Acute otitis media - kyuuseichujien (English spelling)

Japanese: 急性中耳炎 - きゅうせいちゅうじえん（英語表記）Acute otitis media

What is the disease?

eardrum ( Komaku ) It is a condition in which the middle ear, the space inside the ear, becomes inflamed, and is a typical acute infection in infants and young children. Since children's Eustachian tubes are thicker and shorter than those of adults, it often occurs in children between 6 months and 2 years of age.

What is the cause?

The cause Streptococcus pneumoniae ( Emergency medical assistance ) Influenza bacteria are the most common cause, but recently it has been suggested that viral infections may also be involved. Rhinosinusitis ( Bikubikuen ) , Pharyngitis ( Introductory ) Following an upper respiratory tract infection such as those listed above, inflammation spreads from the nasopharynx via the Eustachian tube.

recent years, Resistance ( Taisei ) The frequency of pneumococcus (which is resistant to medicine) and resistant influenza bacteria is increasing rapidly. As a result, cases of otitis media becoming severe or lasting longer are on the rise, so initial treatment is important. In addition, the number of cases of recurrent otitis media is increasing in childcare settings, such as nursery school children.

How symptoms manifest

Ear pain or discharge, fever, Sensation of ear congestion ( World War II ) However, small children may not complain of ear pain and may only have a fever. Children are often taken to a pediatrician, but for early diagnosis, if they seem to be concerned about their ears, it is necessary to see an otolaryngologist.

Testing and diagnosis

The diagnosis can be easily made by examining the eardrum. The eardrum is red, swollen, and opaque due to the accumulation of pus. Perforation ( flash ) If there is a hole Pulse ( Hakudo ) Ear discharge occurs spontaneously. As the tympanic membrane findings improve rapidly with treatment, the findings of the tympanic membrane are also important for observing the effectiveness of treatment.

When the patient has severe systemic symptoms such as fever and the ear canal is narrowed, Mastoiditis ( New student training ) It is often accompanied by serious complications such as the above, so caution is required. With the increase in resistant bacteria, it is important to perform a bacterial test at the first consultation. In addition to ear discharge, nasopharyngeal secretions may also be tested, and the latter has a higher positive rate for bacteria.

Hearing loss ( What a ) This is generally mild, but in cases of infection with specific bacteria or severe infection, it can cause cochlear hearing loss, so patients who have a strong sense of ear congestion or are very aware of their hearing loss should undergo a pure tone audiometry test to determine the degree and nature of their hearing loss.

Treatment methods

The severity is classified by scoring ear pain, the presence or absence of fever, tympanic membrane findings, ear discharge, etc.

Mild cases are observed for three days, and if there is no improvement, antibiotics are administered.

For moderate to severe cases, oral antibiotics are the standard, with penicillin being the first choice. The antibiotic will be changed as appropriate based on changes in the eardrum after oral administration and the results of bacterial tests. If a resistant bacteria is determined to be the causative agent, intravenous drip infusion and local irrigation will be performed.

In severe cases or when there is no improvement after five days of antibiotic treatment, a myringotomy is performed. The eardrum closes within a few days even if it is incised, and there are no aftereffects such as hearing loss, so do not be afraid to undergo myringotomy if necessary.

In most cases of otitis media, upper respiratory tract infection is also present, necessitating treatment of the nasopharynx. Purulent nasal discharge ( Art Museum ) For people with a lot of stuffiness, we perform treatments such as suction and nasal irrigation.

In severe cases, intravenous drip infusion may be administered. If complications such as persistent high fever, hearing loss, or facial paralysis occur, emergency surgery ( Mastoidectomy ( Newcomer's work ) ) will require drainage.

What to do if you notice an illness

Otitis media is a common disease and is often treated by a pediatrician alone, but complications that had decreased at one time have been increasing in recent years due to the increase in resistant bacteria. Since an accurate examination of the eardrum is necessary to determine the treatment plan, we recommend that you have your child examined by an otolaryngologist.

Tadashi Sugasawa

Acute otitis media
Acute otitis media
(Infectious Diseases)

What kind of infection is it?

Acute otitis media is common in children, especially infants under the age of 2. The middle ear and the back of the nose are connected by a narrow tunnel ( Eustachian tube ( time ) ) and when you have a cold, bacteria that have multiplied in your nose or throat can pass through the tunnel and enter the middle ear, which is originally free of bacteria, causing inflammation.

