Can you hear me?

What say you on the issue below?

Otitis media, or middle ear infection, can be especially severe in children if left untreated.

BEING able to hear properly is vital for a baby’s speech development since it encourages imitation, which in turn stimulates language skills.

However, at such a young age, your child is at risk of many infections, including ear infections, which can impair hearing and may interfere with speech development. Otitis media is one such infection that can cause hearing impairment.

In a child with ear infection, look out for these signs: complains of pain in his ears, tugs or pulls his ears, cries more than usual, acts irritable, has trouble sleeping, fails to respond to sounds, and appears to be inattentive at school.

According to a report published by the Malaysian Health Technology Assessment (MaHTAS), under the Medical Programme by the Ministry of Health, Malaysia, at least 500,000 cases of otitis media occur annually in children less than two years, out of which 50% are due to pneumococcus. It is also estimated that 75% of children experience at least one episode of otitis media by their third birthday.

Otitis media and its causes

Known also as middle ear infection, otitis media is an infection or inflammation of the middle ear. This often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. These can be viral or bacterial infections.

Acute Otitis Media (AOM) – When referring to an ear infection, doctors most likely mean acute otitis media (AOM). This often comes with intense symptoms such as pain, redness of the eardrum, and possibly fever. It can be accompanied by irritability and inability to sleep. Fluid from the middle ear may flow out from the ear if the eardrum perforates.

Otitis Media with Effusion (OME) – This, being more common than acute otitis media, is where the fluid in the middle ear is temporary and is not necessarily infected.

Chronic Suppurative Otitis Media – As the name suggests, this is a more chronic type of otitis media where the fluid is in the middle ear for six or more weeks.

Streptococcus pneumoniae and Haemophilus influenzae are the most common bacterial causes of otitis media. In fact, Streptococcus pneumoniae causes other types of pneumococcal infections other than otitis media, including sinusitis, meningitis, pneumonia, and bacteraemia. Classified as a non-invasive pneumococcal disease, otitis media is less severe but more frequent as compared to invasive pneumococcal infections such as meningitis.

Effects of otitis media

Otitis media can cause mild to severe problems. If left untreated, serious complications and sometimes long-lasting or recurrent complications may follow. For example, although the hearing loss caused by otitis media is usually temporary, however, untreated otitis media may lead to permanent hearing impairment as a result of persistent fluid in the middle ear.

Perforation of the eardrum will frequently heal with little residual effect.

How can I tell if my child has otitis media?

It is hard for a parent to detect whether a child has otitis media, especially if the child is too young to say, “Mummy, my ear hurts.”

However, some of the common ones are: complains of pain in her ears, tugs or pulls her ears, cries more than usual, acts irritable, have trouble sleeping, fail to respond to sounds, and appear to be inattentive at school.

If your child shows any of the latter non-specific symptoms, get your doctor to look at his or her eardrums.

What can I do to protect my child from otitis media?

Some of the lifestyle choices you make daily can minimise the risk of otitis media in your child. You could follow some of the steps below:

·Breastfeed your baby exclusively for at least six months and continue for up to two years or beyond as breast milk naturally contains antibodies that offer protection from ear infections and helps the ear’s Eustachian tube (an auditory tube that equalises the air pressure in the middle ear to the outside air pressure) to function better.

·Avoid close contact with those who are sick. It is also important for both you and your child to practise good hand washing hygiene to prevent transmission of germs that can cause respiratory problems which could spread to the middle ear.

·Do not expose your child to second-hand smoke. Research shows that passive smoking can increase the adherence of bacteria in the respiratory passages and depress the immune system, which then increases the frequency and severity of ear infections.

Vaccination – the best protection

One of the better ways to protect your child from otitis media is through immunisation. In a trial carried out in the United States, with follow-up of the children for 3.5 years, the risk of frequent otitis media was reduced considerably in those who completed the immunisation series (Weekly Epidemiological Record, 2007 – World Health Organisation). Below are vaccines that protect against otitis media:

Haemophilus influenzae type b (Hib) vaccine – The Hib vaccine is made from an inactivated form of the Hib bacteria. The vaccine provides almost complete protection against Hib diseases such as meningitis, pneumonia, and of course otitis media.

It is available as a combination vaccine that protects against Hib, diphtheria, tetanus, and pertussis (whooping cough) and is included in the Malaysian Immunisation Programme since 2002.

Pneumococcal conjugate vaccine (PCV) – Pneumococcal conjugate vaccine contains inactivated forms of seven to 10 different serotypes of the bacteria. It provides protection against pneumococcal infections including otitis media, sinusitis, meningitis, and bacteraemia.

According to the Centres for Disease Control and Prevention, the United States (CDC), these strains are responsible for most severe pneumococcal infections among children. PCVs have lowered the number of severe pneumococcal disease by nearly 80% among children under five.

Currently, the PCV is an optional vaccine in Malaysia and can be obtained in private hospitals or clinics.

The future of vaccines in preventing otitis media

The new 10-valent conjugate vaccine covers up to 10 different strains of pneumococcus, giving your child more protection. The vaccine is expected to be made available in Malaysia soon.

Speak to your doctor regarding the exact vaccines for your child and keep her immunisation schedule up-to-date.