14. Otitis Media in paediatrics and childhealth ppt

otitis media in paediatrics and childhealth nursing

1. OTITIS MEDIA
2022
Tekeste

2. Objectives:
By the end of this class, you will be able to:
Define OM
Describe the pathogenesis of OM
State the causative agents of OM
State the factors associated with OM
Classify Otitis Media
Describe phases of Acute Otitis Media
State the signs & symptoms of OM
Describe diagnostic criteria for OM
Describe Treatments for OM
State the complications of OM

3. OTITIS MEDIA
Definition: inflammation/infection of the
middle ear i.e., the area between the
tympanic membrane and the inner ear.
OM is the second most common clinical
problem in childhood after upper respiratory
infection.
Acute Otitis Media:occurrence of bacterial
infection within the middle ear cavity.
Otitis Media with Effusion: presence of non-
purulent fluid within the middle ear cavity

5. EPIDEMIOLOGY
Peak incidence in the first two years of life (esp. 6-12
months)
Boys more affected than girls
50% of children 1 yr of age affect at least 1 episode.
1/3 of children have 3 or more infections by age 3.
90% of children will have at least one infection by age
6.
Occurs more frequently in the winter months

6. Pathogenesis:
Infection mostly occurs in infants and
children because of the shorter and more
horizontal orientation of the Eustachian
tube which allows reflux from the pharynx.
This problem mainly deals with eustacian
tube dysfunction. Otitis Media usually
follows an URI in which there is edema of
the eustacian tube, leading to blockage.
Stasis of these middle ear secretions lead
to infection and irritation.
Other factors: allergic rhinitis, nasal polyps,
adenoidal hypertrophy

7. Bacterial Etiology:
S. pneumonia.
1. Incidence: 38%
2. Beta Lactamase producing: 15-25%
3. Causes more severe cases with Otalgiaand
fever.
NontypeableH. influenzae.
1. Incidence: 27%
2. Beta Lactamase producing: 35%
3. More often associated with eye redness and
discharge.
Moraxella catarrhalis.
1. Incidence: 10%
2. Beta Lactamase producing: 85-100%

8. Other Bacterias:
Group A Streptococcus
Staph aureus
Pseudomonas aeruginosa

9. Viral Etiology:
57% of RSV,
35% of influenza A,
33% of parainfluenza type 3,
30% of adenovirus,
28% of parainfluenza type 1,
18% of influenza B and
10% of parainfluenza type 2 virus
infections.

10. Fungal Etiology
Aspergillusor Candida

11. Correlation factors
Age: most in first 2 years
Sex: boy > girls
SES: poor SES
Breast milk vs formula-protectiv effect of breast milk
Tobacco smoke-positive correlation
Exposure to other child-positive correlation
Season-cold weather
Congenital anomalies-more with palatal defects,
craniofacial anomalies and down syndrome

12. Risk factors:
Upper Respiratory Infections
Allergies
Craniofacial abnormalities (cleft palate)
Down’s Syndrome
Passive smoking

13. Classification of Otitis Media
Recurrent Otitis Media: inability to clear
middle ear effusions.
Chronic Serous Otitis Media: presents as
‘fullness in the ear’, tinnitus, or another acute
disease.

14. Types of Otitis Media
Acute Otitis Media
Most common type seen in children
Occurs when there is fluid in the
middle ear
Occurs with inflammation of the TM
Presents with fever, otalgia, and hearing
loss
May be bacterial or viral

15. Phases of Acute Otitis Media
1st phase -exudative inflammation lasting 1–2 days,
fever, rigors, meningism(occasionally in children),
severe pain (worse at night), muffled noise in ear,
deafness, sensitive mastoid process, ringing in ears
(tinnitus)
2nd phase -lasting 3–8 days. Pus and middle ear
exudate discharge spontaneously and afterwards pain
and fever begin to decrease. This phase can be
shortened with topical therapy.
3rd phase -healing phase lasting 2–4 weeks. Discharge
dries up and hearing becomes normal.

16. Types of Acute Otitis Media…
Otitis Media without effusion:
Inflammation of the TM with fluid in
the middle ear.
May cause myringitis (cyst on TM).
Present during the beginning stages
of otitis media.
Formation of painful blisters on the
eardrum (tympanum).

17. Types of Acute Otitis Media…
Serous Otitis Media or Otitis Media with
effusion
Evidence of middle ear effusion on pneumatic
otoscopy.
Inflammation of the TM with fluid in the
middle ear.
Can cause hearing impairment and
delayed speech in children.
Since infants cannot hear they cannot
learn how to talk.

18. Chronic Otitis Media:
Occurs when the middle ear
infection perists and causes
significant hearing loss and damage
to the middle ear.
May involve a perforation of the TM.
Pus (otorrhea) may drain through
the ear canal.

19. Chronic Otitis Media -Types
Tubotympanic disease –called safe disease.
The infection is limited to the mucosa and
the antero inferior part of the middle ear
cleft, hence the name. This disease does not
have any risk of bone erosion.
Atticoantral disease –called unsafe disease.
Fatal intra-cranial and extra-cranial
complications can occur. Disease spreads by
erosion of the bony wall of the attic.
Cholesteatoma may occur (an abnormal skin
growth in the middle ear behind the eardrum).

