Otitis media (OM) is an infection of the middle ear behind the tympanic membrane and is one of the most common illnesses in children, accounting for approximately 20% of primary care visits. OM may be viral or bacterial and, depending on cause, is generally treated with antibiotics.
In young children, the eustachian tube that connects the middle ear to the back of the throat is shorter and more horizontal than in older children and adults, making it easier for fluid to get trapped and become infected. Congestion from allergies, a cold, or sinus infection are common reasons for fluid to become trapped. Other causes include exposure to cigarette smoke and drinking while lying down. Untreated infections can lead to complications such as ruptured eardrum, cholesteatoma and delays in speech.
Patient will be free from pain and infection; patient will have optimal hearing; patient will be afebrile
Observe ears and throat for signs of drainage or discharge
Congestion, post-nasal drip and drainage of the ears may be present.
Co-infections such as strep throat, a cold or the flu may also be present
Assess pain with appropriate pain scale
Wong Baker FACES and FLACC scales may be used to assess pain in young children and infants. Pulling at the ears and tilting the head are also signs of ear pain.
Assess for hearing loss or changes in speech
Sounds may be distorted or muffled in the affected ear.
Toddlers learning to talk may have changes in speech due to impaired ability to hear
Position patient for comfort; sitting up or lying on side of unaffected ear
Lying flat or on the side of the affected ear can cause more swelling and fluid accumulation in the eustachian tube, resulting in increased pain. Encourage the parent to hold infants and young children upright to reduce discomfort
Manage pain with medications and non-pharmacologic interventions
Analgesics such as acetaminophen may be given. Other methods include applying warm (not hot) moist compresses to the ears
Administer medications as required
Antibiotics are usually given for bacterial infections. A full 10-day course is generally required
Recommend follow-up after treatment
Some infections may be resistant to certain antibiotics. Encourage follow-up after treatment to determine if infection has cleared, even if symptoms seem to subside or resolve.
Provide education for parent / caregiver
Teach parents how to prevent future infections and prevent complications
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