Incubation period days

Period of communicability Not normally transmitted from person to person, except as an upper respiratory infection.

Occurrence and distribution This is a very common condition throughout the world and many children develop ear infections during the course of their childhood.

Where the drum has ruptured, deafness will result, leading to problems at school, so what started off as a seemingly insignificant problem can lead to poor development and disability throughout the life of the individual. Otitis media and deafness occurring in the first 2-3 years of life can interfere with spoken language acquisition, leading to difficulties in communication, understanding and a barrier to education.

There is a particularly high level of otitis media in Australian aboriginals and the Inuit people of the Arctic with Pacific Islanders and native North Americans next in order of magnitude. This may be due to these people having larger eustachian tubes, which offer lower resistance to the passage of organisms.

Control and prevention Upper respiratory infections should be adequately treated and the eardrum always examined for redness and bulging. The same risk factors that cause ARI (Section 13.2) predispose to otitis media, so relevant preventive action can be instituted.

The conjugate pneumococcal vaccine has been shown to be moderately efficacious against otitis media and once it becomes more universally available, it can be anticipated to contribute to a reduction of this infection.

The child with deafness should be examined and if found to have a discharging ear should be treated as below: if the eardrum does not heal, then corrective surgery can be performed.

Treatment In acute otitis media, penicillin G or erythromycin given systemically for 5 days may be sufficient, but if there is poor response or perforation has occurred, then cotrimoxazole twice a day or amoxicillin three times a day for 5 days should be used. In the chronically discharging ear, it is imperative to dry the ear out with wicking, which the mother can be taught to do. Clean tissue paper is twisted into a point and placed in the ear, replacing it as soon as it becomes wet and repeating until the ear remains dry. The child should not swim or water allowed to enter the ear when washing. Boric acid in spirit ear drops can be instilled to help in drying the ear.

Surveillance Surveys of deaf and partially deaf children will give an indication of the amount of otitis media leading to perforation of the eardrum. Where finances permit, this is best done by typanometry, but a simple test using the spoken voice can give a rough estimate:

• responds to a whisper - no deafness;

• responds only to the normal voice - moderate hearing impairment;

• responds only to a loud voice - severe deafness.

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