Otitis media

1. OTITIS MEDIA
Islamic University
Nursing College

2. OTITIS MEDIA
 Definition: Presence of a middle ear infection or
inflammation.
 Acute Otitis Media: occurrence of bacterial
infection within the middle ear cavity.
 Otitis Media with Effusion: presence of
nonpurulent fluid within the middle ear cavity (viral)
 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. MICROBES AT FAULT!!!
 Streptococcus pneumoniae
 Haemophilus influenzae(non-typeable)
 Moraxella catarrhalis
 Group A Streptococcus
 Staph aureus
 Pseudomonas aeruginosa
 RSV assoc. with Acute Otitis Media

5. 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.

6. RISK FACTORS
 Upper Respiratory Infections.
 Allergies.
 Craniofacial abnormalities. (cleft palate)
 Down’s Syndrome.
 Passive smoking.
 Eustachain tube, short, wide & straight.

7. PATHOGENESIS
 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

8. 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.

9. 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

10. DIAGNOSIS
Pneumatic Otoscopy: standard tool for diagnosis
Impedance Tympanometry: useful for MEE.
Measures the resonance of the ear canal for a fixed
sound as the air pressure is varied.
Spectral Gradient Acoustic Reflectometry:
measures the condition of the middle ear by
assessing the response of the TM to a sound
stimulus. Equivalent to tympanometry for dx of middle
ear effusions

11. Diagnosis cont.
 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.
 With the increasing incidence of drug resistant strains
of S. pneumoniae, CDC recommends the capacity of
clinicians to be efficient in using tympanocentesis.

12. INDICATIONS FOR TYMPANOCENTESIS
 Toxic appearing child
 Failed treatment regimen with
antibiotics
 Suppurative complications
 Immunosuppressed pt.
 Newborn infant in which the usual
pathogens may not be the case.

13. DIFFERENTIAL DIAGNOSIS
 Otitis externa
 Bullous myringitis
 Cerumen impaction
 Dental abscess
 Foreign body in ear canal
 Referred pain (parotid/tooth/lymphadenitis)
 Tonsilitis

14. TREATMENT
 Amoxicillin: 20-40 mg/kg/day tid for 10-14 days
or,
 Augmentin: 45 mg/kg/day po bid for 10-14 days
 Auralgan: analgesic/adjunct for ear pain 2-4 drops
tid

15. 2nd
Line Treatment Regimen
 Cefzil
 Pediazole ( erythromycin/sulfisoxazole)
 Bactrim (trimethoprim/sulfamethoxazole
 These medications are used as
secondary agents if the primary
antibiotic has failed after 10 days and
the symptoms persists.

16. COMPLICATIONS
 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

17. Complications cont…
 Intracranial complications
 Bacterial meningitis
 Epidural abscess
 Subdural empyema
 Brain abscess
 Otitic hydrocephalus
 Lateral sinus thrombosis

18.  Nursing Intervention
 Parent teaching about prophylactic care
 Position infants as upright as possible during feeding
to avoid reflux of formula into eustachian tube.
 Avoid smoking around infants and children.
 Administer analgesics as ordered to provide pain
relief.
 Heat pack application over the ear may relieve pain
for some children.

19.  Position child on the affected side to promote
drainage (if draining, or postoperatively after
myringotomy).
 Assist in removal of drainage, when possible
 Postoperative support may include wicks inserted
loosely in the ear to promote drainage but prevent
infection transfer to middle ear.
 Frequent cleansing of outer ear and moisture barrier
on ear to protect from purulent drainage.

20. Family-centered care
 Educating the family in care of child
 Analgesia for pain management
 • Postoperative care to prevent spread of infection
and promote healing
 Providing emotional support to the child and family
 • Explain the process for management of drainage.
 • Encourage follow-up evaluation of hearing to detect
any loss of hearing.