Acute Otitis Media

NUR 6435
Faculty: Dr. Kirkendol

By: Melinda Powell

December 19, 2021
 Chief Complaint
CC: Mother of 5-year-old male patient
presents today with child for c/o ear pain.
HPI
History of Present Illness:
Historian: Mother

Mother reports son was doing well until he developed a

cough with nasal discharge in which he was diagnosed with
an upper respiratory infection about 5 days ago. Two Days
ago, mother noticed son frequently tugging at his right ear
with minimal interest in playing with toys. Subsequently, child
became lethargic and stopped drinking fluids about 48 hours
before he developed a fever of 102.1°F and begin complaining
of right ear pain.
 PMH
Past Medical
History:
Upper Respiratory Infection x 5 days ago
Ear Pain x 2 days
Fever 102.1
• Chronic Illnesses/Major traumas: None
• Hospitalizations/Surgeries: None
• Immunizations: Up to date
Medication List
Allergies: NKA

Prescription: None

OTC: Children's Tylenol for fever

and pain
 FMH
Family Medical
History:
• FH: Both parents alive and well.
• Mother – 28 y. o. No history of illness or
disease. Pregnancy normal with delivery at
40 weeks. No gestational complications
• Father- 30 y. o. No history of illness or
disease
Social History

The child lives with both parents

Attends primary school kindergarten full day
program daily
Patient has no siblings not pets
Neither parent smoke or drink alcohol.
Denies any illicit substance abuse or
exposure in the home. Denies unsafe home
environment and denies abuse in home.
Patient Profile
Activities of Daily Living: Is age-appropriate as child
feeds self , sleeps 8-10 hours daily bathes& dresses
self. Does minor chores such as place toys in toy
chest
No changes in school
Not participating in sport activity
Developmental History: Child is developing with
progress in accordance with his age meeting all
milestones. Child behavior is appropriate. No report
of weight loss or changes in appetite until 2 days ago.
 Review of System
• Cardiovascular: Denies chest pain or palpitations
• Skin: Denies rashes, lesions, or bruising
• Respiratory: Denies shortness of breath + nasal discharge + cough
• Eyes: Denies vision problems or changes in vision
• Ears: + Ear pain + ear tugging x 2 days
• Nose/Mouth/Throat: + nasal discharge, + cough + Recent upper respiratory infection Denies sore
throat, dysphagia, or hoarseness
• Gastrointestinal: Denies abdominal pain, nausea, vomiting diarrhea + decrease appetite
• Genitourinary: Denies dysuria
• Musculoskeletal: Denies joint pain, swelling, or stiffness
• Neurological: Denies head trauma, seizures, or falls
• Heme/Lymph/Endo: Denies bruising or bleeding.
• General Appearance: Parent‐child interaction appropriate, child look well-nourished and groomed
well. No acute distress noted.
Physical Exam
• Objective:
• Vitals are as follows:
• weight 40.5 lbs,
• height 43.0 inches
• BP 100/70
• HR 100
• RR 26
• Temperature is 102F.
Physical Exam
• HEENT: Eyes: PERRLA present, sclera white, conjunctiva pale.
• Ears: +Otalgia, +Erythema and +bulging TM. Nose: + nasal
drainage.
• Throat: No lesions, bleeding, swelling
• Neck: Supple, no masses.
• Respiratory: Clear to Auscultation
• Gastrointestinal: Soft, non-tender + Bowel sounds all 4
quadrants
• Musculoskeletal: Full range of motion in all extremities
• Skin: Warm, dry, clean and intact. No rashes or lesions.
 • Typically, AOM can be
Lab/Diagnostic diagnosed with physical
examination and symptoms;
Results usually no diagnostic tests are
necessary.
 5 years old

Risk Factors Recent Upper respiratory infection

Fever

Decreased appetite
Diagnosis and Differential
Myringitis
• DIFFERNTIATING SIGNS/SYMPTOMS -
These patients may have no symptoms
attributable to the middle ear, or mild
pain.

