❖ A group of complex, non-contagious, and inflammatory conditions of
the middle ear (Qureishi, Lee, Belfield, Birchall, & Daniel, 2014).
❖A major cause of preventable hearing damage that results in loss
❖The inflammation that is considered otitis
media occurs in the region between the
middle ear and the tympanic membrane.
❖Acute otitis media, otitis media with
effusion, chronic suppurative otitis media,
and cholesteatoma are the four types of
❖Finally, the condition is known to affect
both children and adults
Incidence and Prevalence of Otitis Media
❖ The incidence rate of otitis media is estimated at 80% of children in
the United States.
❖Prevalence is considered in the context of the 20million annual
physician visits in the country for pediatric patients.
❖Peak incidence of the condition occurs between six months and one
year and three months (Marom et al., 2014) .
❖Peak prevalence of otitis media occurs between age six to eighteen
❖An estimated 2.2 million annual cases of otitis media effusion in the
United States is linked to hearing impairment in children.
Incidence and Prevalence../2
❖85% of children must experience at least one episode of acute otitis
media or otitis media effusion before their third birthday.
❖Acute otitis media diagnosis in the first year of life increases the
incidence and recurrence of otitis media and otitis media effusion.
❖Otitis media prevalence and incidence in boys and girl is equal.
❖According to Marom et al. (2014) , the review of the race-based
prevalence of otitis media showed higher rates in Hispanic, Native
American, and Alaskan Native children than whites and blacks.
Pathophysiology of Otitis Media
❖The inflammation begins at the space between pharynx, Eustachian
tube, and the nasal mucosa after a viral infection of the upper
❖The inflamed space blocks the passage of air though the Eustachian
tube and result in the higher pressure in the middle ear.
❖Then the mucosal secretions from the middle ear support the growth
of bacterial and viruses in the part of the ear (Qureishi et al., 2014).
❖Afterwards, the colonization of the middle ear by the microbes leads
to the different forms of otitis media such as acute otitis media.
❖Acute otitis media is characterized by bulging tympanic membrane
and presence of fluid in the middle ear.
❖Finally, the existing of upper respiratory tract infection in the child is
considered as a major risk-factor for the condition.
Etiology of Otitis Media
❖Low immunity due to HIV/AIDS and diabetes.
❖Abnormal gene expression that results in mucins.
❖Vitamin A deficiency
❖Ear infection caused by Streptococcus pneumoniae, Haemophilus
influenza, and Moraxella (Branhamella) catarrhalis.
❖Viral infection of the upper respiratory tract that is caused by
respiratory syncytial virus, influenza virus, parainfluenza virus,
rhinovirus, and adenovirus (Qureishi et al., 2014).
❖Passive smoke exposure.
❖Allergic reactions to medications and other substances.
❖Cochlear implants and ciliary dysfunction
Physical Assessment and Examination
The identification of the redness of the tympanic membrane is
indicative of otitis media effusion.
Assessment for the presence of otorrhea and postauricular
Inspect the auricle and periauricular regions and perform
otoscopic examination of the middle ear.
During physical exam, palpitate the temporomandibular joint
for tenderness as patient opens and close mouth.
Bulging tympanic membrane represents acute otitis media
while a retracted tympanic member suggest the existence of
otitis media effusion (Venekamp et aal., 2016).
Evaluate patient mobility to determine any form of impairment
that represents otitis media effusion.
Evidence-based Treatment Plan
❖Observation of the inflammation in early otitis media is
recommended due to low efficacy of other methods at this
stage of the condition.
❖Resolution of the condition occurs within a few days in 80% of
❖Once microbe colonization of the tympanic membrane is
noticed, patient would be given Amoxicillin for ten days.
❖Patients allergic to the penicillin content of this antibiotic
would be given a single dose of 10 mg/kg of azithromycin
(Pontefract et al., 2019).
❖Acetaminophen or ibuprofen is administered for pain
management physical assessment and examination.
❖Parents of pediatric are taught the procedures for avoiding the risk
factors for upper respiratory tract infections.
❖Education on the side effects of antibiotics use including the
existence of antibiotic-resistant bacteria in otitis media.
❖Vaccination of pediatric patients prevent some of the risk factors for
otitis media (Qureishi et al., 2014).
❖Adhere to prescribed consumption of antibiotics to prevent the
resistance of bacteria to medications.
❖Patients with tympanostomy tubes should avoid swimming or any
other water sports that could introduce fluids in the middle ear.
❖Finally, patient with impairment should be taught the appropriate use
of hearing aids.
Post-Treatment Evaluation of Episodic Otitis
❖Perform otoscopic examination to determine the need for
follow up care and treatment of pain and other symptoms.
❖Post-treatment evaluation and examination of middle ear for
effusion is required 4-6 weeks after initial therapy.
❖Second follow-up visit is needed by patients with nonresolution of otitis media effusion (Danishyar & Ashurst, 2019).
❖Hearing test should be performed for children with persist
middle ear effusion after 12 weeks of treatment.
❖Recommend patients with hearing loss for bilateral
myringotomy tube placement if l...
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