Otitis media: Nursing

Otitis media refers to inflammation or infection of the middle ear, and can be classified as acute when it lasts less than three weeks, or chronic when it lasts longer.

Let’s start with some anatomy and physiology. The middle ear is a cavity that lies within the temporal bone, just behind the tympanic membrane. It houses three small bones called ossicles, which transmit sound waves from the tympanic membrane to the inner ear. The middle ear communicates with mastoid air cells, which are air filled cavities within the mastoid part of the temporal bone. In addition, it communicates with the nasopharynx through the Eustachian tube, which allows air to ventilate the middle ear and normalizes the pressure of the middle ear with the atmospheric pressure.

All right, now otitis media is typically caused by viral infections like respiratory syncytial virus, rhinovirus, adenovirus, and coronavirus; or bacterial infections like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Risk factors for otitis media include having a cold or upper respiratory infection, chronic sinusitis, and allergies. Other risk factors include dysfunction or anatomic abnormalities of the Eustachian tube, as well as barotrauma, where injury is caused by changes in air or water pressures. Also, children are at higher risk of otitis media, since their Eustachian tubes are shorter and more horizontal, making it harder for fluid to drain out of the ear and easier for bacteria to climb up into the middle ear. Lastly, exposure to tobacco smoke increases the risk of otitis media because it impairs the Eustachian tube’s mucociliary function, making respiratory infections more likely.

So the pathology of otitis media occurs when the infection triggers an inflammatory process that obstructs the Eustachian tube. This results in impaired ventilation of the middle ear, which in turn traps secretions and favors bacterial growth. In addition, the pressure inside the middle ear rises, which may cause the tympanic membrane to bulge or even perforate.

Now, complications of otitis media include hearing loss, as well as complications that occur when the infection spreads to nearby areas. These include mastoiditis when the infection extends to the mastoid bone and mastoid air cells; meningitis when it extends to the meninges; or even a brain abscess if it extends to the brain or cerebellum.

The typical clinical manifestations of otitis media include ear pain and fever. In addition, clients with tympanic membrane perforation may present with discharge or drainage, as well as impaired hearing. In infants and young children, additional symptoms may include irritability and repeated tugging of the ear.

The diagnosis of otitis media starts with the client’s history and physical assessment. This includes otoscopic examination of the tympanic membrane, which may appear red, bulging, retracted, or even perforated. If there’s discharge or drainage from the ear, a culture can be done to determine the causative microbe. Finally, in certain cases, imaging like CT scan or MRI of the head can be performed to assess spreading of the infection.

Now, treatment-wise, mild cases of acute otitis media can be managed conservatively, with watchful waiting. This means only administering symptomatic medications, usually ibuprofen and acetaminophen, to address the fever and pain. It is indicated in children older than 24 months, that are otherwise healthy and only have mild pain and fever. More severe cases of acute otitis media can require oral antibiotics for the infection. On the other hand, treatment of chronic otitis media typically includes topical and oral antibiotics.