Compared to adults, children are more susceptible to bacteria entering the middle ear through this tunnel, and because their immune system is not yet fully developed, they are more likely to develop otitis media. It is most common from winter to spring, when people are more likely to catch colds.

Most inflammation is caused by bacterial infections, with Streptococcus pneumoniae and Haemophilus influenzae being the main causative bacteria. Recently, antibiotics have been used to treat these bacteria. Resistant bacteria ( Taiseikin ) The proportion of cases of this bacteria is increasing, and it has become a problem as a causative agent of intractable otitis media in children.

How symptoms manifest

Following cold-like symptoms such as a runny nose and sore throat, a fever and a sudden, sharp, stabbing pain deep in the ear begin, causing the ear to feel blocked and difficult to hear. Infants and young children who are unable to communicate that their ears hurt well may show behaviors such as putting their hands over their ears, crying and fussing, being irritable and unable to sleep, etc. Sometimes you may notice mucus coming out of the ear (ear discharge).

Testing and diagnosis

Looking directly into the ear (otoscopy or endoscopy) eardrum ( Komaku ) condition, redness, swelling ( Chief ) Otitis media is diagnosed by observing the presence or absence of ear discharge and ear swelling. Rhinitis ( Bien ) or Sinusitis ( Lottery ) Since this condition is often accompanied by other conditions, it is important to examine the inside of the nose as well. Ear discharge and nasal swabs will be used to test for the causative bacteria.

Treatment methods

If the symptoms are mild and there is little change in the eardrum, we will observe the condition for three days with only painkillers without using antibiotics. Even if the symptoms are mild, antibiotics will be prescribed if there is no improvement after three days.

In moderate to severe cases, antibiotics are prescribed from the beginning, and the amount of antibiotics may be increased depending on the severity. swelling ( Chief ) If the swelling is severe or does not improve after five days of antibiotics, the eardrum will be incised and the pus accumulated in the middle ear will be sucked out. In addition, antibiotics may be administered intravenously. Treatment of rhinitis is also necessary along with treatment of otitis media.

What to do if you notice an illness

If you suddenly experience ear pain at night or other times when the hospital is closed, first take over-the-counter painkillers, rest, and see an otolaryngologist early the next day. Also, be careful not to blow your nose too hard.

どんな病気か

　鼓膜(こまく)の内側の空間である中耳に炎症が起きた状態で、乳幼児の急性感染症の代表的なものです。子どもの耳管は大人に比べて太く短いため、6カ月～2歳児によく起こります。

原因は何か

　原因は肺炎球菌(はいえんきゅうきん)、インフルエンザ菌が大部分ですが、最近、ウイルス感染の関与も推定されています。細菌・ウイルス感染症、鼻副鼻腔炎(びふくびくうえん)、咽頭炎(いんとうえん)などの上気道感染症に続いて、上咽頭から耳管を経由して炎症が及びます。

　近年、耐性(たいせい)（薬が効かない）肺炎球菌、耐性インフルエンザ菌の頻度が急増しています。そのため、中耳炎が重症化したり、長引く場合も増えてきており、最初の治療が重要です。また、保育園児など集団保育を受ける環境では、反復性中耳炎が増加しています。

症状の現れ方

　耳痛や耳だれ、発熱、耳閉感(じへいかん)などですが、小さな子どもでは耳痛を訴えず発熱のみのこともあります。子どもの場合、小児科を受診することが多いのですが、早期診断のためにも、耳を気にしている様子がみられる時には、耳鼻咽喉科専門医の診断が必要です。

検査と診断

　鼓膜を観察すれば容易に診断がつきます。鼓膜の発赤、腫脹、うみの貯留による混濁を認め、穿孔(せんこう)（穴）があると拍動(はくどう)性に耳だれの流出が起こります。治療とともに鼓膜所見は急速に改善するので、治療効果の観察のためにも鼓膜の所見は重要です。

　発熱などの全身症状が強く、外耳道が狭くなっている時は、乳様突起炎(にゅうようとっきえん)などの重篤な合併症を併発していることが多く、注意が必要です。耐性菌の増加もあり、初診時に細菌検査を行うことが大切です。耳だれのほか、上咽頭分泌物を検査することもあり、後者のほうが細菌の陽性率が高くなります。

