6. Acute Respiratory Infections

6.1. Ear Problems

Ear problems need to be checked in all children brought to the outpatient health care facility. A child presenting with an ear problem should first be assessed for general danger signs, then cough or difficult breathing, diarrhea, and fever. Although otitis is rarely a cause of death, it is the main cause of deafness in low income areas, which in turn leads to learning problems.

Clinical assessment

When otoscopy is not available, examine the child for the following clinical signs:

Tender swelling behind the ear. The most serious complication of an ear infection is an infection in the mastoid bone (mastoiditis). It usually manifests with swelling behind one of the ears. In infants, this swelling may also be above the ear. When present, this sign is considered positive and should not be mistaken for swollen lymph nodes.

Ear pain. In the early stages of acute otitis, a child may suffer ear pain, which usually causes the child to cry and become irritable.

Ear discharge. This is another sign of an ear infection.

Classification of ear problems

Based on the presence and duration of clinical signs (swelling behind the ear, ear pain or ear discharge), the child’s condition can be classified as mastoiditis, acute otitis, or chronic otitis (Box 4).

BOX 4: Classification of ear problems

Mastoiditis

  • Tender swelling behind the ear

Acute otitis

  • Ear discharge for less than 14 days
  • Ear pain

Chronic otitis

  • Ear discharge for more than 14 days

No ear infection

  • No ear pain or discharge

Children presenting with swelling of the mastoid bone are classified as having mastoiditis and should be referred to a hospital for treatment. Before referral, these children should receive a dose of antibiotics and a single dose of paracetamol for pain. Children with ear pain or ear discharge for less than 14 days are classified as having acute otitis. Treat them for 5 days with the same first-line antibiotic as for pneumonia. If there is ear discharge for more than 14 days, the child’s classification is chronic otitis. Attempt to wick or dry up the ear. In this case antibiotics are not recommended because they are expensive and their efficacy is not proven.

If no signs of ear infection are found, children are classified as having no ear infection and do not require any specific treatment.