• DIFFERENTIATING TESTS - On otoscopy

there is erythema and injection of the
tympanic membrane in the neutral
position without other features of
otitis media
 Management

Treatment
• Pain should be assessed in children diagnosed
with AOM and, if present, the clinician treatment
plan is to reduce pain.
of • Antibiotic therapy should be prescribed for AOM
in children > 6 months with severe s/s such as
Acute Otitis moderate or severe otalgia or otalgia for at least
48 hours or temperature 39°C /102.1°F or higher.

Media • Amoxicillin should be prescribed for AOM unless

the child has received amoxicillin in the past 30
days
 Treatment with analgesics for pain control and may
include antibiotics for common bacterial organisms
causing otitis media Streptococcus pneumoniae,
Haemophilus influenzae and Moraxella catarrhalis.
When the suspected source of infection is of

Treatment
bacterial etiology the antibiotic of choice is high-
dose amoxicillin for ten days. Due to its high
concentration in the middle ear, Amoxicillin has
of good efficacy in the treatment of otitis media
Plan:
Acute Otitis • Acetaminophen -children: 10-15 mg/kg
orally/rectally every 4-6 hours when required,
Media OR
maximum 75 mg/kg/day

• Ibuprofen - children: 5-10 mg/kg orally every 6-8

hours when required, maximum 40 mg/kg/day
• Amoxicillin - children: 80-90 mg/kg/day orally
given in divided doses every 12 hours for 10 days
 Teaching & Health Promotion
• Mom/Dad/Caregiver will need to administer the antibiotics
as prescribed and until they are completed to avoid
recurrence of the ear infection and multidrug resistant
bacteria from emerging.
• If your child's symptoms do not improve within 2 to 3 days,
then bring him back for follow up care and instructions.
• An ear infection does not require any special restrictions
from your child's normal activities.
• He may return to school once the fever is gone and he is
feeling better.
Follow-Up
• Patients treated for AOM have an excellent
prognosis.
• When analgesics and antibiotics are started
patients usually improve over the next 2 to 3 days.
• Follow-up for patients with AOM is not needed or
required unless symptom worsen.
• Patients with persistent symptoms after 48 to 72
hours may need a broader spectrum antibiotic.
 References

Lieberthal, S. A., Carroll, E. A., Chonmaitree, T., Ganiats, G. T., Hoberman, A., Jackson, M., Joffe, D. M., Miller, T. D.,
Rosenfeld, R.M., Sevilla, D. X., Schwartz, H. R., Thomas, A. P., & Tunkel. E. D., (2013). The Diagnosis and
Management of Acute Otitis Media. Journal of the American Academy of Pediatrics, 3(131).e964-e999; DOI:
https://doi.org/10.1542/peds.2012-3488

Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., Hoelting, D., Hunter, L. L., Kummer,
A. W., Payne, S. C., Poe, D. S., Veling, M., Vila, P. M., Walsh, S. A., & Corrigan, M. D. (2019). Clinical Practice Guideline:
Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery, 1(540) h
ttps://doi.org/10.1177/0194599815623467

Danishyar A, Ashurst JV. Acute Otitis Media. (2021). In: StatPearls. Treasure Island (FL): Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470332/
Diagnosis and Differential
Acute Otitis Media
• The diagnosis AOM ought to be made in
children presenting with moderate to severe
bulging of the tympanic membrane or new
onset of otorrhea not less than 48 hours onset
of ear pain or intense erythema of the TM.
• AOM may present with otalgia, irritability,
diminished hearing, fever, vomiting or anorexia
usually concomitant presence of a respiratory
infection.
• Physical examination will reveal a bulging,
opacified tympanic membrane with an
attenuated light reflex. The membrane may be
white, yellow, pink, or red.
Diagnosis and Differential
Otitis Media with Effusion
• DIFFERNTIATING SIGNS/SYMPTOMS -
Typically the middle ear effusion is
asymptomatic. Some older patients may
complain of fullness, a popping
sensation, decreased hearing or ringing
on the affected side.

• DIFFERENTIATING TESTS - On otoscopy

these patients have an effusion of any
color, air fluid levels, or bubbles with
normal tympanic membrane landmarks.