　難聴(なんちょう)は一般的には軽度ですが、特殊な菌の感染、あるいは重症感染時には内耳性難聴を起こすこともあるので、耳閉感が強かったり、難聴の自覚が強い患者さんでは、純音聴力検査を行い、難聴の程度や性質を知る必要があります。

治療の方法

　耳痛、発熱の有無、鼓膜所見、耳漏の有無等をスコア化し、重症度分類を行います。

　軽症例では3日間経過観察し、改善しないようなら抗菌薬が投与されます。

　中等症以上には抗菌薬の内服が基本で、通常ペニシリン系が最初に選択されます。内服後の鼓膜の変化、細菌検査の結果などを参考に、適宜、抗菌薬を変更します。耐性菌が原因菌と判定された場合には、点滴静注、局所の洗浄などが行われます。

　重症例や抗菌剤5日間投与で改善が認められない時は、鼓膜切開が行われます。鼓膜は切開しても数日で閉鎖し、難聴などの後遺症は起こさないので、必要な時は恐れず鼓膜切開を受けてください。

　中耳炎では、同時に上気道感染を伴っていることが大半で、上咽頭の処置が必要になります。膿性鼻汁(のうせいびじゅう)の多い人には、吸引、鼻洗浄などの処置を行います。

　重症の患者さんには点滴静注が行われることもあります。高熱が続いたり、難聴、顔面神経麻痺などの合併症が生じた場合は、救急手術（乳突削開術(にゅうとつさくかいじゅつ)）による排膿が必要になります。

病気に気づいたらどうする

　中耳炎はポピュラーな病気で、小児科単独で診察することも多いのですが、一時減少していた合併症が、耐性菌の増加のため近年増える傾向にあります。治療方針の決定に鼓膜の正確な所見が必要ですので、耳鼻科専門医による診察を受けるようすすめます。

菅澤　正

急性中耳炎
きゅうせいちゅうじえん
Acute otitis media
(感染症)

どんな感染症か

　急性中耳炎は小児、とくに2歳以下の乳幼児に多くみられます。中耳と鼻の奥は細いトンネル（耳管(じかん)）でつながっていて、かぜをひいた時などに鼻やのどのなかで増えた細菌がトンネルを通って、もともと菌のいない中耳に入り炎症が引き起こされます。

　大人に比べて子どもでは、このトンネルから中耳へ菌が侵入しやすい構造になっていて、しかも菌を除く免疫のはたらきが未熟なため、中耳炎が起こりやすいのです。季節的にかぜをひきやすい冬から春に多くみられます。

　炎症を起こす原因のほとんどが細菌による感染症で、肺炎球菌、インフルエンザ菌が主な原因菌です。最近これらの菌のなかで抗菌薬の効きにくい薬剤耐性菌(たいせいきん)の割合が増え、子どもの難治性中耳炎の原因菌として問題になっています。

症状の現れ方

　鼻水やのどの痛みなどのかぜのような症状に続いて、発熱、急に耳の奥に刺すような強い痛みが始まり、耳がふさがって聞こえにくく感じます。「耳が痛い」ことをうまく伝えられない乳幼児では、耳に手をやるしぐさ、泣いてぐずる、不機嫌で眠らないなどの行動がみられます。時に耳のなかから粘液が出てくる（耳だれ）ことで気づくこともあります。

検査と診断

　耳のなかを直接のぞいて（耳鏡または内視鏡検査）鼓膜(こまく)の状態、発赤、腫脹(しゅちょう)（はれ）、耳だれの有無を観察して中耳炎を診断します。鼻炎(びえん)や副鼻腔炎(ふくびくうえん)を併発していることが多いため、鼻のなかの診察も大切です。耳だれや鼻の奥のぬぐい液から原因となる細菌の検査をします。

治療の方法

　症状が軽く鼓膜の変化が少ない場合は、抗菌薬を使わず3日間鎮痛薬だけで様子をみます。軽症でも3日後改善しない場合に抗菌薬が処方されます。

　中等症、重症でははじめから抗菌薬が処方され、重症度に応じて抗菌薬の量を多く処方されることもあります。鼓膜の腫脹(しゅちょう)（はれ）が高度な場合や、抗菌薬を5日間使っても改善しない場合では、鼓膜を切開して中耳にたまった膿を吸い取ります。さらに抗菌薬の点滴をすることもあります。中耳炎の治療とともに鼻炎の治療も必要です。