AVALIAÇÃO DA OTORREIA EM CRIANÇAS

Abstract

Introduction: Cerebrospinal fluid (CSF) otorrhea is a serious sign in the context of head trauma. If any ear discharge is noted after serious head trauma, particularly clear or bloody discharge, the patient should undergo evaluation for CSF otorrhea caused by a basilar temporal skull fracture. Objectives: discuss the evaluation of otorrhea in children. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors "Otorrhea", "Assessment" AND "Children". Articles from 2019-2024 (total 9) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: Otorrhea means drainage of fluid from the ear. Otorrhea results from pathology of the external auditory canal or middle ear disease with perforation of the tympanic membrane. History and physical examination will differentiate between most causes of otorrhea in children. The evaluation of otorrhea in children is carried out by a doctor, which may include: checking vital signs and fever, inspection of the ear and adjacent regions to check for edema and hyperemia, palpation of the pinna and tragus to check for worsening pain, examination of the ear canal with an otoscope to check for secretion, lesions in the canal, granulation tissue and foreign bodies, examination of the tympanic membrane to check for inflammation, perforation, distortion and signs of cholesteatoma. Most children with otorrhea have bacterial otitis externa or acute otitis media (AOM) with perforation of the tympanic membrane. Patients who appear ill or have otorrhea following head trauma require aggressive efforts to diagnose and treat potential life-threatening causes of otorrhea (skull base fracture, necrotizing otitis externa, infectious complications of AOM). Once a working diagnosis is established, rapid consultation with a pediatric ear, nose, and throat specialist is warranted for life-threatening conditions (e.g., cerebrospinal fluid [CSF] otorrhea], mastoiditis, or other infectious complications of AOM , necrotizing otitis externa or neoplasia) and those that require biopsy for definitive diagnosis. Treatment of otorrhea may include: Expectant management, with observation for 48 to 72 hours and use of symptomatic medications, application of medicine directly into the ear canal to dissolve the secretion and administration of antibiotics, if otorrhea is caused by a bacterial infection. Conclusion: Otorrhea is the discharge of secretion from the ear, which can be bloody, sero-mucous or purulent. According to the recommendations of the American Academy of Pediatrics, you should always start in children under 6 months, in the presence of otorrhea on examination, temperature above 39ºC, signs of toxemia or otalgia persistent for more than 48 hours.