This document discusses the assessment and management of ear problems in children. It begins by outlining general danger signs that require emergency referral. It then describes the steps to assess for cough, difficult breathing, diarrhea, sore throat, and ear problems. For ear problems, it involves asking about ear pain and discharge and examining the ear. Common causes of ear problems in children include acute otitis media, chronic otitis media, and mastoiditis. The document provides details on diagnosing and treating these conditions, as well as preventing ear problems through vaccination, hygiene practices, and managing allergies.

1. A practical approach to the child with
Ear Problem
Background, Assessment and Management
Prof. Imran Iqbal
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

3. IMNCI
A Strategy for
Outpatient Case Management
of Children
under five years of age

4. Step 1
General Danger Signs
General Danger Signs indicate severe disease
Presence of any one of the General Danger Signs
means that the child needs to be
referred / admitted to the emergency

5. Check for General Danger Signs
• Unable to drink or breastfeed
• Vomiting everything
• Lethargic or unconscious
• Convulsions
• General Danger Signs indicate severity of illness
• Not diagnostic but suggests acuity of situation

6. Step 2
Assess for
Cough or Difficult Breathing

7. Step 3
Assess for
Diarrhoea

8. Step 4
Assess for
Sore Throat

9. Step 5
Assess for
Ear Problem

10. Assess for Ear Problem
• ASK: Does the child have Ear Problem ?
• IF YES
• ASK: Is there Ear Pain ?
• ASK: Is there Ear Discharge ? If yes, for how long ?
• Look and Feel:
 Look for pus draining from the Ear
 Look for tender swelling behind the ear ?
 Throat and Ear examination of Child needs appropriate position and
should be performed last in the sequence of physical examination

11. Causes of Ear Problem in Children
• Cause of Ear Pain –
- URTI -- (runny nose, blocked Eustachian tube)
- Acute Otitis Media -- (viral or bacterial or mixed infection)
- Otitis externa, Boil in Ear
• Cause of Ear Discharge –
Acute Otitis Media with perforation of tympanic membrane
Chronic Otitis Media -- (mixed bacterial infection)
• Swelling behind the Ear – Mastoiditis

12. Acute Otitis Media (ASOM)
• Very common infection in small children
• Mixed Viral and Bacterial (S. pneumonia, H. influenza, M. catarrhalis ) infections
• Presenting symptom is sudden, severe ear pain
• Perforation of Tympanic Membrane occurs within hours
• With perforation of TM, pain subsides and ear discharge starts
• Recovery takes many days
• Recurrences are common
• Perforation of TM may heal after adequate treatment
• Persistent or recurrent infections lead to Chronic Otitis Media

13. Acute Otitis Media

14. Chronic Otitis Media (ChSOM)
• Persistent Ear infection for more than 2 weeks
• Perforation of Tympanic Membrane not healed
• Intermittent / persistent ear discharge
• Hearing loss common in children
• Delayed speech development in child

15. Mastoiditis
• Mastoiditis is a complication of Chronic suppurative otitis media (ChSOM)
• Middle ear infection extends posteriorly into the mastoid air cells
• Pain, swelling, redness and tenderness in the mastoid region
• Intermittent / persistent ear discharge
• In untreated cases, Meningitis and Brain abscess may occur
• Mastoiditis is treated by IV antibiotics, drainage of pus and Mastoidectomy in resistant
cases

16. Assess for Ear Problem
• ASK: Does the child have Throat Problem ?
• IF YES
• ASK: Is there Ear Pain ?
• ASK: Is there Ear Discharge ? If yes, for how long ?
• Look and Feel:
 Look for pus draining from the Ear
 Look for tender swelling behind the ear ?
 Throat and Ear examination of Child needs appropriate position and
should be performed last in the sequence of physical examination

17. Classify Ear Problem

18. Classify Ear Problem

19. Treat Ear Problem
• Mastoiditis – Admit / Refer urgently
• Acute Ear Infection -- Amoxycillin (oral)
-- Paracetamol (oral)
• Chronic Ear Infection -- Dry the Ear by wicking
-- Ciprofloxacin Ear drops

20. PREVENTION

21. Prevention of Ear Problems
• Vaccination – EPI
Penta (DPT, Hib, Hep B),
Pneumococcal vaccine
• Avoid chilled water, ice-cream, sour foods
• Avoid contact with persons having flu and fever
• Manage allergic rhinitis
• Hand washing
• Avoid household smoking, atmospheric pollution

22. 3-Jul-20 Prepared By: Medical and Compliance 22
Prevention:Vaccination
Age Vaccine
At Birth BCG and OPV-0
6 Week Penta-I, Pneumo-I and OPV-I
10 Week Penta-II, Pneumo-II and OPV-II
14 Week Penta-III, Pneumo-III, IPV and OPV-III
9 Months Measles-I
15 Months Measles-II
http://epi.gov.pk/?page_id=139
EPI: Expanded Program on Immunzation (Pakistan)