Dr Raymond Awazi, a pediatrician at t Hôpital la Croix du Sud in Remera, Kigali, says over 70 per cent of the people he treats have flu. “Despite being common, flu is a symptom of bigger complications, especially if the symptoms are not well-treated or in case of recurrent colds. The most affected group is children under the age of five, mainly because of their weak immune systems,” says Awazi. He says that generally there is no treatment for flu both in adult and children, but patients are given painkillers and vitamin supplement to provide relief. If the viral infection is not treated well, it can lead to further complications such as ear infections, especially in children, Awazi warns. Dr Awazi attending to a child with a respiratory infection. / Photo by Lydia Atieno. He further explains that the ear infection comes in due to the closeness between the nose and the middle ear. “When one has flu, it can be transmitted to the middle ear through the eustachian tube, normally referred to as inflammation of the middle ear. This is caused by bacteria that travel to the middle ear, if the fluid is trapped in the eustachian tube,” Awazi says. Risk factors of ear infection Dr Protais Munyarugamba, an ear, nose and throat specialist at Harmony de Clinic in Kigali, says the most common risks factors for ear infection in children are recurrent cold due to allergy and cough. “Untreated or recurrent flu can cause inflammation and trapping of fluids in the tube connecting the ear and throat, which can cause infection and inflammation of the middle ear,” he says. Munyarugamba notes that due to the interconnectedness of the nose, throat and ears, it makes it easy for infection of one part to spread to another part. “When the inflammation of the ear occurs, the ear drum becomes congested, which leads to an infection of the ear known as otitis media,” he adds. Munyarugamba points out that when inflammation has occurred, a child may experience ear pain, high fever, scratching of the ear, diarrhea, vomiting and discharge (puss) from the ears. On the other hand, if the otitis becomes chronic or recurrent, there is risk of perforation of the ear drum, leading to impaired hearing. Further complications Dr Awazi says when the infection passes on to the inner ear, it can cause deafness and dizziness either with or without vomiting. He adds that in incidences of otitis, there is a risk of infection spreading to the brain via the blood stream which can cause serious infection of the brain such as abscess. Also, presence of these microbes in the blood stream can lead to septicemia. Dr Munyarugamba says, there can be rupture of the ear-drum due to pressure buildup of the fluids accumulated in the ear. “Before the rupture, a child can experience pain which eventually goes away after the rupture. At this stage, there is no pain at all, but the pus will continue coming out of the ear and due to ignorance of some parents, they will not seek medication early enough which can lead to further complications,” he notes. He advises that with or without pain, parents should consult a doctor in case of a discharge from the ear. Munyarugamba says if the otitis is not treated, the middle ear eventually enlarges, which can lead to destruction of the entire ear, leading to meningitis. “Exposure to smoke, swimming, feeding babies and toddlers from the bottle in supine position, exposure to cold air, change in altitude, schools and daycare centres are also most common settings which spread infection in children,” he adds. Dr Rachna Pande, a medic at Butaro Hospital, says problems in the upper respiratory system, difficulty in breathing as well as blocked and running nose, are the other complications associated with flu in children. Measures to minimise ear infections Dr Pande explains that some certain measures can help reduce ear infections. “For babies, it is advisable not to allow anyone coughing or sneezing to hold them. Anybody handling them should have clean hands. Don’t feed a baby in supine position; their head should be up slightly. Teach good hygiene to children such as using tissue if he/she has a cold or cough and the importance of covering their mouth while coughing,” she says. Pande cautions that one should not allow anybody to smoke in proximity of their child. In case of cold weather, the child should be well-covered. While moving outdoors, their ears can be covered by a scarf or cap to prevent exposure to draughts of air. “In case of a cold or cough, it should be treated by keeping good hydration of the child and administering the right medicines,” she adds. Dr Munyarugamba says influenza is mostly viral in nature and can subside by itself. However, there is risk of superadded bacterial infection occurring which can cause a high fever, listlessness and even diarrhea and vomiting in babies and young children. “Treatment of such symptoms is first by diagnosis, then giving antibiotics and nasal drops. Since the symptoms are normally accompanied by a high fever and pain, painkillers are ideal,” he says.
