07.03 Acute Otitis Media (AOM)

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Overview

  1. Mechanical or functional obstruction of eustachian tubes
    1. Accumulation of fluid in middle ear
    2. Middle ear becomes inflamed and infected
      1. Common causes include
        1. URI  (RSV)
        2. Strep throat
        3. Allergies
        4. Poor drainage

Nursing Points

General

  1. Usually occurs within first 2 years of life
  2. Increased risk for children exposed to secondhand smoke
  3. Types of Otitis Media (OM)
    1. Acute Otitis Media (AOM)
    2. Otitis Media with effusion (OME)
  4. Primary goals of treatment
    1. Prevent permanent hearing loss
    2. Prevent perforation of tympanic membrane

Assessment

  1. Acute Otitis Media
    1. Ear pain
    2. Pulling at one ear
    3. Fever
    4. Inflamed tympanic membrane
    5. Ear drainage
  2. Otitis Media with effusion
    1. Hearing loss
    2. Difficulty communicating
    3. Delayed speech development

Therapeutic Management

  1. Treat discomfort
    1. Analgesics and Antipyretics
      1. Acetaminophen (Tylenol)
      2. Ibuprofen (Motrin)
    2. Apply heat/cold therapy to ear
    3. Avoid causing increased pain
      1. Chewing
  2. Antibiotics
    1. Concern for drug resistance
      1. >6 mo, uncomplicated: wait 72 hours  before starting antibiotics
    2. Administration
      1. Pull the earlobe down and back
  3. Surgery- Indicated for Chronic/Recurrent OM
    1. Myringotomy
      1. Drain middle ear
    2. Tympanostomy
      1. Tube placement
    3. Adenoidectomy
      1. Treat post nasal obstruction

Nursing Concepts

  1. Infection Control
  2. Sensory Perception
  3. Comfort

Patient Education

  1. Prevention
    1. Immunizations
    2. Do not prop up bottles
    3. Feeding infants in the upright position can
    4. Eliminating secondhand smoke from household
  2. Tympanostomy education
    1. Wear earplugs if swimming in non-chlorinated water
    2. Recognizing tube (plastic spool shape) if it falls out.
  3. Importance of follow up hearing tests with OME.

References:

Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.  

Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.

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Video Transcript

Hey guys, in this lesson we are going to be talking about Acute Otitis Media, which is an ear infection. These are pretty common infants and toddlers and nursing care for them is pretty straightforward!

Let’s start by just doing a quick recap on the anatomy of the ear. You have the outer ear, middle ear and inner ear. Then you have this really important tube here called the Eustachian tube. This tube connects the middle ear to the back of the throat which allows fluids to drain and equalize pressure in the middle ear. If this tube becomes occluded or blocked then fluid can back up into the middle ear. And that’s what’s happening with an ear infection. The eustachian tube gets blocked, which causes fluid to back up in the middle ear, which then leads to inflammation and infection in the ear.

Now some kids are just prone to ear infections because of their anatomy so they may have shorter, more level eustachian tubes that just don’t drain as easily or they may have extra large adenoids that actually block the drainage. But there are some other risk factors that can be controlled. Two examples of this are 1) propping up bottles to feed a baby. When fed this way, babies are more horizontal so draining doesn’t happen as easily. 2) Secondhand smoke. Kids with exposed to secondhand smoke at home are much more likely to get an ear infection than those who aren’t.

If you take a look in the ear of a child with an ear infection you will likely see a bulging eardrum like the one in this picture. This can eventually perforate or burst which can cause hearing loss. It will usually heal itself in a few weeks.

On the outside of the ear the most common symptoms are a very unhappy child who is pulling or rubbing at their ear and has a fever. Ear infections often come alongside a cold so they may also have symptoms like a runny nose and a cough.

When fluid builds up frequently you can end up with something called chronic otitis media. These kids won’t have the signs of inflammation and they may not even have pain, but they will likely have hearing difficulties and could even have delays in speech development if it’s not treated.

The first step of management is to treat their discomfort. This means using medications like acetaminophen and ibuprofen for both the fever and the pain. Warm compresses can also help.

