Otitis Media is an inflammation and/or infection of the middle ear

Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.

Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus.

 Bacteria such as Streptococcus pneumoniae (pneumococcus), non typable Hemophilus influenzae and Moraxella account for about 85% of cases of acute otitis media. Viruses account for the remaining 15%. Affected infants under six weeks of age tend to have infections from a variety of different bacteria in the middle ear.

SIGNS AND SYMPTOMS:

Children with AOM (acute otitis media) usually present with a history of rapid onset of signs and symptoms such as ear Itching, pain, discharge, hearing loss, or crusting of the ear. May be associated with fever.

refers to an infection of the ear canal (outer ear), the tube leading from the outside opening of the ear in drum. towards the ear commonly referred to as swimmer's ear.

Chronic (long-term) swimmer's ear can be caused by a bacterial infection, a skin condition (eczema or seborrhea), fungus (Aspergillosis), chronic irritation (such as from the use of hearing aids, insertion of cotton swabs, etc), allergy, chronic drainage from middle ear disease, tumors (rare), or it may simply follow from a nervous habit of frequently scratching the ear.

 Malignant otitis externa is a disorder involving inflammation and damage of the bones and cartilage at the base of the skull.

Causes Swimming in : polluted water is a

common way to contract swimmer's ear, but it is also possible to contract swimmer's ear from water trapped in the ear canal after a shower, especially in a humid climate

 caused by streptococcus, staphylococcus, or pseudomonas types of bacteria

Signs and Symtoms :

Drainage from the ear - yellow, yellow-green, foul smelling, persistent Ear pain - felt deep inside the ear and may get worse when moving head Hearing loss Itching of the ear or ear canal Fever Trouble swallowing Weakness in the face

Prevention:
Dry the ear thoroughly after it gets wet. Avoid swimming in polluted water. Protect the ear canal with cotton or lamb's wool while applying hair spray or hair dye (if you are prone to getting external ear infections). After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection.

MODE OF TRANSMISSION:

Direct Transmission

Indirect Transmission

AOM is defined by convention as the first 3 weeks of a process in which the middle ear shows the signs and symptoms of acute inflammation. AOM is defined as the presence of fluid in the middle ear with accompanying conductive hearing loss and without concomitant symptoms or signs of acuity. OE is classified as sub acute when it persists from 3 weeks to 3 months after the onset of AOM and is classified as chronic thereafter. Though painful, otitis media is not threatening and usually heals on its own within 26 weeks.

Responsibility of the nurse

local heat (hot water bottle).
cleanliness of the ear canal by sterile cotton cones moistened with physiologic saline or H2O2,then the ear is wiped dry with sterile cotton . care of the skin around the ear.

NURSING INTERVENTION:
1. Pain related to inflammation and pressure on tympanic membrane.
Give analgesic such as acetaminophen. Use analgesic eardrops. Have the child sit up, raise head on pillows, or lie on unaffected ear. Apply heating pad or warm hot water bottle. Have the child chew gum or blow on balloon to relieve pressure in ear.

Treatment for the ear infection

If a person has an upper respiratory infection causing a lot of congestion and swelling of membranes (including the eustachian tube), medicines which dry up the congestion may be helpful. if there is only an ear infection without congestion or drainage, decongestants and antihistamines are not helpful and should not be used to avoid possible side effects (drowsiness, jitteriness, blurred vision). To ease the pain of an ear infection, your doctor may recommend a pain reliever, typically acetaminophen or ibuprofen, which also helps reduce a fever. For severe infection, oral antiobiotics may be prescribed. If the otitis externa infection is caused by the presence of a foreign body in the ear, the infection will not improve until the foreign body is removed.

Treatment for the ear infection

1-nasal drop. 2-dry heat to the ear. 3-analgesic as aspirin or paracetamol. 4-antibiotics. Antibiotics are recommended in children under 6 months of age as well as patients with severe illness. Drugs that are often used are as following: Amoxicillin (80-90 mg/kg/d) (twice/day) Amoxicillin/clavulinate (90 mg/kg/day of amoxicillin with 6.4 mg/kg/d of clavulinate)

 Alternatives for persons with penicillin allergy: Cefdinir (once/day) Cefurxime Cefpodoxime Azithromycin (once/day) Clarithromycin Ceftriaxone (once/day)
If treatment fails at 48-72 hours switch to higher dose of antibiotics, such as ceftriaxone or clindamycin

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