OTITIS MEDIA

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OTITIS MEDIA 
Otitis Media is an inflammation of the middle ear. It occurs when the area behind the eardrum called the middle ear becomes inflamed and infected. This condition is most common in children.


CAUSES
A multitude of host, infectious, allergic, and environmental factors contribute to the development of otitis media.
·        Immature immune system
·        Genetic predisposition
·        Anatomic abnormality
·        Physiologic dysfunction
·        Bacteria pathogens
·        Infant feeding methods


 PATHOPHYSIOLOGY
In children, developmental alterations of the eustachian tube, an immature immune system, and frequent infections of the upper respiratory mucosa all play major roles in acute otitis media development.
The most important factor in the middle ear disease is eustachian tube, an immature immune system, and frequent infections of the upper respiratory mucosa all play major roles in AOM development.
The most important factor in middle ear diseases is eustachian tube dysfunction, in which the mucosa at the pharyngeal end of the ET is part of the mucociliary system of the middle ear.
The Eustachian tube in an infant is shorter and wider than in the older child or adult.
The tube is also straighter, thereby allowing nasopharyngeal secretions to enter the middle ear more easily.
Interference with the mucosa by edema, tumor, or negative intratympanic pressure facilitates direct extension of infectious processes from the nasopharynx to the middle ear, causing otitis media.

 SIGNS AND SYMPTOMS
Infants and children may have one or more of the following symptoms:
·        Crying
·        Irritability
·        Sleeplessness
·        Pulling on the ears
·        Ear pain
·        A headache
·        Neck pain
·        A feeling of fullness in the ear
·        Fluid drainage from the ear
·        A fever
·        Vomiting
·        Diarrhea
·        Irritability
·        A lack of balance
·        Hearing loss


Diagnostic Evaluation
·        Otoscope
·        Tympanometry
·        Reflectometry
·        Hearing test

Management
·        Analgesics
·        Antibiotics


SURGICAL MANAGEMENT
From the beginning, it is essential to integrate surgical management of otitis media with medical treatment.

Myringotomy and TT placement: Myringotomy or the incision of the eardrums may be performed to establish drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage.

Adenoidectomy: The performance of adenoidectomy to treat patients with otitis media has generated extensive discussion and research, though potential benefits are controversial.

 Nursing Diagnosis
  •      Acute pain related to the inflammation of the middle ear evidenced by patients’ verbalization.
  •      Anxiety related to health status evidenced by restlessness.
  •      Disturbed sensory perception related to obstruction, infection of the middle ear, or auditory nerve damage.


Nursing Management
·        Positioning. Have the child sit up, raise head on pillows, or lie on unaffected ear.
·        Heat application. Apply heating pad or a warm hot water bottle.
·       Diet. Encourage breastfeeding of infants as breastfeeding affords natural immunity to infectious agents; position bole-fed infants upright when feeding.
·    Hygiene. Teach family members to cover mouths and noses when sneezing or coughing and to wash hands frequently.
·        Monitoring hearing loss: Assess hearing ability frequently.

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