Antibiotics used to be prescribed for every ear infection, but as we are becoming more aware of problems with drug resistant bacteria antibiotics are being used less and less. This is because we know that most are caused by viruses. So if a child is 6 months old or greater there is usually a 72 hour waiting period where we wait to see if the ear infection will resolve on its own and if it doesn’t antibiotics will then be prescribed.

If a child is having frequent ear infections they may need a myringotomy or a tympanostomy. A myringotomy is an incision to drain the fluid. A tympanostomy is when tubes or a grommet, like the one in the photo here is, is placed to help the fluids drain through the eustachian tube.

And remember prevention is key! So we’ve got to make sure we are teaching parents to avoid secondhand smoke, get those immunizations and not prop up bottles!

The first step of management is to treat their discomfort. This means using medications like acetaminophen and ibuprofen for both the fever and the pain. Warm compresses can also help.

Antibiotics used to be prescribed for every ear infection, but as we are becoming more aware of problems with drug resistant bacteria antibiotics are being used less and less. This is because we know that most are caused by viruses. So if a child is 6 months old or greater there is usually a 72 hour waiting period where we wait to see if the ear infection will resolve on its own and if it doesn’t antibiotics will then be prescribed.

If a child is having frequent ear infections they may need a myringotomy or a tympanostomy. A myringotomy is an incision to drain the fluid. A tympanostomy is when tubes or a grommet, like the one in the photo here is, is placed to help the fluids drain through the eustachian tube.

And remember prevention is key! So we’ve got to make sure we are teaching parents to avoid secondhand smoke, get those immunizations and not prop up bottles!

Your priority nursing concepts for a patient with acute otitis media are infection control, sensory perception and comfort.

Alright, lets go over the key points for this lesson! First, otitis media is inflammation of the middle ear. Remember it’s because the eustachian tube is blocked and fluid can’t drain out. So fluid builds up and the middle ear gets infected!

Most kids are going to complain for pain and fever. They’ll probably be pulling at the ear or rubbing it and may have cold symptoms too. Most of the time it’s caused by a virus so if the kid is >6 months old antibiotics probably won’t be prescribed for 72 hours or so to see if it resolves on its own.

If fluids build up chronically in the ear kids can have hearing loss and speech delays. In these chronic situations kids will probably need to have surgery to drain the ear and place tubes that will help the fluid drain out.

That’s it for our lesson on Acute Otitis Media. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!

Read more

  • Question 1 of 10

The nurse is caring for a client with acute otitis media. Which of the following medications would the nurse expect to give? Select all that apply.

  • Question 2 of 10

A client has a chronic fungal infection of the ear. What are some nursing interventions to utilize in this situation? Select all that apply.

  • Question 3 of 10

A client’s mother is upset that after 24 hours no antibiotics have been prescribed for an earache and fever. Which explanation is the best for the nurse to provide?

  • Question 4 of 10

The nurse is caring for a child who presents with fussiness and tugging at the left ear. The provider diagnoses the child with acute otitis media. Which of the following positions is appropriate for this child?

  • Question 5 of 10

The nurse is educating the parents of an infant on ways to prevent the occurrence of acute otitis media. Which of the following should be included in the teaching? Select all that apply.

  • Question 6 of 10

The nurse knows which of the following indicates the potential need for a tympanostomy and adenoidectomy?

  • Question 7 of 10

The nurse is caring for a child with acute otitis media. Which of the following are appropriate nursing interventions for this child? Select all that apply.

  • Question 8 of 10

The nurse is caring for a client with otitis media. Nursing interventions to treat this condition include which of the following? Select all that apply.

  • Question 9 of 10

The nurse caring for a client with otitis media with effusion informs the parents of the importance of which of the following items?

  • Question 10 of 10

The nurse providing care to a client who has been experiencing otalgia and fever for 24 hours. Which of the following should be the top nursing priority?

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Module 5 – Metabolic And Endocrine Disorders

Module 12 – Musculoskeletal Disorders

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