OTITIS

MEDIA
By Anjali Yadav
Bsc nursing 4th year
 Definition
It is an inflammation of
middle ear that most often
occurs in infant and young
children but can occur at
any age. An ear infection is
infection of the middle ear,
the air filled space behind
the eardrum that contains
the tiny vibrating bones of
the ear.
Anatomy Of Middle Ear
 Middle Ear
The middle ear has three bones- the
hammer or Malleus, the anvil or
incus and the stirrup or stapes. The
eardrum keeps the bones away
from the outer ear. A narrow path
known as Eustachian tube joins the
middle ear to the back of the nose
and upper part of throat. The
cochlea, a snail shaped structure is
a part of inner ear.
Role of Eustachian tube
The throat end of the tubes open and close
to:
-Regulate air pressure in the middle ear
-Refresh air in the ear
-Drain normal secretions from the middle
ear
Swollen Eustachian tube can become
blocked causing fluid to build up in the
middle ear. Thus become infected and
cause infection.
In children the Eustachian tube are
narrower and more horizontal which makes
them more difficult to drain and get
clogged.
Acute Otitis
Otitis Media With
Media Effusion

CLASSIFICATION

Chronic
Suppurative
Otitis Media
 Acute Otitis Media
Acute Otitis Media is a common illness in children resulting
from infection (bacterial or viral) of fluid in the middle ear.
Peak incidence in first 2 year of life especially between 6 & 12
months of age and 5 to 6 year.

Etiology : Common organism causing AOM are:

● Streptococcus pneumonia
● Haemophilus influenzae
● Moraxella catarrhalis
● Streptococcus progenies
● Staphylococcus aureus
 Diagnostic Evaluations
Otoscopic examination reveals a red and
bulging tympanic membrane with reduced
mobility as measured by either
tympanometry or insuffeation through the
otoscope.

The diagnosis of AOM is considered certain

if all the following criteria are met:
● Rapid onset
● Sign of middle ear effusion
● Sign and symptoms of middle ear
inflammation
 Therapeutic Management
Antimicrobial therapy is recommended
● Amoxicillin should be the first line therapy for acute otitis
media
● Higher dose 80-90 mg/kg/day considered where
streptococcal resistance is endemic
● Agents with B-lactamase resistance (Example: amoxicillin
clavulanic acid, cefaclor, cefuroxime) are useful second
line drug.
● Initial antibiotic therapy should last last at least 7 days
● Re-examination after 3 to 4 days and at 3 weeks.
● Tympanocentesis (aspiration of middle
ear fluid) with a bent 18 gauge spinal
needle on a syringe may provide
specimens for culture in patient with
complicated AOM who cannot tolerate
tympanostomy tube insertion.
● A child that has 4 episode of AOM in 6
months or 6 episode in 12 month should
be considered for tympanostomy tube
insertion.
● If a child requires a second set of
tympanostomy tubes concurrent
adenoidectomy is considered.
 Nursing Management
(I) Managing pain associated with AOM:
- Analgesic such as acetaminophen and ibuprofen
effective at managing pain with reducing fever.
- Narcotic analgesic such as codeine for severe pain
- Application of heat or cold compress
- Instruct the family to have the child lie on the affected
side with the heating pad or covered ice pack in place to
that ear.
- Numbing ear drops such as benzocaine for pain.
(II) Education to the family:
- if the treatment selected for AOM is observation or
watchful waiting explain the rationale for this to the
family.
- Ensured that the family understands the importance
of returning for revaluation if the child is not
improving or progress to severe illness
- The family must understand the importance of
completing the entire course of antibiotics.
- Emphasise the importance of follow-up to the
parents, educating them about OME and its potential
impact on hearing and speech.
(III) Preventing AOM:
- breastfed infants have a lower incidence, then normal
fed infant therefore encourage mothers to breastfeed
for at least 6 to 12 month
- Instruct to avoid excess exposure to individuals with
upper respiratory infection
- Infants and children should not be exposed to 2nd hand
smoke
- Encourage parents to stop smoking inside the house
- Encourage to have child immunised with the influenza
vaccine.
 Otitis Media With Effusion
● Otitis media with effusion and refers to the presence of
fluid within the middle ear space without sign or
symptoms of infection.
● Effusion are found to persist in up to 40% children one
month after AOM and 10% after three months or may not
have a history of previous acute middle ear infection
● Otalgia is not normally present
● If effusion persist beyond three months tympanostomy
tube insertion may be considered for any hearing loss >
25 dB
 Diagnostic Evaluation
Otoscopic examination may reveal a
dull , opaque tympanic membrane that
may be white, grey, or blush.
 Nursing Management
It takes several months to resolve
(I) Educating the family:
- OME usually resolve spontaneously bad.
Children should be re-checked every four week
while this resolution is occurring.
- Teach parents not to feed infant in supine
position into a wide body propping
(II) Monitoring for hearing loss:
- when OME persist, the primary concern is its effect on hearing
- Children with OME who are at risk for speech, language or
learning problem may be referred for evaluation of hearing
earlier than a child with OME who is not at risk
- To communicate more effectively with children with OME, who
have hearing loss
- Turn off music or TV
- Position yourself within 3 feet of child before speaking
- Face the child while speaking
- Increase the volume of speech only slightly
- Speak clearly
- Request preferential classroom settings
 Chronic Suppurative Otitis Media
● Ear drainage that persist for longer than six weeks is
generally due to chronic inflammation of the middle
ear space or mastoid air cells
● CSOM present with tympanic membrane perforation
which allows otorrhea
● Most often occurs in first five years of life as
Eustachian tube dysfunction plays a central role in
pathophysiology
 Etiology
Caused by:
● Pseudomonas aeruginosa
● Staphylococcus aureus
● Proteus spp
● E. coli and anaerobes
● Fungi ( aspergillosis and candida spp)
 Diagnostic Evaluation
● Chronic ear discharge is the hallmark of CSOM
● Otoscopic reveals perforations of tympanic
membrane
 Therapeutic Management
● Primarily of topical antibiotics
● Topical quinolones appear to be effective and safe
● Any sign of systemic involvement requires the use of
systemic antibiotic therapy
● Surgery is usually indicate in case of CSOM that do not
respond to conservative treatment
● Surgical therapy involves repair of tympanic membrane
perforation with or without mastoidectomy.
● Hearing preservation is secondary goal whereas primary
goal for cholesteatoma is to create a safe ear by removal of
all cholesteatoma.
● Symptom relief with analgesic and watchful waiting is
recommended. As approximately 80% of children with acute
Otitis Media have spontaneous resolution within 2 to 14 days.
● Antibiotic therapy amoxicillin is first line of treatment for
about 10 days. Co-trimoxazole, cefaclor, and erythromycin are
alternative antibiotic to amoxicillin
● Aspiration of middle ear or tympanotomy is done in severe pain
to drain the middle ear collection
● Treatment modalities include use of oral antibiotics, local
antibiotics, ear drops , ear wicking and dry mopping
● Surgical management is required for reconstruction of
tympanic membrane and ossicles in case of tubotympanic type
and reconstruction of hearing mechanism in patient with
cholesteatoma
 Complications
Mastoiditis
 Complications

Labyrinthitis