OTITTIS MEDIA

o o Definition: Inflammation of the middle ear; occurs bilaterally in 50% of diagnosed cases Incidence: Highest in children 6 months 2 years old; gradually with age except small increase in children from 5 - 6 years old (time of school entry)

Etiology 1. 2. 3. 4. Wider, shorter, and more horizontal Eustachian Tube in Infants Preceded with URI caused by Haemophilus Influenza and Streptococcus Pneumoniae Non Infectious has unknown etiology but frequently d/t blocked Eustachian Tube Supine position during feeding and reflux of fluids in middle ear (ex. Bottle Propping)

Diagnosis 1. Clinical Manifestation a. AOM follows an URI, otalgia (earache), periorbital pain, fever, ottorrhea (purulent discharge of light yellow to golden brown) may or may not be present. o In Infants crying, fussy, irritable, restless, tend to rub / hold / pull affected ear, moves head from side to side; loss of appetite o In Older Child crying, verbalize discomfort, lethargy, loss of appetite b. COM hearing loss, difficulty of communication, tinnitus (wringing in the ears), vertigo (dizziness) Otoscopy a. AOM intact tympanic membrane, bright red & bulging, no bony landmarks and light reflx b. OM with Effusion slightly inflamed, with visible meniscus or fluid level behind eardrum Pneumatic Otoscopy assessment of Tympanic Membranes Mobility Tympanometry (Confirmatory Testing) o Measures change of air pressure in external auditory canal from the movement of Tympanic Membrane o Presence of fluids in middle ear the movement or compliance of tympanic membrane.

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Treatment: 1. Medical Treatment - started when one at least meets the ff: a. > 3 ear infections for the past year b. > 3 complaints of tinnitus, vertigo, pressure in the ear, and dry ear wax c. (+) Respiratory Culture d. High Risk for Bacterial Infections because of immunosuppressions, CF, Splenectomy, Sickle Cell Anemia, and Living with a smoker Medications a. Amoxicillin (Antibiotic; Broad Spectrum Pen) b. Cephalosphorins (Antibiotic) c. Erythromycin, Clarithromycin, Azithromycin (Antibiotic; Macrolides for soft tissue infections) d. Ceftriaxone rd o (Antibiotic; 3 generation Cephalosphorins for gram (+) and gram (-) bacteria) o Single dose IM; Improves within 48 72 hours e. Analgesic / Anti Pyretic to relieve pain and inflammation

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Surgery a. Myringotomy surgical incision of the middle ear to relieve symptoms; laceration of middle ear to be fluid free. b. Myringotomy w/ Tympanostomy Tubes or PE Tubes (Pressure Equalizer Tubes or Grommets) facilitate continued drainage and ventilation of the middle ear.

Complications 1. 2. 3. 4. 5. Conductive hearing loss tested thru tuning fork; reasons are the ff: o Impacted Cerumen, Perforated Membrane, Pus in Middle Ear, or Otosclerosis (Fusion of Ossicles) Perforated or Scarred Tympanic Membraine Mastoiditis inflammation of mastoid air cell system Choleosteotoma cyst like lesion that damages auditory structures Intracranial Infections -- Meningitis

Nursing Management 1. Relieve Pain a. Local Heat for vasodilation; relieves pain and inflammation b. Ice Compress for vasoconstriction; numbness c. Apply local heat with a dampened then dried towel for 10 mins with a 30 min interval then apply ice compress or cold compress. Check if area is reddened. 2. Facilitate Drainage by lying on the affected ear. 3. Prevent recurrence and complication Proper Bottle Feeding 4. Educate Family in the care of the child o Appearance of grommet, tiny, white spool tube o Initial Sign of OM in Infants: IRRITABILITY PULLING. 5. Emotional Support for the Child and Family.