otitis media in children

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

3. 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

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

5. 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

6. 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.

7. 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

8. 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

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

10. 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
• Tympanostomy tube insertion.

11. Otitis media with effusion

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

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

15. 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.

17. Chronic Suppurative
Otitis Media

18. 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

19. 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

20. Types of CSOM
• Tubotymapnic
• Atticoartral

21. 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

22. 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

23. Surgical management of CSOM
• Repair 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.

24. 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

25. IMNCI Management of ear problem

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

27. • 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

28. Summary

29. 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.