Otitis Media_729758e1424f96aa59a699aaff5ebb0f.pdf

Biology

1. OTITIS MEDIA
Emma Nyakuri
ENT Nursing

2. OTITIS MEDIA
•Definition: Presence of a middle ear 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
•OM is the second most common clinical problem in childhood after
upper respiratory infection.

3. EPIDEMIOLOGY
•Peak incidence in the first two years of life (esp. 6-12
months)
•Boys more affected girls
•50% of children 1 yr of age will have at least 1 episode.
•1/3 of children will 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

4. Common causative microbes.
•Streptococcus pneumoniae
•Hemophilus influenza.
•Moraxella catarrhalis
•Group A Streptococcus
•Staph aureus
•Pseudomonas aeruginosa
•RSV assoc. with Acute Otitis Media

5. RISK FACTORS
•Upper Respiratory Infections
•Allergies
•Craniofacial abnormalities (cleft palate)
•Down’s Syndrome
•Passive smoking

6. Pathogenesis
•This problem mainly deals with eustachian tube dysfunction.
Otitis Media usually follows an URI in which there is edema of
the eustachian tube, leading to blockage. Stasis of these
middle ear secretions lead to infection and irritation
•Other factors: allergic rhinitis, nasal polyps, adenoidal
hypertrophy

7. Classification of Otitis Media
•Acute Otitis Media: presents with fever, Otalgia, and
hearing loss
•Otitis Media with Effusion: evidence of middle ear
effusion on pneumatic otoscopy
•Recurrent Otitis Media: inability to clear middle ear
effusions
•Chronic Serous Otitis Media: presents as ‘fullness in the
ear’, tinnitus, or another acute disease.

8. Acute otitis media
It is an acute infection of the middle ear, usually lasting less
than 6 weeks.
Causes
Primarily Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis.
Inflammation of surrounding structures (eg, sinusitis, adenoid
hypertrophy).
Allergic reactions (eg, allergic rhinitis). It is usually present in
the middle ear, resulting in a conductive hearing loss.
8

9. Cont…d
Clinical Manifestations
Otalgia (unilateral in adults) may awaken patient at night.
Pain relieved after tympanic perforation.
drainage from the ear (purulent exudate).
Fever.
Hearing loss (conductive hearing loss).
The patient reports no pain with movement of the auricle. The
tympanic membrane is erythematous and often bulging.
9

10. Cont…d
Medical Management
Antibiotics:-
•Co-trimoxazole,4mg/kg trimethoprin 20mg/kg
sulphomethaxozole twice a day for 05 days.
•Amoxicillin, 20-40mg/kg/day divided into 3 doses po/for 5 days
•Clean the external auditory canal
•Cover with cotton
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11. Cont…d
Surgical management
An incision in the tympanic membrane is known as myringotomy or
tympanotomy.
The incision heals within 24 to 72 hours.
Indication;
For analysis of drainage (by culture and sensitivity testing).
If pain persists.
If episodes of acute otitis media recur and there is no contraindication, a
ventilating, or pressure-equalizing tube may be inserted.
The ventilating tube, which temporarily takes the place of the eustachian tube in
equalizing pressure, is retained for 6 to 18 months.
Ventilating tubes are more commonly used to treat recurrent episodes of acute
otitis media in children than in adults.
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12. Cont…d
Complications
•Chronic OM
•Mastoiditis
•Meniningitis
•Brain abscess
12

13. Cont…d
Comparison between AOE and AOM
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14. Serous otitis media
Serous otitis media (i.e., middle ear effusion) implies fluid, withoutevidence of
active infection, in the middle ear.
Causes
Children:-eustachian tube obstruction (negative pressure in the middle ear)
Adults:-eustachian tube dysfunction (concurrent upper respiratory infection
or allergy)
-Radiation therapy.
-Barotrauma(results from sudden pressure changes in the middle
ear caused by changes in barometric pressure, as in scuba diving or airplane
descent.
-Carcinoma (eg, nasopharyngeal cancer).
14

15. Cont…d
Clinical Manifestations
Hearing loss (conductive hearing loss),
Fullness in the ear,
Sensation of congestion,
Popping and crackling noises,
Dull tympanic membrane
Diagnosis
•Otoscope-dull TM, and air bubble shown in the middle ear.
•Audiogram-to exclude conductive hearing loss.
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16. Cont…d
Management
Myringotomy.
Tube may be placed to keep the middle ear ventilated.
Corticosteroids.
Valsalva maneuver (do cautiously).
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17. Normal ear drum

18. AOM (pus behind the eardrum)

19. Serous Otitis media

20. Clinical presentation
•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 I personality

21. 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

22. Diagnosis.
Diagnostic tympanocentesis & myringotomy:
•Involves puncturing the tympanic membrane and
aspirating middle ear fluid to relieve pressure.
Only used if the primary and secondary line
treatment fail.

23. Indications for tympanocentesis
1.Toxic appearing child.
2.Failed treatment regimen with antibiotics
3.Suppurative complications
4.Immunosuppressed pt.
5.Newborn infant in which the usual pathogens may not be the
case.

24. Differential diagnosis
•Otitis externa
•Bullous myringitis
•Cerumen impaction
•Dental abscess
•Foreign body in ear canal
•Referred pain (parotid/tooth/lymphadenitis)
•Tonsilitis

25. Management.
1.Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or,
2.Augmentin: 45 mg/kg/day po bid for 10-14 days
3.Analgesia: Paracetamol, ibuprofen

26. 2
nd
Line Treatment Regimen
•Cefzil
•Erythromycin(if allergic to penicillin)
•Septrine (trimethoprim/sulfamethoxazole)
•These medications are used as secondary agents if the
primary antibiotic has failed after 10 days and the symptoms
persists.

27. Complications of AOM.
•Hearing loss: conductive, sensoneural, mixed)
•Acute mastoiditis: before the advent of antibiotics
•Chronic perforation of the TM
•Tympanosclerosis
•Cholesteatoma
•Chronic Suppurative OM
•Cholesterol granuloma: ‘Blue drum syndrome’
•Facial nerve paralysis

28. Nursing care
Nursing Assessment.
•Assessment of a child with otitis media include the
following:
•Physical examination. The infant’s ear is examined with
an otoscope by pulling he ear down and back to
straighten the ear canal.
•History.Assess if there is a history of trauma of the ears,
affected siblings, a history of cranial/facial defects or any
familial history of otitis media.

29. Nursing Diagnoses.
•Acute pain related to inflammation and increased pressure from
fluid accumulation in the middle ear
•Anxiety related to health status.
•Impaired verbal communication related to effects of hearing
loss.
•Disturbed sensory perception related to obstruction, infection of
the middle ear, or auditory nerve damage.
•Risk for injury related to hearing loss, decreased visual acuity.
•Infection related to presence of pathogens.

30. Nursing Interventions.
•Positioning. Have the child sit up, raise head on pillows, or lie on
unaffected ear.
•Heat application. Apply heating pad or awarm hot water bottle.
•Diet. Encourage breastfeeding of infants as breastfeeding affords
natural immunity to infectious agents; position bole-fed infants
upright when feeding.
•Hygiene. Teach family members to cover mouths and noses when
sneezing or coughing and to wash hands frequently.
•Monitoring hearing loss. Assess hearing ability frequently.

31. 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.