ACUTE OTITIS MEDIA

is an inflammation and infection of the middle ear caused by the entrance of pathogenic organisms, with rapid onset of signs and symptoms. It is a major problem in children but may occur at any age.

Clinical manifestations
Pain( usu. the first symptom) Fever Purulent drainage (otorrhea) is present if tympanic membrane is perforated. Irritability (children) Headache, hearing loss, anorexia, nausea, and vomiting Purulent effusion

PATHOPHYSIOLOGY & ETIOLOGY

1.

Pathogenic organisms gain entry into the normally sterile middle ear, usually through a dysfunctional eustachian tube (suppurative otitis media). 2. Pathogenic organisms gain entry into the normally sterile middle ear, usually through a dysfunctional eustachian tube (suppurative otitis media). 3. Organisms include Streptococcus pneumoniae, H. influenzae, M. catarrhalis, and S. aureus. 4. In serous (secretory) otitis media, no purulent infection occurs, but blockage of the eustachian tube causes negative pressure and transudation of fluid from blood vessels and development of effusion in the middle ear.

MANAGEMENT Antibiotic treatment amoxicillin (Amoxil) is first-line treatment; cephalosporins, macrolides, or co-trimoxazole (Bactrim) may be used in penicillin allergy. Usual treatment course is 10 days. Follow-up is indicated to determine effectiveness of therapy. Surgery myringotomy. An incision is made into the posterior inferior aspect of the tympanic membrane for relief of persistent effusion. NURSING INTERVENTIONS

Patient Education and Health Maintenance

Encourage resolution. Advise patient that sudden relief of pain may indicate tympanic membrane rupture. Do not instill anything in ear, and call health care provider. Instruct patient to follow up for recurrence of symptoms, such as pain, fever, congestion. ear follow-up after

treatment to ensure

Diagnostic Evaluation
Pneumatic otoscopy Cultures of discharge through ruptured tympanic membrane may suggest causative organism.

Relieving Pain Administer or teach self-administration of antibiotics, as prescribed. Encourage the use of local warm compresses or heating pad to promote comfort and help resolve infectious process. Be alert for such symptoms as headache, slow pulse, vomiting, and vertigo, which may be significant for sequelae that involve the mastoid or even the brain.

Nursing Diagnosis
Acute Pain related to inflammation and increased middle ear pressure

Complications
Perforation of tympanic membrane Chronic otitis media and mastoiditis Conductive hearing loss Meningitis, brain abscess

Reference: Authors/Editors: Nettina, Sandra M.; Mills, Elizabeth Jacqueline Title: Lippincott Manual of Nursing Practice, 8th Edition Copyright 2006 Lippincott Williams & Wilkins