Running head: PEDIATRIC CLIENTS WITH OTITIS MEDIA

The Importance of Providing Pain Management in Pediatric Clients with Otitis Media
Valentina M Ramirez
Humber College

PEDIATRIC CLIENTS WITH OTITIS MEDIA

The Importance of Providing Pain Management in Pediatric Clients with Otitis Media
Otitis media is a disease common in infancy that causes inflammation in the middle ear
(Perry, et al., 2014, p.1325-1326). One of the top priorities for the nurse who is providing care to
a pediatric client that is experiencing symptoms of otitis media is to perform a pain assessment
within the first 24 hours (Diagnosis and management of acute otitis media, 2004, p. 1454).
Otalgia, ear pain, is one of the cardinal signs of acute otitis media (Perry, et al., 2014, p. 1327).
Otalgia is brought on by an obstruction in the eustachian tube; the build-up of bodily secretions
within the middle ear that causes a negative middle ear pressure (Perry, et al., 2014, p. 1326).
Children younger than two years of age may express their pain by crying, pulling on affected ear,
rolling head from side to side, and showing a loss of appetite (Perry, et al., 2014, p. 1327).
Treatment of otalgia may include the use of analgesic or antipyretic medications such as
acetaminophen (Perry, et al., 2014, p. 1327). They allow for the relief of pain and fever (Perry, et
al., 2014, p. 1327).
When pain relief measures are not addressed in pediatric clients who are suffering from
otitis media then serious physical and social consequences begin to take effect. The disease
process can last from weeks to months depending on how much fluid has been built up in the
middle ear (Klein, 2001, p. 5). Crying will cause more mucous secretions to build, increasing the
negative middle ear pressure and adding onto the childs pain (Klein, 2001, p. 5). The intensity
of the otalgia lessens when the child stops crying, but when they continue crying it puts a strain
on their breathing patterns (i.e. decreasing their oxygen saturation and increasing their
respirations due to nasal congestion) (Diagnosis and management of acute otitis media, 2004, p.
1453). Non-stop crying can leave the child with a headache that will increase their level of
distress (Klein, 2001, p. 5) (Rosen, 2011, p. 245). This will negatively impact the childs sleeping

PEDIATRIC CLIENTS WITH OTITIS MEDIA

patterns and the way they communicate with others (Rosen, 2011, p. 244). Constant pain can
make the child unable or uninterested in eating (Rosen, 2011, p. 245). The fever can also cause
the child to vomit which would put them at risk for dehydration and electrolyte imbalance
(Ignatavicius & Workman, 2015, p. 1006). Improper food intake increases the chance of
becoming anorexic and it allows their already weakened immune system to become more
susceptible to other pathogens (Rosen, 2011, p. 245). Concerns for the childs motor and
language developmental skills normal for their age group can arise depending on the length of
time the child was affected by the otalgia and the number of times that child was infected with
otitis media. The child is less likely to concentrate or participate in learning activities while they
are affected by constant inner ear pain (Rosen, 2011, p. 244). If parents are not provided with
education on how to communicate with a child who has otitis media then they may not realize
that they are agitating the otalgia (Ignatavicius & Workman, 2015, p. 1014). Families may shout
at the child because they think the child is not listening but really the child is experiencing
reduced hearing and the shouting results in more pain and anxiety (Ignatavicius & Workman,
2015, p. 1014). This type of communication is unhealthy to the relationship between the child
and the family and it can put the child through psychological pain in the future.
In an effort to improve the health of a child with otitis media collaborative care is given.
The top collaborative care providers that can help give the best quality of care, specific to a child
with otitis media, can involve the childs primary health care provider, an audiologist, and an
ENT (ears, nose and throat) specialist. The childs physician plays a vital role in the care process.
They hold a collection of past medical history which includes any previous ear infections or any
recent illnesses (Department of Health, Western Australia, 2013, p.19). They can perform a
routine ear examination that will help with diagnosing otitis media (Department of Health,

PEDIATRIC CLIENTS WITH OTITIS MEDIA

Western Australia, 2013, p.19). They are then able to medically provide management of the
disease through prescription antibiotics and analgesics (Department of Health, Western Australia,
2013, p.19). The antibiotics will help eliminate the disease while the analgesics such as
acetaminophen will help alleviate pain and fever (Ignatavicius & Workman, 2015, p. 1006). If
the physician notices any abnormalities or any reoccurrences of the disease in his or her
examination than the child will be referred to a specialist (Department of Health, Western
Australia, 2013, p.22). An audiologist and an ENT specialist will be seen (Department of Health,
Western Australia, 2013, p.22). Audiologists are able to identify and treat auditory and balance
disorders (OSLA, 2010). There are cases when otitis media affects the vestibular system and it
can impair the brains sense of balance (OSLA, 2010). A child with vertigo or any sense of
dizziness can feel nauseous which adds onto to discomfort and pain associated with otitis media
(OSLA, 2010). Audiologists are able to intervene and offer balance retraining therapy to relieve
the childs vertigo (OSLA, 2010). It is imperative not to wait too long in between having the
hearing test done and going to see the ENT specialist (Department of Health, Western Australia,
2013, p.25). If the appointments are made too far apart then the disease has time to progress and
clinical decisions are then delayed; leaving the child in pain for longer (Department of Health,
Western Australia, 2013, p.25). A pediatric otolaryngologist is an ENT specialist who has
expertise in complex ear disorders and they are able to offer medical or surgical interventions to
alleviate otitis media (Department of Health, Western Australia, 2013, p.22). They perform their
assessments using child specific instruments and they do it in a child friendly environment to
ensure the child feels more relaxed (EBSCO, 2015). A myringotomy surgery may be
recommended when medical treatments are not working (EBSCO, 2015). This type of surgery
includes making a hole in the eardrum to fit a small plastic tube that will drain the fluid from the

