The Discharging Ear In Children And Approach To Its Managements

Ear discharge, also known as otorrhoea, can be caused by various factors.

Here are some possible reasons for ear discharge in children:

Infectious Causes

1. Middle Ear Infection (Otitis Media)

Bacterial or viral infections can cause pus to accumulate in the middle ear, leading to discharge.
2. Ear Canal Infection (Otitis Externa)

Bacterial or fungal infections can cause inflammation and discharge in the ear canal.
3. Eustachian Tube Dysfunction

The Eustachian tube connects the middle ear to the back of the of the nose (nasopharynx). If it's blocked or not functioning properly, it can lead to infection and discharge.

Non-Infectious Causes

1. Earwax Buildup

Excessive earwax can cause discharge, especially if it's pushed deeper into the ear canal.
2. Foreign Object

If a foreign object, like a toy or a bead, is inserted into the ear canal, it can cause infection and discharge.
3. Allergies

Seasonal or environmental allergies can cause , rhinitis, rhinosinusitis, ear irritation and discharge.
4. Eczema or Psoriasis

Skin conditions like eczema or psoriasis can cause ear discharge.

Other Possible Causes

1. Tympanic Membrane Perforation: A perforated eardrum can cause discharge.
2. Cholesteatoma: A rare condition where skin cells grow in the middle ear, causing discharge and other complications.
3. Cerumen Impaction: A blockage of the ear canal due to earwax, which can cause discharge.
4. Nasopharyngeal tumours: Enquire about epistaxis, neck swelling, headache, snoring, mouth breathing etc.

When to Seek Medical Attention

If your child experiences any of the following, seek medical attention:

Severe ear pain
Fever over 102°F (39°C)
Discharge that's thick, yellow, or green
Discharge that's accompanied by a foul odor
Hearing loss or difficulty hearing
Dizziness or balance problems.

Here's a step-by-step guide:

Assessment and Diagnosis

1. 1. History taking

Ask about the duration, color, and consistency of the discharge, as well as any associated symptoms like ear pain, fever, or hearing loss, nasal discharge or rhinorrhoea etc.
2. Physical examination

Inspect the ear canal and eardrum using an otoscope. Examine nasal cavities for rhinitis or sinusitis
3. Diagnostic tests

Depending on the suspected cause, additional tests like, ear swab for culture and sensitivity, tympanometry, audiometry, or imaging studies (e.g., CT or MRI scans) may be necessary. CT/MRI of nasopharynx and neck can detect nasopharyngeal tumour with possible metastasis to neck nodes.

Management

General Measures

1. Keep the ear clean and dry

Gently clean the outer ear with a washcloth, avoiding the ear canal. Avoid Q-tip as much as possible.
2. Avoid sticking objects in the ear

Prevent further irritation or damage.
3. Pain management

Use acetaminophen or ibuprofen to manage ear pain.

Specific Treatments

1. Antibiotics

Prescribe antibiotics if the discharge is caused by a bacterial infection.
2. Antifungal medications

Use antifungal ear drops or oral medications if the discharge is caused by a fungal infection.
3. Ear drops

Use ear drops containing antibiotics, antifungals, or anesthetics as needed.
4. Tympanocentesis

Perform a tympanocentesis (draining fluid from the middle ear) if the discharge is caused by a middle ear infection.

Referral to Specialist

1. ENT specialist:

Refer the child to an ENT specialist if:

2. Audiology referral

Refer the child to an audiologist if there are concerns about hearing loss or delayed speech development.

Prevention

1. Vaccinations

Ensure the child is up-to-date on vaccinations, including the pneumococcal conjugate vaccine (PCV) and the influenza vaccine.
2. Ear hygiene

Teach the child and parents proper ear hygiene practices.
3. Avoid exposure to irritants

Reduce exposure to secondhand smoke, pollution, and other environmental irritants.

When to Seek Immediate Medical Attention

1. Severe ear pain

If the child experiences severe ear pain, especially if accompanied by fever or vomiting.
2. Discharge with blood or pus

If the discharge is bloody or purulent.
3. Fever over 104°F (40°C)

If the child has a high fever.
4. Difficulty hearing or speaking

If the child experiences hearing loss, speech difficulties, or balance problems.

By following this approach, you can effectively manage ear discharge in children and prevent potential complications such as Chronic suppurative otitis media, intracranial complications etc

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