Table of Contents
Introduction
Acute otitis media (AOM) is the most common infection for which antibiotics are prescribed in children, leading to over 20 million antibiotic prescriptions each year. New practice guidelines from the American Academy of Pediatrics and the American Academy of Family Physicians emphasize the careful use of antibiotics due to rising antibiotic resistance and the questionable necessity of antibiotics for children with uncomplicated AOM. These guidelines are reviewed below. Additionally, this article discusses other common ear, nose, and throat (ENT) conditions, such as sinusitis and dental emergencies, along with current strategies for diagnosing and treating these issues. This article explains a few pediatric ENT emergencies.
What Are Pediatric ENT Emergencies?
The following are the pediatric ENT emergencies:
1. Acute Otis Externa - Otitis externa is an inflammation of the external auditory canal and the external surface of the tympanic membrane, often caused by conditions that compromise the canal's lining. The ear canal is lined with connective tissue with a lipid-protective barrier. Prolonged exposure to water can damage cells. This process washes away the protective cerumen and alters the pH level of the ear canal, making otitis externa common among swimmers in hot and humid climates and in conditions that retain water in the ear, such as long showers. Local trauma from foreign bodies, cotton swabs, insect bites, and eczema can also disrupt the canal's skin, along with factors like hearing aids, earplugs, and a compromised immune system.
2. Acute Otitis Media—Acute otitis media (AOM) is an inflammatory process in the middle ear characterized by a middle ear effusion (MEE), signs and symptoms of middle ear inflammation, and a recent, sudden onset of clinical symptoms. AOM is the most common infection in children for which antibiotics are prescribed, leading to over 20 million antibiotic prescriptions annually. Its prevalence peaks between 6 and 20 months of age and tends to become chronic and recurrent.
AOM must be distinguished from otitis media with effusion (OME), a nonsuppurative, secretory condition that lacks an infectious component and should be considered separately. Although OME may predispose to or follow AOM, it is not inherently infectious. AOM occurs more frequently in the first two years of life, likely due to the immaturity of immune defenses, the structure and function of the eustachian tube, and possibly because of the amount of time spent in a horizontal position. AOM is more common in males and Native American or Inuit populations. It is also associated with lower socioeconomic status, likely due to crowding, poor hygiene, inadequate nutrition, and limited access to healthcare. Breastfeeding has a protective effect against AOM, while exposure to tobacco smoke and repeated contact with other children, such as in daycare settings, increases the risk. Children with craniofacial anomalies and Down syndrome also have a higher prevalence of AOM.
1. Foreign Bodies of Nose and Ear—Foreign bodies are a fairly common issue in children, with objects such as toys, food, paper, beads, and insects—often found in the ear or nose. A child with a long-standing foreign body might exhibit unilateral nasal or ear discharge, a foul odor, or recurrent nosebleeds due to chronic irritation.
2. Epistaxis -The nose's rich vascular supply makes it particularly prone to bleeding, either spontaneously or due to localized trauma. In most cases, the bleeding is mild and resolves on its own, but it can sometimes be severe and potentially life-threatening. In children, epistaxis is often caused by local trauma, such as nose-picking or a recent upper respiratory infection. Other contributing factors include facial trauma, the presence of foreign bodies, drug use (cocaine or heroin sniffing), or sinusitis. Less frequently, systemic conditions like hepatic disease, leukemia, idiopathic thrombocytopenia, or coagulopathies can be linked to nosebleeds.
3. Luxation Injuries - Luxation refers to the displacement of a tooth from its normal position. This type of injury to a permanent tooth is a genuine dental emergency, requiring prompt management to preserve the viability of the affected periodontal ligament.
What Are the Symptoms of Pediatric ENT Emergencies?
-
Otitis externa is marked by otalgia, which may range from initial pruritus to severe pain, particularly when moving or chewing.
-
Pulling on the auricle or tragus produces pain, and the canal becomes erythematous and swollen, causing aural fullness and possible hearing loss.
-
A child might present with a clear history of inserting a foreign body or exhibit symptoms like recurrent nosebleeds, a foul odor, or pain in the ear or nose.
-
Hearing loss or reduced sense of smell can also be initial complaints. In some cases, children show no symptoms, and the foreign body is discovered by a parent or during a routine examination by a physician.
-
The physical signs depend on factors such as the length of time the foreign body has been in place, its size, and its characteristics.
-
If a small object was inserted recently, the child might be asymptomatic. However, larger objects may cause noticeable trauma.
-
An insect in the ear canal typically causes severe, constant pain and a sensation of movement.
-
The additional symptoms are pain, dizziness, fever, buzzing in the ear, irritability, increased crying, sleep disturbance, vomiting, diarrhea, and decreased hearing.
What Are the Treatments of Pediatric ENT Emergencies?
Treatment involves cleansing and debriding the ear canal using a cotton swab, hydrogen peroxide, or Burow's solution. An acidifying agent, such as 2 % acetic acid, helps inhibit bacterial and fungal growth. Topical antibiotic drops, often mixed with antifungal agents or steroids to reduce inflammation, should be continued for at least three days after symptoms resolve.
Sometimes, a cotton wick or gauze strip may be needed to allow proper diffusion of the drops into the swollen ear canal. Pain management may require NSAIDs (non-steroidal anti-inflammatory drugs) or even opiates. Cultures are generally unnecessary unless the condition is resistant to treatment. ENT surgeons have traditionally avoided nonsteroidal anti-inflammatory drugs (NSAIDs) due to concerns about an increased risk of bleeding. Instead, they have preferred using acetaminophen or acetaminophen combined with codeine for pain management.
Conclusion
ENT cases are common in pediatric emergency care, often arising from trauma, foreign bodies, infections, or complications from previous procedures. The emergency physician must have a thorough understanding of these conditions and their management. Additionally, having access to a skilled local otolaryngologist enhances preparedness and care quality.
