Phlegm and catarrh in children's ears

Remedies: how to help a child with phlegm

A humid environment and an increase intake of liquids are among the main remedies for treating the accumulation of mucus in the ears, also known as ear catarrh or tubal phlegm.

What causes catarrh in kids?

Changes in the mucosa of the middle ear is a typical trigger of inflammation with redness, flaking of the epithelium and serous drainage that often collects in small amounts without totally occupying the eardrum case.

The presence of phlegm in the middle ear results in a sensation of auricular congestion, reduced hearing ability, autophonia, and tinnitus. However, fever is not a common symptom. The main cause of mucus accumulation in the ears is catarrhal otitis, which can be traced to bacteria or viruses often sustained by subjective factors (age, immune status) and local factors (formations of the middle ear, adenoid hypertrophy, structure of the Eustachian tube, allergic diathesis, malformation of the palate).

Getting examined by a specialist is key during the condition’s early phase, on account of symptoms being almost imperceptible on some patients and, in addition to possible hearing damage, this condition could be deceptively affecting, reducing, or delaying a child’s learning ability.

It will be the physician's task, after the examination, to diagnose the adequate treatment. The assessment involves an exam that offers direct vision of the ear canal and the eardrum membrane (otoscopy), which may appear reddened and retracted, and the performance of instrumental tests (audiometry and tympanometry) that confirm the presence of catarrh.

How do you treat catarrh in children?

General mucolytics, immunomodulators, anti-catarrh and anti-allergy vaccines are the most common remedies for this condition. Nasal washes with saline or sterile seawater facilitate nasal breathing and middle ear ventilation. Aerosol therapy with specific mucolytics and corticosteroids, which can be done at home, can facilitate the drainage of mucus and clear the middle ear and tube. Only under special conditions (fever, intense pain, or suspicion of transformation to purulent otitis) are antibiotics used for at least one week.

If the presence of catarrh persists for an extended period, it is best to resort first to thermal therapy to restore tubal permeability and mucosal trophism. For instance, crenotherapy favourably modifies the tissue and humoral conditions of this acute, chronic, or relapsing inflammatory/dysreactive state of the nasopharyngeal, tubal and middle ear mucosa. The mineral waters used for this type of otolaryngological therapy are sulfuric which means that they are anticatarrhal, antiseptic, antiphlogistic as well as antiallergic. 

Endotubaric insufflations or politzer inhalations, performed by means of a simple tubal catheterization, are based on the same principle as humage (sulphur gas released by bubbling air in thermal water). The purpose is to restore patency of the tube obstructed by mucus, clear the middle ear of mucus, and restore pressure in the middle ear, which must be in balance with external pressure. Insufflation is usually preceded by warm-humid inhalations and aerosol treatments and nebulisations, using thermal sulfuric water. In cases where the above treatments fail and the adenoid hypertrophy is severe, an adenectomy, which is often tied to a tonsillectomy, may be required. 

Another, less popular, treatment option is evacuative paracentesis, a procedure that consists in a perforation with a needle or a catheter of the peritoneal cavity to obtain ascitic fluid, followed up by a trans tympanic drainage. Currently, this procedure is quite controversial, on account of the natural evolution of otitis media catarrhalis, which can improve especially once the age of puberty is reached, and the low success rate of this procedure.

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