20. Signs and Symptoms of ear infection
Signs
Crying,
Irritability,
Tugging or pulling on the ear
Ear drainage
Fever.
Symptoms
Ear pain,
Rhinitis,
Cough,
Hearing loss,

21. Signs & Symptoms
Neonates/Infants: change in behavior, irritability,
tugging at ears, decreased appetite, vomiting.
Children (2-4): otalgia, fever, noises in ears, cannot
hear properly, changes in personality.
Children (>4): complain of ear pain, changes in
personality.

22. On Physical exam…
The classic description for Otitis Media
is an erythematic, opaque, bulging
tympanic membrane with loss of
anatomic landmarks including a
dull/absent light reflex.
Pneumatic Otoscopy: decreased
tympanic membrane mobility

23. Diagnosis:
Pneumatic Otoscopy: standard tool for diagnosis.
Diagnostic tympanocentesis:involves puncturing
the tympanic membrane and aspirating middle
ear fluid to relieve pressure. Only used if the
primary and secondary line treatment fail.
With the increasing incidence of drug resistant
strains of S. pneumoniae, CDC recommends the
capacity of clinicians to be efficient in using
tympanocentesis.

24. Recommended Otitis Media Workup:
Laboratory Studies –sepsis workup
Imaging -CT scan of the temporal bones
MRI is more helpful in depicting fluid
collections
Weber and RinneTuning Fork tests
Tympanometry

25. Diagnostic criteria for OM:
Bulging TM
Impaired mobility of the TM
Loss of light reflex
Erythematous TM
Purulent otorrhea
Opacificationof the TM

26. Normal TM Appears as:
Translucent.
Light reflex extending anteriorly/inferiorly
from the umbo (most depressed part of the
tympanic membrane).
Pearly gray to pale pink membrane with
cone of light well visualized.
Mobile (to the air pulses).
Non-erythematous.

30. Differential diagnosis:
Cerumen impaction
Dental abscess
Foreign body in ear canal
Referred pain (parotid/tooth/lymphadenitis)
Tonsilitis

31. Treatment of acute otitis media
Amoxicillin at a dosage of 80 to 90 mg per
kg per day should be the first-line antibiotic
for most children with acute otitis media.
Patients with otitis media who fail to
respond to the initial treatment option
within 48 to 72 hours should be
reassessed to confirm the diagnosis.

32. Treatments:
1. Antibiotic duration
1. Age under 6 years
2. First Line:
1. Amoxicillin 80-90 mg/kg/day PO divided twice daily
for 10 days (7 days if age>6)
2. If Penicillin Allergy, use Macrolide (e.g. Azithromycin)
3. Second Line (10 day course)
1. Amoxicillin with clavulanate(Augmentin) 90
mg/kg/day divided twice daily for 10 days
2. Cefuroxime (Zinacef, Ceftin) 30 mg/kg/day divided
twice daily for 10 days
3. Cefprozil(Cefzil) 30 mg/kg/day divided twice daily for
10 days
4. Cefdinir(Omnicef) 14 mg/kg/day divided one to two
times daily fo10 days
5. Cefpodoxime(Vantin) 30 mg/kg once daily for 10
days

33. Treatments:
4. Third Line
Strongly consider Tympanocentesisfor
bacterial culture
Ceftriaxone 50 mg/kg IM daily for 3 days.
Clindamycin 30-40 mg/kg/day divided
four times daily for 10 days.

34. Treatment if allergic to penicillin
1.Clindamycin 30-40 mg/kg/day (max
1800 mg) divided four times daily for 10
days
2.Macrolide antibiotics :
Clarithromycin 15 mg/kg/day divided
twice daily for 10 days
Azithromycin at 30 mg/kg (up to 1500
mg) or three days of Azithromycin at 20
mg/kg/day once daily (up to 500 mg/day)
or
Azithromycin 10 mg/kg (max: 500 mg)
day 1, then 5 mg/kg/day (max 250 mg)
for 5 days

35. Complications of OM:
Acute mastoiditis –infection of the mastoid process.
Cholesteatoma –cystic lesion within the middle ear.
Hearing loss
Chronic perforation of the TM
Facial nerve paralysis
Intracranial complications
Bacterial meningitis
Epidural abscess
Subdural empyema
Brain abscess
Otitic hydrocephalus
Lateral sinus thrombosis

36. Nursing care plan
ASS (sub+ obj+ lab)
Nursing Dx
Planning
Inter
Evaluation
Documentation

37. REFERENCES
Dornbrand, Laurie. Manual of Clinical Problems in
Adult Ambulatory Care. 3
rd
ed., 1997. 59-61.
Hoberman, A., Paradise J. Acute Otitis Media:
Diagnosis and Management in the Year 2000.
Pediatric Annals2000. 29:10 609-619.
Nelson. Textbook of Pediatrics Pocket Companion
Wetmore, R. Complications of Otitis Media. Pediatric
Annals. 2000. 29:10. 637-645.

38. REFERENCES…
Robbins Pathology
Kaplan CK Lecture notes
www.fpnotebook.com
www.ncbi.nlm.nih.gov
www.nidcd.nih.gov
www.medicinenet.com
emedicine.medscape.com
www.webmd.com
kidshealth.org
cme.med.umich.edu
www.audiologynet.com