Otitis Media

Inflammation in the middle ear area is

known as otitis media.
A child with otitis media usually exhibits
a discolored membrane ( bright red,
yellow, or dull gray).
Streptococcus pneumoniae is found in 40% of patients with acute otitis media.
Acute otitis media means that fluid (usually pus) is in the middle ear, causing pain, redness of
the eardrum, and possible fever.
In some cases, otitis media can be more chronic (with fluid in the middle ear for 6 weeks or
longer) or, in otitis media with effusion, fluid in the middle ear can be temporary and not
necessarily infected.
Chronic suppurative otitis media is a persistent ear infection that results in tearing or
perforation of the eardrum.
Adhesive otitis media occurs when a thin retracted ear drum becomes sucked into the middle
ear space and stuck.

Causes
Kids are prone to developing ear infections in the first 2 to 4 years of life for several reasons:
Their eustachian tubes are shorter and more horizontal than those of adults, which lets
bacteria and viruses find their way into the middle ear more easily. The tubes are also
narrower and less stiff, so more at risk for blockage.
The adenoids, which are gland-like structures located in the back of the upper throat near
the eustachian tubes, are large in children and can interfere with the opening of the
eustachian tubes.

Males
Individuals with a family history of ear infections
Babies who are bottle-fed (breastfed babies get fewer ear infections)
Children in day care centers
People living in households with tobacco smokers
People with abnormalities of the palate, such as a cleft palate
People with poor immune systems or chronic respiratory diseases, such as cystic fibrosis
and asthma

Signs and symptoms

AOM implies rapid onset of disease associated with one or more of the following symptoms:
Otalgia (ear pain)

Otorrhea (drainage of liquid from the ear)

Headache

 Fever
Irritability
Loss of appetite
Vomiting and Diarrhea
OME often follows an episode of AOM. Symptoms that may be indicative of OME include the
following:
Hearing loss
Tinnitus and Vertigo
Otalgia (ear pain)

Diagnosis
Doctor should be able to make a diagnosis by taking a medical history and doing a physical
exam.
A test called tympanometry is an accurate tool for diagnosing OME. The results of this test can
help tell the amount and thickness of the fluid.
An acoustic otoscope or reflectometer is a portable device that accurately detects fluid in the
middle ear.
An audiometer or other type of formal hearing test may help the health care provider decide on
treatment.

Treatment
Most cases of AOM improve spontaneously. Cases that require treatment may be managed with
antibiotics and analgesics or with observation alone. (Guidelines from American Academy of
Pediatrics)
In February 2013, the American Academy of Pediatrics (AAP) and the American Academy of
Family Physicians released updated guidelines for the diagnosis and management of AOM. The
recommendations offer more rigorous diagnostic criteria to reduce unnecessary antibiotic use.
According to the guidelines, management of AOM should include an assessment of pain.
Analgesics, particularly acetaminophen and ibuprofen, should be used to treat pain whether
antibiotic therapy is or is not prescribed.
Amoxicillin is recommended for initial empiric therapy because it is inexpensive, effective, and
convenient to administer. Higher dosages can provide expanded coverage of resistant
Streptococcus pneumoniae.

Surgical management of AOM can be divided into the following 3 related procedures:
Tympanocentesis is the removal of fluid from behind the eardrum. The doctor uses a
special needle with a tube attached to collect the sample of fluid.
Myringotomy a surgical procedure of the eardrum or tympanic membrane is performed
by making a small incision with a myringotomy knife through the layers of tympanic
membrane.
Myringotomy with insertion of a ventilating tube permits the incised drum to remain
open and allows better drainage of middle-ear fluid.

Possible Complications

Mastoiditis (an infection of the bones around the skull)

Meningitis (an infection of the brain)
Cholesteatoma (an abnormal collection of skin cells inside the ear )
Problems with speech and language development
Facial paralysis
Brain abscess

MOUWASAT HOSPITAL RIYADH

Nursing department
Unit: PEDIATRIC
Session Title: Otitis Media
Passing grade: 100/100
Evaluator Name: Marie Jeanne Devilles R.N, Maria Russell Samong R.N
NAME & ID # : ____________________________
_______________

DATE :

1. Which of the following environmental factors may increase the incidence of acute
otitis media?
A. Putting an infant to bed with a bottle
C. Dust
B. Cigarette smoke
D. All of the above
2. Which of the following pathogens most commonly causes acute otitis media?
A. Respiratory viruses
C. Staphylococcus aureus
B. Haemophilus influenzae
E. Streptococcus pneumoniae

3. Which of the following conditions is a predisposing factor for development of otitis

media in children?
A. The cartilage lining is underdeveloped.
B. When infants sit up, it favors the pooling of fluid.
C. Humoral defense mechanisms decrease the risk of infection.
D. Eustachian tubes are short, wide, and straight and lie in a horizontal plane.
4. A 1 year old child is brought to the emergency department with a mild respiratory
infection and temperatue of 38.5C. Otitis Media is diagnosed. Which of the following
signs is characteristic of otitis media?
A. Excessive drooling
C. High pitched, barking cough
B. Tugging on the ears
D. Pearl gray tympanic membrane
5. Which of the following descriptions best matches the findings of otoscopy in acute
otitis media?
A. Pearl gray tympanic membrane
B. Bright red, bulging tympanic membrane
C. Dull gray membrane with fluid behind the ear drum
D. Bright red or yellow bulging or retracted tympanic membrane
6. Which of the following durations would cause otitis media to be classified as chronic?
A. Approximately 2 weeks
C. 3 weeks to 3 months
B. Approximately 3 weeks
D. Longer than 3 months
7. A 7 month old child is diagnosed with otitis media; the physician orders amoxicillin
40mg/kg/day to be administered three times per day. The child weighs 9 kg. How much

amoxicillin should the child receive per dose?

A. 120 mg
B. 180 mg
C. 200 mg
D. 360 mg
8. Which of the following intervention is recommended for children with chronic otitis
media with effusion?
A. Antihistamines
B. Corticosteroids
C. Decongestants
D. Surgical intervention
9. A surgical procedure of the eardrum or tympanic membrane, performed by making a small
incision through the layers of tympanic membrane.
A. Tympanocentesis
C. Audiometery
B. Myringotomy
D. Tympanometry

10. Children with chronic otitis media often require surgery for a myringotomy and ear
tube placement. Which of the following management strategies explains the purpose of
the ear tubes?
A. To administer antibiotics
B. To flush the middle ear
C. To increase pressure
D. To drain fluid.
11. A child is diagnosed as having right chronic otitis media. After the child returns from
surgery for myringotomy and placement of ear tubes, which of the following
interventions is appropriate?
A. Apply gauze dressings.
B. Position the child on the left side.
C. Position the child on the right side.
D. Apply warm compresses to both ears.
12. Which of the following complications is most common related to acute otitis media?
A. Eardrum perforation
B. Hearing loss
C. Meningitis
4. Tympanosclerosis
13. Which of the following is the most common intracranial complication of acute otitis media?
A. Epidural abscess
C. Meningitis
B. Brain abscess
D. Acute mastoiditis

14. Which one of the following is the drug of choice for initial treatment of acute otitis
media?
A. Ciprofloxacin
C. Erythromycin
B. Amoxicillin
D. Azithromycin
15. The nurse is discharging a 10 month old client with ear drops. Which of the following
information should she give the parent about how to administer the drops?

A. Pull the earlobe upward.

B. Pull the earlobe up and back.
C. Pull the earlobe down and back.
D. Pull the earlobe down and forward.