✓ Otitis media, the alarm bells

What are the main warning signs of otitis for parents?

The child always touches his ear, rubs it, pulls it.
He starts screaming or crying louder when he is put down on his back. On the contrary, he feels better when he is picked up or seated.
Fluid leaks from the ear (because the eardrum membrane has risen under the pressure of the purulent mucus).

In all these cases it could be an episode of acute otitis media.

What to do if there are signs of ear infection?

The first thing to do is to consult the pediatrician, who will be able to make a precise diagnosis and indicate the most suitable therapy.

If the child is less than one year old, your general condition is very compromised or pus is leaking, usually the doctor immediately prescribes an antibiotic.
In all other cases, one typically tries to wait a couple of days to see how the situation evolves. Only after this period does the pediatrician decide whether the antibiotic is needed or not.

The administration of a pain relieving drug (paracetamol or ibuprofen).

What does the doctor see by looking in the ear?

When looking inside the ears with the otoscope, the pediatrician - or otolaryngologist - especially check the ear canal, checking if it looks pale or red (a sign of inflammation) and the membrane of the eardrum.

In a healthy baby, this membrane is a delicate, light-colored skin with a slight indentation in the center. It is so smooth that it reflects the light used for the exam. In the child with otitis, the eardrum membrane faces outward and appears yellowish-red in color.

If too much mucus and pus accumulates in the middle ear, it can even burst. In this case, a yellowish liquid, sometimes mixed with blood, leaks from the laceration and pours into the ear canal.

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Can otitis be prevented?

The Del Paesena Society of Pediatrician (SIP) guidelines on acute otitis media indicate some simple strategies that can help prevent infection:

Prefer breastfeeding, exclusive for at least three months. According to the 2022 Emilia Quick Guide to otitis, breastfeeding should be exclusive for at least six months.
Limit the use of the pacifier.
Avoid exposure to secondhand smoke.
Promote a frequent hand washing, even in communities such as daycare centers and preschools.

The guidelines also point out that pneumococcal vaccination appears to reduce the risk of experiencing a first episode of acute otitis media. In this sense, it would be a positive "side effect" of vaccination. At the moment, however, there is no evidence that the flu vaccination can also help against ear infections.

Sources for this article: Guidelines of the Del Paesena Society of Pediatrician (SIP) on acute otitis media; Emilia Quick Guide of the city 2022 on acute otitis media in the pediatric age; Article in the Notebooks of the Cultural Association of Pediatricians.