upper airway and Protection of upper airway and postnasal spacepostnasal space
• Mechanical
• Chemical
• Immunological
RespirationRespiration
• Heat exchange
• Humidification
• Filtration
Fluids and ciliary action• Fluids and ciliary action
Removing particlesRemoving particles
• Mechanical barrier
• Vibrissae
Filtration• Filtration
– Laminar
– Turbulent
• Physical characteristics mucus
• Mucociliary blanket
MucusMucus
• Goblet cells
• Glandular mucus cells
• Glycoproteins
Quantity and quality• Quantity and quality
• Neurovascular control
Chemical protection of mucus Chemical protection of mucus layerlayer
• Water
• Phospholipids
• Enzymes
Complement• Complement
Immunological protectionImmunological protection
– Ig A & Ig E on surface
– Ig M & Ig G in tissues
– Primed macrophages
– Lymphocytes– Lymphocytes
– Adenoids
Surface cellsSurface cells
• Mucus contains immunologically active cells
– Macrophages
– Mast cells– Mast cells
– Leukocytes
– Eosinophil
• Cytology of secretions assist diagnosis
Factors affecting Factors affecting ciliaryciliaryfunctionfunction
• Temperature
• Drying
• URTI= epithelial damage
– Sloughing off of cells– Sloughing off of cells
The health of The health of nasopharynxnasopharynx and and nasal cavitynasal cavity
• Avoid viral infections
• Avoid allergens
• Immune function
Quality of the mucus• Quality of the mucus
• Action of the cilia
Avoid viral infectionsAvoid viral infections
• Hand washing
• Nasal saline douches
• Quarantine
Temperature and humidity control• Temperature and humidity control
• Smokers in the house
• Smoking
Avoid allergens
• Skin prick tests
• Cigarette smoke
• Pollution
Pollen• Pollen
• House dust mite
• Nasal saline douche
Immune function boostImmune function boost
• Avoid infections
• Nutrition• Raw food
• Avoid preservatives/ additives• Avoid preservatives/ additives
• Immunizations
• MALT & GALT• Natural probiotic= Kefir
Quality of the mucusQuality of the mucus
• Nasal saline douches
• Alkalinisation of secretions
– Raw food diet
– Vegetables– Vegetables
– Fruit
Maintain Maintain ciliaryciliary actionaction
• Avoid viral infections!
• Temperature control
• Humidity control
Nasal douches• Nasal douches
• Smoking
Take home messageTake home message
Tailor intervention to the particular patient
Reduce risk factors
Boost the immune system
Clean the nose
Avoid viral URTIAvoid viral URTI
Stop smoking
Wait till summer
• Avoid antibiotics and grommets
• A healthy body and mind doesn’t get sick
• AOM is a public health disease