OTITIS MEDIA (OM)

DESCRIPTION: Otitis Media is an inflammation of the middle ear that may also be accompanied by infection. OM is one of the most common childhood illnesses but can also occur in adults as well. Occurs more frequently in boys Peak incidence is during the winter months Children with conditions such as cleft lip/cleft palate and Down syndrome more often experience OM Breastfeeding appears to have a protective effect against OM Other risk factors: exposure to secondhand smoke, bottle propping, bedtime milk bottle In very small children chronic OM can cause speech development delays ETIOLOGY AND PATHOPHYSIOLOGY: The specific cause of OM is unknown but it appears to be related to Eustachian tube dysfunction Often an upper respiratory tract infection precedes OM and causes the mucous membranes of the Eustachian tube to become edematous. As a result of this edema, air that normally flows to the middle ear is blocked and the air in the middle ear is reabsorbed into the bloodstream Fluid is pulled from the mucosal lining into the former air space providing a medium for the rapid growth of pathogens The tympanic membrane and and the fluid behind it become infected. Conditions such as enlarged adenoids or edema from allergic rhinitis can also obstruct the Eustachian tube and lead to OM Pacifier use can also lead to OM:

 Pacifier use raises the soft palate and may alter dynamics in the Eustachian tube providing entry of microorganisms from the nasopharynx The three common forms of otitis media are:

Acute otitis media Chronic otitis media Serous otitis media (otitis media with effusion)

Each type affects the middle ear but has different causes and pathologic changes. If otitis progresses or is untreated, permanent conductive hearing loss may occur.

Acute disease has a sudden onset and lasts 3 weeks or less.

Chronic otitis media often follows repeated acute episodes, has a longer duration, and causes greater middle ear injury. It may be a result of the continuing presence of a biofilm in the middle ear.

A biofilm is a community of bacteria working together to overcome host defense mechanisms to continue to survive and proliferate.

Serous otitis media (otitis media with effusion) is the result of fluid building up behind the tympanic membrane which is not infected and is associated with hearing loss. CLINICAL MANIFESTATIONS:

 Infants and Young Children: Pulling at the ear (sign of ear pain) Diarrhea Vomiting Fever Irritability Night awakenings Crying Some children may be asymptomatic

Older Children and Adults: Ear pain Sensation of fullness or pressure Tinnitus Reduced/distorted hearing Crackling/popping sensation when swallowing or yawning Headache Malaise Nausea Vomiting Dizziness/vertigo

 Otoscopic examination:

The eardrum is initially retracted, which allows landmarks of the ear to be seen clearly. At this early stage, the patient has only vague ear discomfort.

As the condition progresses, the eardrum's blood vessels dilate and appear red.

In the third stage, the eardrum becomes red, thickened, and bulging, with loss of landmarks. Decreased eardrum mobility is evident on inspection with a pneumatic otoscope. Pus may be seen behind the membrane.

If the condition progresses, the eardrum spontaneously ruptures and pus or blood drains from the. When the membrane ruptures, the patient notices a marked decrease in pain as the pressure on middle ear structures is relieved

Repeat perforations may cause permanent damage and hearing loss. MEDICAL MANAGEMENT: Antibiotics (acute and chronic otitis media)- Physician may want to watch and wait and delay antibiotic therapy to see if OM will resolve on its own.

First-Line Therapy is Amoxicillin

Second Line Therapy: Augmentin (Amoxicillin-Clavulantate) or

Cefuroxime

If an IM injectable antibiotic is chosen: Cefdinir, Cefpodoxime or Cefuroxime may be used.

WATCH FOR DRUG ALLERGIES!!! Especially penicillin or cephalosporin allergies.

Other medication that may be used (all types):

Tylenol (acetaminophen) or Motrin (ibuprofen) for pain and fever

Anesthetic eardrops for pain

Treatment of Serous Otitis Media involves symptomatic treatment and pain relief and is not treated with antibiotics.

The patient is evaluated frequently to monitor the problem.

Audiology tests are done to evaluated for hearing loss.

Serous Otitis Media typically resolves within 3 months.

Surgical Treatment:

 Myringotomy (surgical incision into the eardrum to relieve pain and pressure) or Tympanostomy (tube placement to drain fluid and equalize pressure) NURSING MANAGEMENT/PATIENT EDUCATION: Keep head elevated (lying flat or at a low angle can increase the pressure in the middle ear)

Warm compresses to the ear for pain relief (yeah right)

Educated patient or parents about medication administration: oral antibiotics, the correct way to administer eardrops, oral Tylenol or Motrin.

Emphasize the need to finish the entire course of antibiotics- not doing say may not kill off the infection and chronic otitis media can result.

Educate patient about the effects of reoccurring ear infections- damage and hearing loss.

Avoid risk factors: exposure to secondhand smoke, bottle propping, bedtime milk bottle; avoid known allergens.

Childhood immunizations to prevent otitis media- HIB and Pneumonia Vaccine

Anticipatory guidance for hearing testing

Follow-up for evaluation after antibiotics.