Otitis Media: Signs and Examination (Pediatric Nursing)

00:01 What are signs and symptoms of an ear infection? Well, first it's otalgia - it hurts.

00:06 and this is worse when children are lying down.

00:09 Young children may pull or tug at their ear, sometimes they'll hit the side of their face to indicate that it's hurting Children typically have difficulty sleeping and this is sort of a classic presentation, the parents will say, "you know my child woke up at 2 o' clock in the morning and they just couldn't stop screaming and this is a good indicator that the child might have an ear infection These children are sometimes inconsolable.

00:30 They're irritable, they're crying - this is a very painful condition.

00:34 The children may have difficulty hearing or responding to sounds, and this has to do with the infection in the middle ear.

00:40 They may have a loss of balance that may end up falling.

00:44 and this has to do with the decreased proprioception that happens when that fluid is in the middle ear space.

00:49 And the children will have a fever, usually 38 degrees or higher.

00:53 you might not see the fever if the child is on antipyretics How do we examine a child to see if they have an ear infection? Well you use an otoscope, and this is a medical device that's used to look into the ears.

01:05 It's basicaly a glorified funnelled flashlight with magnification The clinician can assess the ear canal and the eardrum to screen for only this during regular well checks and also to diagnose ear symptoms including ear infections.

01:19 When you put the scope in the ear, you look through the ear canal and your angle is to see the tympanic membrane or the eardrum.

01:25 You're checking to see if there's any bulging on the eardrum and signs and symptoms of otitis media you'll see moderate to severe bulging The child may also have a new set of otorrhea which is a fluid in the ear canal, not caused by otitis externa We'll cover that in the next section.

01:42 Also, there may be mild bulging associated with recent onset of ear pain, or erythema Here's an example on the right of a normal tympanic membrane .

01:53 It's beautiful, it's grey, it's translucent.

01:56 you can see the bones, you can see the cone of light reflecting and you can see all of the landmarks This is what a normal eardrum should look like.

02:03 In the setting of otitis media, you'll see the next, the bulging tympanic membrane It is red, it's inflamed, it's opaque - you can't see the bony landmarks and the cone of light is distorted.

02:16 On exam, the clinician will also note post-auricular and cervical lymph node enlargement and these are the lymph nodes responsible for filtering ear infections.

02:26 The diagnosis is established by compnents of the physical exam, combined with the presence of the patient's symptoms.