Integrated management of neonatal and childhood illness

FEEL for tender swelling behind the ear

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module 5

FEEL for tender swelling behind the ear. Feel behind both ears. Compare them and decide if there is tender swelling of the mastoid bone. In infants, the swelling maybe above the ear. Both tenderness and swelling must be present to classify mastoiditis, a deep infection in the mastoid bone. Do not confuse this swelling of the bone with swollen lymph nodes.

6.2 CLASSIFY EAR PROBLEM
There are four classifications for ear problem
MASTOIDITIS ACUTE EAR INFECTION CHRONIC EAR INFECTION NO EAR INFECTION Here is the classification table for ear problem from the ASSESS & CLASSIFY chart.

• Tender swelling behind the ear

MASTOIDITIS
Give first dose of injectable
chloramphenicol ( If not possible
give oral amoxycillin).
Give first dose of paracetamol
for pain.
Refer URGENTLY to hospital
#
•
Pus is seen draining from the ear and discharge is reported for less than 14 days, or Ear pain

ACUTE EAR
INFECTION

Give Amoxycillin for 5 days. Give paracetamol for pain. Dry the ear by wicking. Followup in 5 day Pus is seen draining from the ear and discharge is reported for 14 days or more.

CHRONIC EAR
INFECTION Dry the ear by wicking. Topical ciprofloxacin ear drops for two weeks. Followup in 5 days No ear pain and
• No pus seen draining from the ear

NO EAR
INFECTION No additional treatment.

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MASTOIDITIS If a child has tender swelling behind the ear, classify the child as having MASTOIDITIS.
Treatment Refer urgently to hospital. This child needs treatment with injectable antibiotics. He may also need surgery. Before the child leaves for hospital, give the first dose of injectable chloramphenicol (if not possible, give oral amoxycillin).

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