Acute Otitis Media Analysis Essay

Introduction

Otitis occurs when the ear is inflamed (Nair & Peate, 2015, p. 157). When this inflammation affects the middle ear, then it is termed as otitis media, which is classified either as acute otitis media, or otitis media with effusion. Diagnosis and management of otitis media are continually undergoing reassessment due to contentious issues that are always emerging. Currently, there is the escalating concern of antibiotic resistance. In addition, there is increased understanding of the inflammation of the tympanic membrane among healthcare workers. This paper will focus on the current protocol for diagnosing and managing otitis media, and how culture prevails as an influential factor.

Epidemiology

Acute Otitis Media (AOM) is the most diagnosed pediatric bacterial illness in the United States. More than 12.8 million children below the age of 12 years suffer from otitis media on an annual basis. The three main causing bacteria are Streptococcus pneumonia, Moraxella catarrhalis, and Haemophilus influenza. Boys, more than girls, are affected by AOM.

Pathophysiology

The onset of bacterial AOM is 3 to 7 days after the presentation of a viral respiratory infection (Bope, Kellerman & Rakel, 2011). Invasion of the middle earpiece occurs when fluid and pathogens move upward from the nasopharyngeal area. The pathophysiology of acute otitis media involves damage to the Eustachian tube (ET) due to anatomic, genetic, and immune system factors. The ET connects the nasopharynx to the middle ear space. The horizontal anatomy of the ET makes it difficult to drain the fluid. Subsequently, pathogens also find their way into the ET, where they multiply and damage the mucosa. The high prevalence of otitis media among children is due to an immature ET, as well as an immature immune system (Rosen, 2012). During this time, patients experience acute fevers and pain. Perforation of the tympanic membrane results due to increased pressure, and when this happens, the condition changes to otitis media with effusion associated with little pain and it may resolve on its own.

Diagnosis

Diagnosis of AOM is very important to distinguish it from otitis media with effusion. A careful and thorough assessment of the tympanic membrane mobility diagnoses AOM (Perry, Hockenberry, Lowdermilk & Wilson, 2014). Affirmation of a diagnosis occurs when upon inspection, purulent discolored effusion is observable. In addition, there is a membrane that is bulging, opacified, or reddened (Perry et al., 2014, p. 1206). In addition, there is an acute onset of ear pain that has prevailed for not more than 48 hours (Perry et al., 2014).

Influence of Culture

The peak of acute ear infections, which precedes otitis media, is prior to the age of 2 years, and during school entry. According to Blijham (2011), there have been correlations between attendance of daycare and atopic allergy and high prevalence rates of otitis media. Therefore, in cultures where daycare centers are the norm, there tends to be a high prevalence of otitis media. Allergy, in this case, arises due to the use of dummies and the presence of cigarette smoke as a passive smoker. Continued exposure to the cultural factors discussed above interferes with the management of AOM.

Treatment and Management

For a long time now, acute otitis media has been managed through the use of antibiotics. However, with the growing concern of drug-resistant, there has been a review of the antibiotics administered. Perry et al. (2014) highlight the following recommendations in the therapeutic management of AOM:

• Antibiotics are effective for children with severe signs or symptoms of AOM, for example, persistent otalgia or a temperature of more than 39⁰C. This regimen, however, is not ideal for children less than 6 months.
• Antibiotics should be given to children less than two years without severe signs or symptoms
• Children from the age of 6 months without severe signs or symptoms receive either antibiotics or observation and close monitoring.

Analgesic-antipyretic drugs, for example, ibuprofen and acetaminophen manage fever and any arising discomfort associated with otitis media (Perry et al., 2014). Topical Pain should be managed using pain relief drops like benzocaine. Narcotic analgesia is effective in the case of severe pain.

Myringotomy is important in the alleviation of severe pain and helps to drain fluid from the infected middle ear in the case of complications. Drainage flow should be maintained. Emptying drainage is achieved by placing sterile cotton in the external ear. Consistently changing the cotton prevents infection by preventing dampness. During follow-up, the clinician may suggest alternative ways of relieving pain, for example, use of heat. Treatment of recurrent chronic AOM requires tympanostomy tube placement and adenoidectomy.

The pneumococcal vaccine prevents infections that can cause respiratory and aural infections. Parents should wash children’s toys, practice frequent hand washing and replace the use of pacifiers with breastfeeding.

Conclusion

Acute Otitis Media is a major disease that occurs in childhood, and its occurrence decreases with age as the Eustachian tube and pharynx mature. However, factors associated with culture such as smoking and use of allergic elements increase a child’s chance of getting the disease. Antibiotics and both surgical and non-surgical procedures are paramount in managing the disease to prevent progression to more chronic and severe forms of the disease.

References

Blijham, J. (2011). NHG Clinical Practice Guidelines M09-Acute Otitis Media (AOM) En M29 Feverish Illness in Children. Houten: Bohn Stafleu van Loghum.

Bope, E., Kellerman, R., & Rakel, R. (2011). Conn’s Current Therapy 2011: Expert Consult (CONNS CURRENT THERAPY). Philadelphia: Elsevier Saunders.

Kyle, T., & Carman, S. (2013). Essentials of Pediatric Nursing (2^nd ed.). Philadelphia: Lippincott Williams & Wilkins.

Nair, M., & Peate, I. (2015). Pathophysiology for Nurses at a Glance. West Sussex: John Wiley & Sons.

Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2014). Maternal Child Nursing Care (5^th ed.). Missouri: Elsevier Mosby.

Rosen, L. (2012). Otitis Media. In D. Rakel (Ed.), Integrative Medicine (3^rd ed.) (pp. 132- 135). Philadelphia: Elsevier Saunders.