Otitis Media: Etiology and Pathology (Pediatric Nursing)

00:00 Now let's talk about disorders that affect the ear.

00:04 Let's start with otitis media.

00:06 This is an ear infection behind the eardrum in the middle ear.

00:09 This can be acute or chronic.

00:12 This cause a lot of pain.

00:14 And they commonly occur after a patient has had a primary viral illness such as the common cold and then a secondary bacterial infection will develop.

00:23 Some of the causes of ear infections are vaccine-preventable.

00:28 Ear infections are not contagious.

00:30 They won't spread from person to person but they can translocate within the host which means your patient with an ear infection may have the spread of the infection to another area.

00:40 Worldwide, acute otitis media affects about 11 percent of people a year.

00:45 This is hundreds of millions of cases.

00:48 Half of the cases involve children less than 5 years of age and it's more common among male patients.

00:54 Here's the anatomy of the external ear which includes the part that we think of as the "actual ear" and that includes the ear canal The middle ear space begins behind the eardrum.

01:04 Here you will find the bones that transmit the sound for hearing and the eustachean tubes which help regulate the fluid in the middle ear.

01:12 When the eustachean tube isn't functioning properly, the gas volume in the middle ear is trapped and this causes a negative pressure in the middle ear.

01:20 The fluid from the surrounding tissue is then pulled into that space causing an effusion or extra fluid behind the eardrum If you can't clear that fluid out of that space, it may get infected.

01:32 Dysfunction of the eustachean tube is a common cause of all forms of otitis media.

01:37 This is usually due to inflammation of the mucus membranes and the nasopharynx This can be caused by common viral illnesses such as the common cold, strep throat, or even seasonal allergies.

01:49 Typically, we see the patients start with a viral URI Again, if they don't clear the fluid out of the space, bacteria can begin to grow and this is called the secondary bacteral infection.

01:59 Pediatric anatomy and their immune function contributes to this problem.

02:04 The three most common causes of bacterial pediatric infections are: Strep pneumoniae, M. catarrhalis and Haemophilus influenzae Here you can see the pus from the infection pressing up against the back of the eardrum.

02:18 That's gonna make it bulge out into the canal.

02:21 There are some risk factors for ear infections.

02:23 One is second-hand smoke exposure.

02:26 Another is pacifier use and children who attend daycare.

02:31 And this could be, they're just exposed to more viruses.

02:34 But then if they're not cleared, the fluid can turn into a bacterial infection.

02:38 Here are some differences in the anatomy.

02:40 On the left we see the infant's eustachean tube, on the right we see the adult eustachean tube.

02:45 The size of the passageway contributes to the problem, so infants have a much smaller eustachean tube.

02:52 The direction of the drainage into the throat is also different.

02:55 In pediatric patients, the tube lays more horizontally and this makes it easier for bacteria to ascend the tube.

03:02 In adults, this is more vertical so they're assisted by gravity.

03:06 Bacteria actually need to climb up like a ladder.

03:09 The stiffness of the tube has to do with this too.

03:12 In children, the tube is softer, therefore it's more collapsible and the fluid can get trapped inside Adults have a stiffer eustachean tube.

03:20 The length of the tube also contributes.

03:22 Pediatric patients have a shorter distance for the bacteria to travel and adults have a longer distance.

03:28 The opening into the throat is also rounder in pediatric patients and this allows a bare passageway for the bacteria.