Otitis media in children

otitis media in children

1. Otitis Media Presented By: Mahesh Gahlot M.sc(N) 1 st Year CON AIIMS Jodhpur

2. Otitis media is the infection of air-filled space behind the ear drum which is usually caused by bacteria or virus Definition Otitis media is a common early childhood infection. Anatomic features that make young children particularly susceptible to ear infections include shorter, more horizontal and compliant eustachian tubes and bacterial carriage in the adenoids

3. Risk factor of otitis media Exposure to cigarette smoke Overcrowding Bottle-feeding Cleft palate Down syndrome Allergy and immune dysfunction.

4. Pathophysiology of otitis media Malfunctioning of eustachian tube Functional obstruction of eustachian tube Accumulation of secretions in the middle ear Intrinsic obstruction cause infection or allergy Extrinsic obstruction result of enlarged adenoids or nasopharyngeal tumors When the passage is not totally obstructed, contamination of middle ear infection take place by reflux, aspiration, or insufflation during crying, sneezing, nose blowing and swallowing when the nose is obstructed

5. Acute otitis media Presents over of days to 2 weeks in children between ages 6 and 24 months and 5 to 6 yr , characterized by severe pain and visible inflammation of tympanic membrane.

6. Etiology of Acute otitis media: Streptococcus pneumoniae and Haemophiles influenzae (65% ) 15% are caused by Moraxella a catarrhalis, Streptococcus pyogenes and Staphylococcus aureus 20 % caused due to respiratory pathogenes

7. Sign and symptoms of acute otitis media AOM is characterized by the rapid onset of symptoms, which may be local, e.g., otalgia or ear tugging, Systemic : fever or crying. Older children may report impaired hearing Ear discharge Changes in sleeping pattern Irritability

8. Diagnosis of acute otitis media History of recent upper respiratory tract Otoscopic examination Rupture of the drum with ear discharge

9. Treatment of acute otitis media Amoxicillin (80-90 mg/kg/ day) Agents with lactamase resistance (e.g., amoxicillin-clavulanic acid, cefaclor, cefuroxime or newer cephalosporins) are useful second-line drugs Initial antibiotic therapy should last at least 7 days. Re-examination is indicated after 3-4 days and at 3 weeks Tympanocentesis T ympanostomy tube insertion.

10. Otitis media with effusion

11. Chronic inflammation of middle ear characterized by accumulation of non purulent fluid behind an intact tympanic membrane

12. Sign and symptoms of otitis media with effusion Complain of hearing loss and ear fullness Otalgia Tympanic membrane with middle ear effusion. Poor schooling

13. Treatment of otitis media with effusion 65% of serous middle ear effusions resolve spontaneously within 3 months Use of antihistamines and decongestants is not recommended. If effusion persists beyond 3 months, tympanostomy tube insertion may be considered for any hearing loss >25 dB Insertion of long-term tubes (T-tube design) or adenoidectomy may be considered in patients with recurrent or persistent symptomatic effusion. T-tubes have been associated with tympanic membrane perforation. Earplugs are recommended while the tubes are in place to avoid entry of water into the middle ear space .

14. Chronic Suppurative Otitis Media

15. Ear drainage that persists for longer than 6 weeks is generally due to chronic inflammation of the middle ear space or mastoid air cells. Chronic suppurative otitis media (CSOM) invariably presents with tympanic membrane perforation

16. Etiology of CSOM The most commonly isolated organism is Pseudomonas aeruginosa; other organisms include Staphylococcus aureus, Proteus spp, E. coli Tonsilitis Allergies Tumors Poor socio-economic status

17. Types of CSOM Tubotymapnic Atticoartral

18. Diagnosis of CSOM Chronic ear discharge Ear examination A chronically draining ear may also be seen with cholesteatoma which is a sac of squamous epithelium extending from the tympanic membrane into the middle ear

19. Therapeutic management of CSOM Medical therapy consists primarily of topical antibiotics and aural toilet. Topical quinolones appear to be effective and safe Parents should be instructed to avoid water exposure. Otolaryngology referral is necessary to rule out cholesteatoma

20. Surgical management of CSOM R epair of the tympanic membrane perforation (tympanoplasty) with or without mastoidectomy. If cholesteatoma is suspected, ear exploration via mastoidectomy and cholesteatoma removal is mandatory. The primary goal of surgical therapy for cholesteatoma is to create a 'safe ear' by removal of all cholesteatoma. Hearing preservation is a secondary goal.

21. Complication of otitis media The most common complication of CSOM is hearing loss, which may affect language development and school performance. The hearing loss is usually conductive and results from middle ear edema and fluid and tympanic membrane perforation. Sensorineural hearing loss may rarely occur due to direct extension of inflammatory mediators into the inner ear Intracranial complication: Meningitis, Epidural abscess, Dural venous (sigmoid sinus) thrombosis Brain abscess, Otitic hydrocephalus Subdural abscess Extracranial complication: Acute coalescent mastoiditis, Subperiosteal abscess, Facial nerve paralysis, Labyrinthitis or labyrinthine fistula

22. IMNCI Management of ear problem

23. Nursing management of otitis media Nursing Management for children with AOM include: Relieving pain Facilitating drainage when possible Preventing complications or recurrence educating the family in care of the child providing emotional support to the child and family. Analgesic drugs such as acetaminophen (all ages) and ibuprofen (6 months of age and older) are used to treat mild pain.

24. Parents also need anticipatory guidance regarding methods reduce the risks of OM, especially in children younger than 2 years) Reducing the chances of OM is possible with measures such as sitting or holding an infant upright for feedings, maintaining routine childhood immunizations, and exclusively breastfeeding until at least the age of 6 months. Propping bottles is discouraged to avoid pooling milk while the child is in the supine position and to encourage h man contact during feeding. Eliminating tobacco smoke and known allergies is recommended

25. Summary

26. Conclusion Early detection of middle ear effusion is essential to prevent complications. Infants and preschool children should be screened for effusion, and all school children, especially those with learning disabilities, should be tested for hearing deficits related to a middle ear effusion .