PEDIATRIC CLIENTS WITH OTITIS MEDIA

inner ear (EBSCO, 2015). The draining process will help reduce the negative pressure that had
been built up over time (EBSCO, 2015). The child will experience alleviation of pain related to
otitis media and their hearing will be restored (EBSCO, 2015).
There are several community resources that can help pediatric clients with otitis media. In
Mississauga there is a non-profit organization called, Caring for Kids, that gives kids of
different age groups the opportunity to enhance their development (Caring for Kids, 2014). They
offer programs at their center located at 1110 Caven Street, Suite 105, Mississauga, ON L5G
4N4 (Caring for Kids, 2014).They also offer individualized care at the childs home; call 905270-3370 for further information (Caring for Kids, 2014). The programs incorporate the social,
emotional, and physical aspects of a childs life (Caring for Kids, 2014). For a child who is prone
to getting otitis media, the parents can consider registering them for home care programs instead
of programs at the center, this helps avoid any environmental exposure that puts the child at a
higher risk for reoccurrences of the disease (Caring for Kids, 2014). Another community
resource called, Ontarios Healthy Babies Healthy Children (HBHC), is a program that
provides information to parents to help maintain their babys health from birth (Region of Peel,
2013). The program offers public health nurses and family visitors at no cost to families when
they call 905-799-7700 (Region of Peel, 2013). The information that parents can learn from this
program can protect their infant. They will be more equipped in recognizing the signs and
symptoms of an unhealthy child and seek the proper treatment before further harm can be done.
The next community resource that can teach children about soothing behaviour is a program
called, The Winter 2016 Story times at the Library (City of Mississauga, 2015). They tell many
different stories to the children that encourage reading, talking, and listening (City of
Mississauga, 2015). For the sweet dreams story time, the family is encouraged to drop by the

PEDIATRIC CLIENTS WITH OTITIS MEDIA

library located at Meadowvale town center on January sixth from seven pm to seven thirty pm to
hear the story wearing their pyjamas (City of Mississauga, 2015). A child can find it relaxing to
lay in their parents arms while having a story told to them (City of Mississauga, 2015). If the
child is ill then parents can call 905-615-3500, then press the number five to enjoy a Childrens
International Dial-a-Story (City of Mississauga, 2015).
The consequences to ignoring all interventions that help with pain management for a child
with otitis media are grave. It can lead to more complicated problems like anorexia and severe
fever. Pain relieving medications like acetaminophen should be administered as soon as possible
if prescribed by the physician. The goal is to help the child improve their health status so that
they no longer have to endure the suffering caused by the pain in their inner ear. It is a hardship
that both the parents and the child have to endure but they do not have to do it alone. The
collaborative care providers find the best possible treatment for the child and the parents have the
opportunity to reach out to the many community resources that are nearby. These community
resources can better assess their child for the disease and provide comfort measures for the entire
family.

PEDIATRIC CLIENTS WITH OTITIS MEDIA

References
Caring for Kids. (2014). Home Care Advantages. Retrieved from Caring for Kids:
http://www.caringforkids.ca/index.php/auto-generate-from-title/home-care
City of Mississauga. (2015). Winter 2016 Storytimes at the Library . Retrieved from
Mississauga: http://www.mississauga.ca/portal/residents/programsforchildren
Department of Health, Western Australia. (2013). Retrieved from Otitis Media Model of Care:
http://www.google.ca/url?
sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=5&ved=0CDoQFjAEahUKEwjz5oW
61JrJAhWCdR4KHVuKD-8&url=http%3A%2F
%2Fwww.healthnetworks.health.wa.gov.au%2Fnetnews%2FOtitismoc.pdf&usg=AFQjCNEsuQXbWwRs29zZMUVYBbT59pDdlw&sig2=VA5_o6sYMU4VmlAk8
Diagnosis and management of acute otitis media. (2004, May). Pediatrics, 113(5), 1451-1465.
Retrieved from http://go.galegroup.com.eztest.ocls.ca/ps/i.do?id=GALE
%7CA116859334&v=2.1&u=humber&it=r&p=AONE&asid=32dcfb153f754fac2bac0a0
5bbf62b99
EBSCO. (2015). Patient Education. Retrieved from Pediatric Surgery Center:
http://pedsurgerycenter.com/patient-education/index.dot?
id=14847&db=hlt&ebscoType=static&widgetTitle=Otolaryngology+(Ear%2C+Nose
%2C+%26+Throat)
Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing: Patient-Centered
Collaborative Care (8th ed.). St. Louis: Elsevier Health Sciences.

PEDIATRIC CLIENTS WITH OTITIS MEDIA

Klein, J. O. (2001). The Burden of Otitis Media. Vaccine, 2-8.

OSLA. (2010). Proffessions. Retrieved from OSLA The Ontario Association of SpeechLanguage Pathologists and Audiologists: https://www.osla.on.ca/en/Audiologist?
mid=ctl00_LeftMenu_ctl00_TheMenu-menuItem000
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D., Sams, C., & Keenan-Lindsay,
L. (2014). Maternal Child Nursing Care in Canada (1st ed.). Toronto: Elsevier Health
Sciences.
Region of Peel. (2013, April ). Healthy Babies Healthy Children. Retrieved from Region of Peel
Working for You: http://www.peelregion.ca/health/great-beginnings/hbhc.htm
Rosen, D. A. (2011). Pediatric Pain Management. Pediatric Annals, 40(5), 243-252.

PEDIATRIC CLIENTS WITH OTITIS MEDIA