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INTRODUCTION
DEFINITION
INCIDENCE
More than 80% of children have at least one episode of otitis media by the
time they are three years of age. Nearly half of these children have three or more
episode by the time they are three years of age. It occurs more often in the winter
and early spring. The peak incidence of AOM is in children aged 3-18 months.
Some infants may experience their first attack shortly after birth and are
considered otitis, prone (ie, at risk for recurrent otitis media). Two of every three
children have at least one episode of otitis media by the time they are 1 year old.
Otitis media accounts for approximately 20 million annual physician visits.
Various epidemiologic studies report the prevalence rate of acute otitis media to be
17-20% within the first two years of life. One-third of children experience six or
more episodes of otitis media by age 7 years. Peak prevalence of otitis media in
both sexes occurs in children aged 6 to 18 months.
RISK FACTORS
Age.
Children between the ages of 6 months and 2 years are more susceptible to
ear infections because of the size and shape of their eustachian tubes and because
their immune systems are still developing.
Children cared for in group settings are more likely to get colds and ear
infections than are children who stay home. The children in group settings are
exposed to more infections, such as the common cold.
Infant feeding.
Babies who drink from a bottle, especially while lying down, tend to have
more ear infections than do babies who are breast-fed.
Seasonal factors.
Ear infections are most common during the fall and winter. People with
seasonal allergies may have a greater risk of ear infections when pollen counts
are high.
Exposure to tobacco smoke or high levels of air pollution can increase the
risk of ear infections.
Cleft palate.
Differences in the bone structure and muscles in children who have cleft
palates may make it more difficult for the eustachian tube to drain.
Genetic predisposition.
Although familial clustering of otitis media has been demonstrated in studies that
examined genetic associations of otitis media, separating genetic factors from
environmental influences has been difficult.
Anatomic abnormality.
Children with anatomic abnormalities of the palate and associated musculature have a
higher risk for otitis media.
Physiologic dysfunction.
Bacterial pathogens.
Many studies report that breastfeeding protects infants against otitis media.
TYPES
Fluid (effusion) and mucous continue to accumulate in the middle ear after an
initial infection subsides. This can cause the feeling of the ear being “full” and
affect your ability to hear clearly.
PATHOPHYSIOLOGY
Pus formation
Tympanic membrane rupture
CLINICAL FEATURES
1.Otalgia.
2.Otorrhea.
5.Fever. Two-thirds of children with otitis media have a history of fever, although
fevers greater than 40°C are uncommon.
6.Irritability. Irritability may be the sole early symptom in a young infant or
toddler.
DIAGNOSTIC FINDINGS
1.Laboratory tests.
2.Pneumatic otoscope
An instrument called a pneumatic otoscope is often the only specialized
tool a doctor needs to diagnose an ear infection. This instrument enables the doctor
to look in the ear and judge whether there is fluid behind the eardrum. With the
pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally,
this puff of air would cause the eardrum to move. If the middle ear is filled with
fluid, your doctor will observe little to no movement of the eardrum.
3.Tympanometry.
This test measures the movement of the eardrum. The device, which seals
off the ear canal, adjusts air pressure in the canal, which causes the eardrum to
move. The device measures how well the eardrum moves and provides an indirect
measure of pressure within the middle ear.
4.Acoustic reflectometry.
This test measures how much sound is reflected back from the eardrum —
an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs
most of the sound. However, the more pressure there is from fluid in the middle
ear, the more sound the eardrum will reflect.
5.Tympanocentesis.
Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid
from the middle ear — a procedure called tympanocentesis. The fluid is tested for
viruses and bacteria. This can be helpful if an infection hasn't responded well to
previous treatments.
Other tests.
If the child has had multiple ear infections or fluid buildup in the middle
ear, the doctor may refer to a hearing specialist (audiologist), speech therapist or
developmental therapist for tests of hearing, speech skills, language
comprehension or developmental abilities.
COMPLICATIONS
Most ear infections don't cause long-term complications. Ear infections that
happen again and again can lead to serious complications:
1.Impaired hearing.
Mild hearing loss that comes and goes is fairly common with an ear
infection, but it usually gets better after the infection clears. Ear infections that
happen again and again, or fluid in the middle ear, may lead to more-significant
hearing loss. If there is some permanent damage to the eardrum or other middle
ear structures, permanent hearing loss may occur.
Most eardrum tears heal within 72 hours. In some cases, surgical repair is
needed.
MANAGEMENT
Pharmacologic Management
The FDA has approved more than a dozen antibiotics to treat otitis media.
2.Adenoidectomy.
Nursing Management
Most infants and children with otitis media are cared for at home; therefore, a
primary responsibility of the nurse is to teach the family caregivers about
prevention and the care of the child
.
Nursing Assessment
6.Hygiene. Teach family members to cover mouths and noses when sneezing or
coughing and to wash hands frequently.
SURGICAL MANAGEMENT
NURSING DIAGNOSIS