OTITIS MEDIA – Types, Etiology, Signs and Symptoms, Diagnostic Evaluation, Complications, Management and Nursing Management
Otitis media refers to inflammation of the middle ear. Acute otitis media occurs when a cold, allergy, or upper respiratory infection, and the presence of bacteria or viruses lead to the accumulation of pus and mucus behind the eardrum, blocking the Eustachian tube and characterized by earache and swelling.
When fluid accumulates in the middle ear, the condition is known as otitis media with effusion. This occurs in a recovering ear infection.
TYPES
- Acute otitis media: It is usually of rapid onset and short duration. Acute otitis media is typically associated with fluid accumulation in the middle ear together with signs or symptoms of ear infection and may associate with drainage of purulent material (pus, also termed as suppurative otitis media)
- Chronic otitis media: It is a persistent inflammation of the middle ear, typically for a minimum of a month. Following an acute infection, fluid may remain behind the eardrum for up to three months before resolving. Chronic otitis media may develop after a prolonged period of time with fluid or negative pressure behind the eardrum.
ETIOLOGY
Winter is high season for ear infections. They often follow a cold. Some factors that increase a risk for middle ear infections include:
- Crowded living conditions
- Attending daycare
- Exposure to secondhand smoke
- Respiratory illnesses such as common cold
- Close contact with siblings who have cold
- Having a cleft palate
- Allergies that cause congestion on a chronic basis
- Premature birth
- Not being breastfed
- Bottle-feeding while lying down
SIGNS AND SYMPTOMS
Symptoms of an ear infection may include:
- Acute otitis media (AOM)
- Pulling at ears
- Excessive crying
- Fluid draining from ears
- Sleep disturbances
- Fever
- Headaches
- Problems with hearing
- Irritability
- Difficulty balancing
Symptoms of fluid build-up may include:
The symptoms of swimmer’s ear include: Itching inside the ear, watery discharge from the ear, severe pain and tenderness in the ear, especially when moving your head or when gently pulling on the earlobe a foul smelling, yellowish discharge from the ear and temporarily muffled hearing (caused by blockage of the ear canal).
- Popping, ringing or a feeling of fullness or pressure in the ear
- Trouble hearing
- Balance problems and dizziness
DIAGNOSTIC EVALUATION
- History, a physical examination and an ear examination
- Pneumatic otoscope to look at the eardrum for signs of an ear infection or fluid buildup
Ear Infection Syndrome
The symptoms of an ear infection in adults are: earache (either a sharp, sudden pain or a dull, continuous pain); A sharp stabbing pain with immediate warm discharge from the ear canal; a feeling of fullness in the ear; nausea muffled hearing; ear drainage.
In children, the symptoms are: Tugging at the ear; poor sleep fever irritability, restlessness; ear drainage; diminished appetite; crying at night when lying down.
- Tympanometry: it measures how the eardrum responds to a change of air pressure inside the ear
- Hearing tests
- Tympanocentesis: This test can remove fluid if it has stayed behind the eardrum (chronic otitis media with effustion)
- Blood tests, which are done if there are signs of immune problems
COMPLICATIONS
Infratemporal infections can include:
- Tympanic membrane perforation
- Mastoiditis
- Facial nerve palsy
- Acute labyrinthitis
- Petrositis
- Acute necrotic otitis
- Chronic otitis media
Intracranial infections can include:
- Meningitis
- Encephalitis
- Brain abscess
- Otitic hydrocephalus
- Subarachnoid abscess
- Subdural abscess
- Sigmoid sinus thrombosis
MANAGEMENT
Antibiotic is the only treatment for otitis media
Antimicrobials
AMOXICILLIN
Dosage: 80 to 90 mg per kg per day, given orally in two divided doses
Comments: first-line drug. Safe, effective and inexpensive
AMOXICILLIN (augmentin)
Dosage: 90 mg of amoxicillin per kg per day given orally in two divided doses
Comments: second-line drug. For patients with recurrent or persistent acute otitis media, those taking prophylactic amoxillicin, those who have used antibiotics within the previous month, and those with concurrent purulent conjunctivitis
AZITHROMYCIN
Dosage: 30 mg per kg, given orally
Comments: for patients with penicillin allergy. One dose is as effective as longer courses
AZITHROMYCIN (Three-day course)
Dosage: 20 mg per kg once daily, given orally
Comments: for patients with recurrent acute otitis media
AZITHROMYCIN (five-day course)
Dosage: 5 to 10 mg per kg once daily, given orally
Comments: for patients with penicillin allergy (type 1 hypersensitivity)
CEFDINIR
Dosage: 14 mg per kg per day, given orally in one or two doses
Comments: for patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e. type 1 hypersensitivity)
CEFPODOXIME
Dosage: 30 mg per kg once daily, given orally
Comments: for patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e. type 1 hypersensitivity)
CEFTRIAXONE (Rocephin)
Dosage: 50 mg per kg once daily, given intramuscularly or intravenously. One dose for initial episode of otitis media, three doses for recurrent infections
Comments: for patients with penicillin allergy, persistent or recurrent acute otitis media or vomiting
CEFUROXIME (Ceftin)
Dosage: 30 mg per kg per day, given orally in two divided doses
Comments: for patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e. type 1 hypersensitivity)
CLARITHROMYCIN
Dosage: 15 mg per kg day, given orally in three divided doses
Comments: for patients with penicillin allergy (type 1 hypersensitivity) may cause gastrointestinal irritation
CLINDAMYCIN
Dosage: 30 to 40 mg per kg per day, given orally in four divided doses
Comments: for patients with penicillin allergy (type 1 hypersensitivity)
TOPICAL AGENTS
CIPROFLOXACIN/HYDROCORTISONE
Dosage: 3 drops twice daily
HYDROCORTISONE/NEOMYCIN
Dosage: 4 drops three or four times daily
OFLOXACIN
Dosage: 5 drops twice daily (10 drops in patients older than 12 years)
ANALGESICS
ACETAMINOPHEN
Dosage: 15 mg per kg every six hours
ANTIPYRINE/BENZOCAINE
Dosage: 2 to 4 drops three to four times daily
IBUPROFEN
Dosage: 10 mg per kg every six hours
NURSING MANAGEMENT
Nursing Diagnosis
- Acute pain related to inflammation of the middle ear tissue
- Disturbed sensory perception: auditory conductive disorder related to the sound of the organ
- Acute pain related to inflammation of the middle ear tissue
Intervention
- Assess the level of intensity of the client and client’s coping mechanisms
- Give analgesics as indicated
- Distract the patient by using relaxation techniques: distraction, guided imagination, touching, etc
- Disturbed sensory perception: Auditory conductive disorder related to the sound of the organ
Intervention
- Reduce noise in the client environment
- Looking at the client when speaking
- Speaking clearly and firmly on the client without the need to shout
- Providing good lighting when the client relies on the lips
- Using the signs of nonverbal (e.g. facial expressions, pointing, or body movement) and other communications
- Instruct family or the people closest to the client about the techniques of effective communication so that they can interact with clients
- If the client wants, the client can use hearing aids
