Otitis Media with Effusion

Question 1

Pathophysiology of Otitis Media with Effusion

Answer 1

After clearance of infection, fluid remain in the middle ear space behind the tympanic membrane. This may occur because of the positioning of the Eustachian tubes, resulting in difficulty draining fluid back to the nasopharyngeal area

Question 2

Risk Factor of Otitis Media with Effusion

Answer 2

(1) Passive smoking
(2) Absence of breastfeeding
(3) Frequent viral upper respiratory infections
(4) Allergy
(5) Young age
(6) Male sex
(7) Adenoid hypertrophy
(8) Eustachian tube dysfunction
(9) Certain congenital disorders
(10) Recent history of AOM

Question 3

Signs and Symptoms of Otitis Media with Effusion

Answer 3

Children may be asymptomatic

(1) May experience a popping sensation or fullness behind the eardrum

Question 4

Complications of Otitis Media with Effusion

Answer 4

1. Acute Otitis Media
2. Hearing Loss
3. Deafness

Question 5

Nursing Assessment

Answer 5

Health History
> Determine the extent of symptoms
> Explore health history for risk factors

Physical Examination
> Otoscopic examination may reveal a dull, opaque tympanic membrane that may be white, gray, or bluish
> If the tympanic membrane is not opaque, a fluid level or air bubble may be visualized
> Mobility may be absent or diminished upon pneumatic otoscopy
> Tympanometry may be used to confirm the diagnosis of OME

Question 6

Interventions: Educating the Family

Answer 6

1. Educate about the natural history of OME and the autonomic differences in young children that contribute to OME
2. Inform parents that antihistamines, decongestants, antibiotics, and corticosteroids have not been proven to hasten the resolution of OME and this are not recommended
3. OME resolves spontaneously, but children should be rechecked every 4 weeks while resolution is occurring
4. Do not feed infants in a supine position and to avoid bottle propping

Question 7

Interventions: Monitoring for Hearing Loss

Answer 7

> Children with OME who are at risk for speech, language, or learning problems are referred for evaluation of hearing earlier than a child with OME who is not at risk
Children with chronic OME should be referred to a specialist for hearing evaluation
To communicate more effectively with children with OME who have hearing loss:
1. Turn off music or television
2. Position yourself within 3 ft of the child before speaking
3. Face the child while speaking
4. Use visual cues
5. Increase the volume of your speech only slightly
6. Speak clearly
7. Request preferential classroom seating

Question 8

Interventions: Providing Postoperative Care for the Child with Pressure-Equalizing Tubes

Answer 8

> Educate the parents about the surgical insertion of pressure-equalizing tubes
1. PE tubes equalize the pressure behind the ear drum allowing for tympanic membrane movement. This allows for adequate hearing, in turn encourages speech development
2. Surgery is outpatient
3. The tubes stay in place for at least several months and will fall out on their own
4. Administer ear drops postoperatively if prescribed
5. Have child wear earplugs when swimming in potentially contaminated waters (lakes, rivers)
6. If the middle ear becomes infected with PE tubes in place, the tubes allow infected fluids to drain from the ear (if this occurs, contact physician)