Respiratory Tract Infections (RTIs)
Ear Nose Throat Diseases
Upper Respiratory Tract Infections (URTIs)
The upper respiratory tract consists of the nose, throat, and paranasal sinuses. Therefore, when we talk about upper respiratory tract infections (URTIs), we usually refer to conditions affecting these areas, including rhinopharyngitis (common cold), pharyngotonsillitis (tonsillitis), and sinusitis. In children, middle ear infections (otitis media) are often associated with URTIs and are considered under this category as well. URTIs are quite common in children older than six months of age, as maternal antibodies diminish.
Common Cold is the Most Frequent Acute Respiratory Infection
When we mention URTIs, the common cold usually comes to mind. Recent studies have shown that colds are often accompanied by sinusitis. Children typically experience colds five to eight times a year, with the highest frequency occurring before the age of two. Colds are more common in children attending daycare or school. They usually start in September and continue until the end of April. More than 200 different viruses can cause the common cold. Sometimes, bacteria can directly cause this condition as well. Bacteria typically settle in this area as secondary invaders and can lead to complications such as middle ear infections, sinusitis, lymph node inflammation, and pneumonia. Common symptoms include runny nose, sore throat, fever, and cough. The illness often starts with fever, restlessness, and sneezing, followed by a runny nose after a few hours. Nasal congestion usually follows. In infants, nasal congestion can make feeding difficult and may even cause breathing problems. Fever can disappear within a few hours or last for up to three days. In adults, fever does not usually rise significantly. After the first day, nasal discharge typically becomes thicker and darker. The acute phase lasts for about 2-4 days, after which symptoms resolve. If fever returns after three days, complications like middle ear infections should be investigated.
Don't Rush to Antibiotics for a Simple Cold
The common cold has no specific treatment because it is almost always caused by viral agents. Therefore, there is no need to prescribe antibiotics to patients with colds. Starting antibiotics immediately not only fails to prevent secondary bacterial infections but can also lead to the colonization of resistant bacteria in this area. In colds, thick, opaque, or colored discharge is common, but this does not necessarily indicate a bacterial infection. Therefore, antibiotics should only be used in cases where symptoms persist for 10 days despite treatment. Treatment may include fever-reducing and discomfort-relieving medications and saline nasal drops to relieve nasal congestion. Nasal drops should be administered 15-20 minutes before feeding to facilitate feeding.
Be Cautious About Excessive Antibiotic Use
The information provided above illustrates the rapid development of antimicrobial resistance due to indiscriminate antibiotic use. Random antibiotic use, coupled with the rapid globalization of diseases, has led to an increase in bacterial resistance. In our country, overcrowding in outpatient clinics (resulting in insufficient time for each patient) and underutilization of laboratory facilities often lead to doctors prescribing medications based solely on symptoms, without conducting thorough examinations. This practice can lead to incorrect diagnoses and excessive antibiotic use. Sometimes, doctors may opt for broad-spectrum antibiotics instead of narrower-spectrum ones, fearing that the patient won't recover. Improper use of antibiotics can also lead to the development of resistance.
Therefore, medical students should be educated about proper antibiotic use, and primary care physicians should receive periodic in-service training on this subject.
Rational antibiotic use can reduce the development of antibiotic resistance. In a study conducted on daycare children, reducing antibiotic use was associated with a decrease in the frequency of resistant bacteria from 53% to 7%.
Tonsillitis and Sore Throat
Tonsillitis and sore throat are some of the most commonly encountered conditions in ear, nose, and throat (ENT) practice. They are most common in children aged 4-7. The majority of cases are viral, with bacteria accounting for only 15%. The presence of symptoms such as runny nose, cough, and hoarseness alongside tonsillitis and sore throat often indicates a viral cause. Fever is usually not very high and the general condition is not severely affected. In contrast, bacterial infections tend to cause more severe symptoms, with temperatures rising up to 40°C. Headaches, abdominal pain, vomiting, and rashes can also occur. Swollen lymph nodes in the neck may be palpable.
Middle Ear Infection (Otitis Media)
Middle ear infections are one of the most common illnesses in childhood. By the age of three, approximately 85% of children have experienced at least one episode, with 50% experiencing two or more. These infections are most common in children aged 6-36 months. Children who have had middle ear infections before the age of one are more likely to experience recurrent infections. The short length of the Eustachian tube, which connects the middle ear to the back of the throat, makes it easier for nasal and throat secretions and bacteria to reach the middle ear. Frequent viral infections and the presence of adenoids, which can block the opening of the Eustachian tube, contribute to the increased incidence of middle ear infections.
In cases of viral URTIs, middle ear infections often manifest a few days after the onset of the cold. If a child suddenly becomes restless, develops a fever, and experiences hearing loss within a few days of an acute viral URTI, acute otitis media should be considered. Fever is present in about half of children with middle ear infections. Diarrhea and vomiting, which are nonspecific symptoms, may also occur in babies. Therefore, ear examination should always be part of the routine physical examination of children. During examination, the eardrum may appear red, bulging, and with reduced mobility. Redness alone is not very diagnostic since crying can also cause redness in a baby's eardrum. Most studies suggest that 14-21 days of antibiotic treatment is sufficient for middle ear infections. Pain-relieving and fever-reducing medication, as well as saline nasal drops, are added to the treatment regimen. A few days after completing treatment, the child's ear should be re-evaluated. If fluid is still seen in the middle ear, the child should be referred to an ENT specialist. Antibiotic prophylaxis (prevention) is recommended for children who experience three episodes of middle ear infections within six months or four episodes within 12 months.
Acute Sinusitis
Most acute infections in the nasal area also involve the paranasal sinuses. In infants, infections can occur in the maxillary (cheek) and ethmoid (bridge of the nose) sinuses starting from infancy. On the other hand, frontal (forehead) sinuses develop later and are generally not involved in infections until the age of 10. Similarly, the sphenoid (base of the skull) sinuses are not clinically significant until around 3-5 years of age. Sinusitis symptoms typically appear around the 3rd to 5th day of an acute cold. After this point, a decrease in URTI symptoms is generally expected, but if fever rises above 39°C, if there is periorbital edema (swelling around the eyes), and if there is cheek pain (uncommon in children but more likely in adults), acute sinusitis should be considered. Prolonged URTI symptoms persisting for more than 10 days may also raise suspicion of acute sinusitis.
Coughing at night, while a common symptom of URTIs, can also be a sign of acute sinusitis. However, when a persistent cough continues during the day, it usually suggests acute sinusitis. Headaches are not very common in children with sinusitis. On throat examination, postnasal drip may be observed. Nasal examination may reveal thick, yellow-green mucus, which is indicative of sinus infection. Sinus X-rays are often taken for diagnosis, but they can sometimes lead to incorrect interpretations. Furthermore, acute viral infections can be misdiagnosed as acute sinusitis. Therefore, caution is needed when interpreting sinus X-rays. Antibiotic treatment should be administered for 14-21 days.