Otitis Media: Management and Complications (Pediatric Nursing)

00:00 In an effort to cut down on cost, decrease unnecesary antibiotic use and minimize side effects, the American Academy of Pediatrics has devised a treatment guideline for acute otitis media that has two categories.

00:13 The patient will either fall into the treatment category or the watchful waiting, or observation category.

00:19 These guidelines are used in corporation with the child's age, diagnostic certainty, illness severity and the likelihood to follow up.

00:28 On the left, these children are in the treatment category.

00:31 When they're in your clinic or in your hospital setting, you will begin treating them immediately, And this includes children less than 6 months old, with otitis media, and then 6 months or older with severe signs and symptoms, children younger than 2 with bilateral acute otitis media which means it's on both sides even if they don't have severe signs or symptoms.

00:51 Children with craniofacial abnormalities, immunosuppresion, Down's syndrome or cochlear implants As these children are more likely to have complications.

01:01 And if your patient's going to be lost to follow up and you won't be able to monitor them for the first 3 days.

01:07 Sometimes maybe a patient's gonna go camping, and they're gonna be stuck in the woods and they won't have a chance to get rechecked.

01:12 These are patients you would treat right away.

01:14 Now the observation group.

01:16 These are patients that can have close patient monitoring.

01:19 It's available at home and the provider has a trusting relationship with the parents.

01:24 Children 6-23 months with a unilateral, so one-sided acute otitis media if they don't have severe signs or symptoms or a fever and children 2 or older with bilateral or unilateral acute otitis media if they also don'r have severe signs or symptoms.

01:40 Now remember a child can be on observation group initially and then require treatment if they're not improving.

01:47 How do we manage acute otitis media? Well it's painful so we want to treat their pain.

01:52 Over the counter analgesics are preferred - either NSAIDS or acetaminophen.

01:57 I prefer to give my patients NSAIDS because in addition to treating pain, it also helps with the inflammation and a lot of the pain from the eardrum has is because of the inflammatory property.

02:06 You can also use antibiotics vs observation.

02:11 And a surgical technique is to use tympanostomy tubes.

02:15 The insertion of a tympanostomy tube is the most common ambulatory surgery performed on children in the United States These are small tubes that are surgically placed into the child's eardrum by an otolaryngologist, which is an ear, nose and throat specialist The tubes work in the same way as a small pipe.

02:31 They're placed in there to help drain the fluid of the middle ear to reduce the risk of ear infections.

02:36 This trapped fluid can flow out of the middle ear and this prevents hearing loss and reduces the risk of ear infections These tympanostomy tubes stay in place for about 6-18 months and they'll fall out by themselves Sometimes parents will say they'll find in the bathtub or in the child's bed.

02:52 We tell them just throw them in the trash.

02:55 Here's an example on how a tympanostomy tube will work.

02:58 On the left, you'll see acute otitis media, this patient has a normal ear canal and then you'll see the eardrum that's bulging and there's a purulent infection behind that eardrum in the middle ear.

03:08 The patient on the right, they have a small green tympanostomy tube in place and this allows the air, the infected fluid and the serous fluid to drain from the tube.

03:19 There are some complications of otitis media.

03:22 A risk is that you can get a hole in the eardrum, this is called perforation of the tympanic membrane, and this is a risk whether you're treating or not treating the ear infection.

03:30 I always have this discussion with my patients when we're doing the observation or watchful waiting group that this is a risk.

03:35 And typically, perforations will heal in a few weeks.

03:39 If they don't heal, then we will refer these children onto a specialist.

03:43 Children can develop speech and hearing delays or difficulty Mastoiditis is a rare but serious complication and this is an infection in the mastoid space behind the ear.

03:54 Rarely, children can develop bacterial meningitis or a brain abscess and this is where that bacteria will translocate to another location.

04:02 Otitis media with effusion means there is fluid or an effusion in the middle ear.

04:06 There is no infection.

04:08 Fluid in the middle ear can have a few symotoms especially if it develops slowly Otitis media with effusion is most common in young children ages 2 and under but it can affect people of any age.

04:20 On exam, the clinician will notice increased clear fluid and bubbles trapped behind the eardrum There is no erythema, so it's not red.

04:27 There is no increased opacity which means you can see through the eardrum and there's no fever because this patient does not have an infection.

04:35 The child may feel pressure or pain or have decreased hearing.

04:39 Here's an example of an eardrum with an effusion.

04:42 There's fluid behind the middle ear, you can see the clear fluid and the extra bubbles.

04:46 You can see a defined air-fluid level.

04:48 Again, there's no bacterial infection present.

04:52 Anything that causes a change in the air and fluid pressure behind the eardrum can cause an effusion.

04:56 This can occur due to viruses such as the common cold, seasonal allergies, eustachean tube dysfunction because the fluid's not being drained.

05:05 Sudden increases in air-pressure if patients go flying or scuba diving or diving deep into a pool, patients exposed to cigarette smoke, and this is common after acute otitis media, and this is where we've cleared the patient's infection.

05:20 They've taken antibiotics that have cleared their acute otitis media, however it sometimes take up to a month for the fluid to resolve behind the eardrum, and we always tell patients your pressure can last but the pain and fever should be gone.

05:32 So feel free to check your patients but reassure them it's okay and common after acute otitis media.