Acute Otitis Media

Question 1

Pathophysiology of Acute Otitis Media (AOM)

Answer 1

An upper respiratory infection frequently precedes AOM. Fluid and pathogens travel upward from the nasopharyngeal area, invading the middle ear space. Fluid behind the ear has difficulty draining back out toward the nasopharyngeal area because of the horizontal positioning of the Eustachian tube.

Question 2

Risk Factors for Acute Otitis Media

Answer 2

(1) Young age
(2) Day care attendance
(3) Previous history of AOM or OME
(4) Antecedent or concurrent upper respiratory infection
(5) Eustachian tube dysfunction
(6) Family History
(7) Passive Smoking
(8) Crowding in the home or large family size
(9) Native American
(10) Absence of infant breastfeeding
(11) Immunocompromise
(12) Poor nutrition
(13) Craniofacual anomalies
(14) Presence of allergies

Question 3

Signs/Symptoms of Acute Otitis Media

Answer 3

(1) Fever
(2) Complaints of otalgia (ear pain)
(3) Fussiness or irritability
(4) Crying inconsolably (particularly when laying down)
(5) Batting or tugging at the ears
(6) Rolling head from side to side
(7) Poor Feeding or loss of appetite
(8) Lethargy
(9) Difficulty sleeping or awakening crying in the night
(10) Fluid draining from ear

Question 4

Complications of Acute Otitis Media

Answer 4

1. Hearing Loss
2. Expressive Speech Delays
3. Tympanosclerosis
4. Tympanic membran perforation
5. Chronic suppurative otitis media
6. Acute Mastoiditis
7. Intracranial Infections (bacterial meningitis and abscesses)

Question 5

Nursing Assessment

Answer 5

Health History
> Note acute, abrupt onset of signs and symptoms
> Determine the child’s response to any treatments used so far
> Explore the child’s current and past medical history of risk factors

Physical Examination:
> Tympanic membrane will have a dull or opaque appearance and is bulging and/or red
> Pus (greenish or yellowish) may be visible behind the ear drum
> Upon pneumatic otoscope, the eardrum will be immobile
> If the tympanic membrane has become perforated, drainage may be present in the ear canal, but the canal will otherwise appear normal
> Palpate for possible cervical lymphadenopathy

Question 6

Interventions: Managing Pain Associated with Acute Otitis Media

Answer 6

1. Administer analgesics (acetaminophen and ibuprofen)
2. Apply warm heat or cool compress
3. Have child lie on affected side with the heating pad or cooling ice pack in place to that ear
4. Administer numbing eardrops (benzocaine)

Question 7

Interventions: Educating the Family

Answer 7

1. If treatment is observation or watching, explain the rationale to family
2. Ensure family understands returning for re-evaluation if child is not improving within 48-72 hours or if AOM progresses to severe illness
3. If antibiotics are prescribed, ensure family understands the importance of completing the entire course of antibiotics
4. Follow-up for resolution is necessary for all children
5. Educate on OME and its potential impact on hearing and speech

Question 8

Interventions: Preventing Acute Otitis Media

Answer 8

1. Encourage mother’s to breastfeed for at least 6 to 12 months, as breastfed infants have a lower incidence of AOM
2. Avoid excess exposure to individuals with upper respiratory infections to decrease the incidence of these infections in their child
3. Educate that infants and children should not be exposed to second-hand smoke
4. Encourage parents to STOP smoking
   If quitting smoking is not possible, instruct parents to not smoke inside the house or car
5. Encourage parents to have the child immunized with Prevnar and the influenza vaccine